Exploring machine learning to predict depressive relapses of bipolar disorder patients.

BACKGROUND: Bipolar disorder (BD) is a chronic mood disorder characterized by recurrent episodes of mania or hypomania and depression, expressed by changes in energy levels and behavior. However, most of relapse studies use evidence-based approaches with statistical methods. With the advance of the precision medicine this study aims to use machine learning (ML) approaches as a possible predictor in depressive relapses in BD. METHOD: Four accepted and well used ML algorithms (Support Vector Machines, Random Forests, Naïve Bayes, and Multilayer Perceptron) were applied to the Systematic Treatment Enhancement Program for Bipolar Disorder (STEP-BD) dataset in a cohort of 800 patients (507 patients presented depressive relapse and 293 did not), who became euthymic during the study and were followed for one year. RESULTS: The ML algorithms presented reasonable performance in the prediction task, ranging from 61 to 80% in the F-measure. The Random Forest algorithm obtained a higher average of performance (Relapse Group 68%; No Relapse Group 74%). The three most important mood symptoms observed in the relapse visit (Random Forest) were: interest; depression mood and energy. LIMITATIONS: Social and psychological parameters such as marital status, social support system, personality traits, might be an important predictor in depressive relapses, although we did not compute this data in our study. CONCLUSIONS: Our findings indicate that applying precision medicine models by means of machine learning in BD studies could be feasible as a sensible approach to better support medical decision-making in the BD treatment and prevention of future relapses.

Predominant polarity classification and associated clinical variables in bipolar disorder: A machine learning approach.

BACKGROUND: Bipolar disorder (BD) is a severe psychiatric disorder characterized by periodic episodes of manic and depressive symptomatology. Predominant polarity (PP) appears to be an important specifier of BD. The present study employed machine learning (ML) algorithms to accurately determine a patient´s PP without the inclusion of number and polarity of past episodes, while exploring associations between PP and demographic and clinical variables. METHODS: From a cohort of 148 BD patients, demographic and clinical variables were collected using a customized questionnaire and the SCID-CV. The algorithm employed was the Random-Forest method. The algorithm was programed to classify patients into either depressive or manic predominant polarities and to reveal which variables were associated to the specifier. RESULTS: The algorithm attained an AUC ROC of 74.72% (95% CI = 72.29-77.15%) in classifying patients into either manic or depressive PP. The variables selected by the algorithm were: (1) age at first depressive episode; (2) number of hospitalizations; (3) BD Type II; (4) manic onset; (5) delusions; (6) psychotic features at onset; (7) tobacco addiction; (8) family history of BD; (9) hallucinations; and (10) comorbid anxiety disorders, (11) alcohol dependence, (12) eating disorders and (13) substance dependence. LIMITATIONS: The study is limited due to the small sample size, the inclusion of only self-reported and clinician-observed clinical variables and its cross-sectional design. DISCUSSION: The results suggest that the ML approach could be effective in determining a patient´s PP. Furthermore, although not previously reported, some variables, such as tobacco use and comorbid eating disorders, appear to be closely associated with PP.

A randomized, double-blind, placebo-controlled, proof-of-concept trial of creatine monohydrate as adjunctive treatment for bipolar depression.

Depressive episodes are a major cause of morbidity and dysfunction in individuals suffering from bipolar disorder. Currently available treatments for this condition have limited efficacy and new therapeutic options are needed. Extensive research in the pathophysiology of bipolar disorder points to the existence of mitochondrial and bioenergetic dysfunction. We hypothesized that creatine monohydrate, a nutraceutical that works as a mitochondrial modulator, would be effective as an adjunctive therapy for bipolar depression. We conducted a double-blind trial in which 35 patients with bipolar disorder type I or II in a depressive episode by DSM-IV criteria and in use of regular medication for the treatment of this phase of the disease were randomly allocated into two adjunctive treatment groups for 6 weeks: creatine monohydrate 6 g daily (N = 17) or placebo (N = 18). Primary efficacy was assessed by the change in the Montgomery-Åsberg Depression Rating Scale (MADRS). We did not find a statistically significant difference in the comparison between groups for the change in score on the MADRS after 6 weeks in an intention-to-treat (ITT) analysis (p = 0.560; Cohen's d = 0.231). However, we found significant superiority of creatine add-on vs. placebo when we considered the remission criterion of a MADRS score ≤ 12 at week 6 analyzing the outcome of the 35 randomized patients on ITT (52.9% remission in the creatine group vs. 11.1% remission in the placebo group) and of the 23 completers (66.7% remission in the creatine group vs. 18.2% remission in the placebo group) (p = 0.012; OR = 9.0 and p = 0.036; OR = 9.0, respectively). Two patients who received creatine switched to hypomania/mania early in the trial. No clinically relevant physical side-effects were reported or observed. This proof-of-concept study, aiming to restore brain bioenergetics using an adjunctive mitochondrial modulator, is not conclusive on the efficacy of creatine add-on for bipolar depression, but suggests that this compound may have a role in the adjunctive treatment of this phase of the illness. Further investigation through randomized controlled trials with larger samples should be conducted to verify the efficacy of creatine supplementation for bipolar depression and also for subsyndromal depressive symptoms.

Qualidade de vida de mulheres climatéricas / Quality of life of climacteric stage women

OBJETIVO: Analisar a qualidade de vida de mulheres climatéricas. MÉTODOS: A pesquisa foi realizada em uma Unidade de Saúde da Família, com 75 mulheres na faixa etária de 35 a 65 anos. Trata-se de uma pesquisa epidemiológica, transversal. A coleta de dados foi realizada por meio dos formulários Questionário de Avaliação da Qualidade de Vida, Formulário Socioeconômico e Formulário Clínico. Para análise estatística, foram utilizados o programa BioEstat 5.0 e o teste estatístico qui quadrado de proporções esperadas iguais. RESULTADOS: Entre as entrevistadas, de maioria entre 35 e 45 anos, observou-se predominância de mulheres de raça parda e com companheiro marital, com menor predominância de sintomas. As mulheres que recebiam entre dois ou mais salários mínimos apresentaram menor intensidade de sintomas, ou mesmo não os apresentaram. Estes fatores podiam estar condicionados ao tipo de atividade exercida ou às condições de trabalho. Evidenciou-se significativa prevalência de falta de ar, suor, calor intenso e ansiedade, sendo o comprometimento do componente mental o mais significativo. Em pacientes com sobrepeso ou obesidade, foi observada maior intensidade de sintomas.CONCLUSÃO: Observou-se grande impacto por conta das mudanças do período do climatério na qualidade de vida das mulheres. Muitos dos sintomas apresentados são influenciados por fatores modificáveis. O controle dos sintomas por meio de mudanças de hábitos é necessário para a manutenção da qualidade de vida.(AU)

OBJECTIVE: To analyze the quality of life of climacteric stage women. METHODS: The study was conducted at a Family Health Unit, with 75 women aged 35-65 years. This is an epidemiological, cross-sectional research. Data collection was done through the forms: Questionnaire for Assessment of Quality of Life, Socioeconomic Form, and Clinical Form. For statistical analysis, the software Bioestat 5.0, and the chi-square statistical test of equal expected proportions were used. RESULTS: Among the interviewees, most of them between 35 and 45 years of age, there was a predominance of brown women with marital partners, with a lower prevalence of the symptoms. The women earning between two or more minimum wages presented less severe symptoms, or do not have them. These factors may be conditioned to the type of activity performed or to the working conditions. There was a significant prevalence of shortness of breath, sweat, intense heat and anxiety, with the most significant impairment being to the mental component. In patients with overweight or obesity, a greater severity of symptoms was observed. CONCLUSION: A great impact in the quality of life of women was observed due to the changes of the climacteric period. Many of the symptoms presented are influenced by modifiable factors. The control of symptoms through changes in habits is necessary for keeping quality of life.(AU)

Cognitive effects of creatine monohydrate adjunctive therapy in patients with bipolar depression: Results from a randomized, double-blind, placebo-controlled trial.

BACKGROUND: Depressive episodes and cognitive impairment are major causes of morbidity and dysfunction in individuals suffering from bipolar disorder (BD). Novel treatment approaches that target clinical and cognitive aspects of bipolar depression are needed, and research on pathophysiology suggests that mitochondrial modulators such as the nutraceutical creatine monohydrate might have a therapeutic role for this condition. METHODS: Eighteen (N=18) patients with bipolar depression according to DSM-IV criteria who were enrollled in a 6-week, randomized, double-blind, placebo-controlled trial of creatine monohydrate 6g daily as adjunctive therapy were submitted to neuropsychological assessments (Wisconsin Card Sorting Test, Digit Span subtest of the Wechsler Adult Intelligence Scale-Third Edition, Stroop Color-Word Test, Rey-Osterrieth complex figure test, FAS Verbal Fluency Test) at baseline and week 6. RESULTS: There was a statistically significant difference between the treatment groups of the change on the total scores after 6 weeks in the verbal fluency test, with improvement in the group receiving adjunctive treatment with creatine. We did not find significant differences between the groups of the changes on other neuropsychological tests. LIMITATIONS: Small sample and lack of a control group of healthy subjects. CONCLUSIONS: Our trial, which was the first to investigate the cognitive effects of creatine monohydrate on bipolar depression, indicates that supplementation with this nutraceutical for 6 weeks is associated with improvement in verbal fluency tests in patients with this condition.

Telemental health in Brazil: past, present and integration into primary care

Telemental Health Care has reported very good results and is included within mental health priorities by the World Health Organization. Objective To provide an overview of the current situation of the integration of Brazilian telemedicine activities into primary health care. Methods Critical review based on MEDLINE database, using the keywords “telemedicine”, “primary health care” “mental health” and “telemental health”, on websites of the Brazilian Ministry of Health and Brazilian Telehealth Network Program, and on personal communication. Results The Brazilian Telehealth Network Program is well positioned and connects primary health care with academic centers. Regulations standards allow a broader scope of activities for psychologists, however, are more restrictive for physicians. In Brazil most of telemental health activities are focused on education and second opinion consulting. A huge challenge must be overcome considering the regional differences and the telehealth implementation experience. Research initiatives have been initiated both in the implementation and evaluation of the mental health assistance into primary health care. Discussion Brazilian Telemental Health initiatives into Primary Care are aligned with other examples around the world, have a great potential for improving mental health care service delivery, and access to proper mental health care, especially if articulated in a national program and coordinated research...

Analysis of the detection coefficient for the association between leprosy and pregnancy in the integration region of Carajas, State of Para, Brazil

Introduction The association between leprosy and pregnancy is currently poorly understood and has been linked to serious clinical consequences. Methods A retrospective study between 2007 and 2009 was performed in the integration region of Carajás, Brazil on a population of pregnant lepers, with non-lepers of ages 12-49 years serving as the reference population. Results Twenty-nine pregnant lepers were studied during the study period. The detection rates (DRs) for the studied association were 4.7 in 2007, 9.4 in 2008, and 4.3 in 2009. Conclusions The Carajás region presented a medium pattern of endemicity during most of the study period, with a high DR found in 2008. .

Analysis of the detection coefficient for the association between leprosy and pregnancy in the integration region of Carajás, State of Pará, Brazil.

INTRODUCTION: The association between leprosy and pregnancy is currently poorly understood and has been linked to serious clinical consequences. METHODS: A retrospective study between 2007 and 2009 was performed in the integration region of Carajás, Brazil on a population of pregnant lepers, with non-lepers of ages 12-49 years serving as the reference population. RESULTS: Twenty-nine pregnant lepers were studied during the study period. The detection rates (DRs) for the studied association were 4.7 in 2007, 9.4 in 2008, and 4.3 in 2009. CONCLUSIONS: The Carajás region presented a medium pattern of endemicity during most of the study period, with a high DR found in 2008.

Leprosy and pregnancy in the State of Pará: an epidemiological perspective.

INTRODUCTION: A few older publications describe leprosy associated with pregnancy, a situation that has been linked to leprosy exacerbation. This study aimed to describe the detection rate of this association in the State of Pará by county and Integration Region (IR) from 2007 to 2009 via an analysis of socio demographic, epidemiological and operational indices. METHODS: This was a descriptive study using information generated by the SINAN. The Detection Coefficient of the Leprosy and Pregnancy Association (DCLP) epidemiological index was constructed to help interpret the endemicity parameters. The disease was considered hyperendemic when greater than two cases per 10,000 inhabitants were identified. RESULTS: During the study period,149 associations were detected, with 14 hyperendemic counties: seven in 2007, fi ve in 2008 and two in 2009. The Carajás Integrated Region displayed the highest DCLP index in the period. Eldorado dos Carajás had the single highest DCLP index(5.7/10,000 inhabitants, 2008), whereas the DCLP index in Conceição do Araguaia was very high in all three years. However,most counties displayed low or medium DCLP indices. The annual averages were 0.31 DCLP (2007), bass; 0.30 (2008), bass and 0.19 (2009), bass. The average DCLP index was 0.26, which is considered low. Three clusters of medium endemicity were identified by the average DCLP in the study period. CONCLUSIONS: The analyses indicated that the surveillance program is still unsatisfactory in Pará. The interpretation of the endemicity parameters enabled qualitative and quantitative analyses to determine the epidemiological panorama of this association. The identification of high endemicity requires further clarification.

Clínica da Atenção Psicossocial: ansiedade e transtornos relacionados

Material utilizado no módulo de Clínica da Atenção Psicossocial do curso de capacitação em Saúde Mental produzido pela UNA-SUS/UFMA. Apresenta o conceito de ansiedade e os transtornos relacionados, assim como os tipos de tratamento.

Clínica da Atenção Psicossocial: transtornos do humor

Material utilizado no módulo de Clínica da Atenção Psicossocial do curso de capacitação em Saúde Mental produzido pela UNA-SUS/UFMA. Apresenta as causas dos transtornos do humor, as dimensões em se enquadram e seus tipos. Aborda, ainda, os transtornos depressivos, destacando a depressão em populações específicas e episódios de mania.

Clínica da atenção psicossocial: esquizofrenia

Material utilizado no módulo de Clínica da Atenção Psicossocial, do curso de Capacitação em Saúde Mental, produzido pela UNA-SUS/UFMA. Apresenta a esquizofrenia, identificando seus tipos, algumas causas, seus sintomas, formas de diagnóstico e possíveis tratamentos.

Clínica da atenção psicossocial: demência

Material utilizado na Unidade 5 do Módulo 3, Clínica da Atenção Psicossocial, do curso de capacitação em Saúde Mental produzido pela UNA-SUS/UFMA. Apresenta o transtorno cognitivo (demência), identificando sinais e sintomas que podem indicar um quadro demencial no paciente. Classifica, também, a demência listando e conceituando algumas doenças relacionadas

Clínica da atenção psicossocial: suicídio

Material utilizado no módulo de Clínica da Atenção Psicossocial do curso de capacitação em Saúde Mental produzido pela UNA-SUS/UFMA. Apresenta o suicídio (relacionando-o com outros transtornos mentais), indicativos de risco de suicídio e como intervir, aspectos psicológicos e qual a postura o profissional da saúde deve ter diante de pacientes suicidas.

Leprosy and pregnancy in the State of Para: an epidemiological perspective

Introduction A few older publications describe leprosy associated with pregnancy, a situation that has been linked to leprosy exacerbation. This study aimed to describe the detection rate of this association in the State of Pará by county and Integration Region (IR) from 2007 to 2009 via an analysis of sociodemographic, epidemiological and operational indices. Methods This was a descriptive study using information generated by the SINAN. The Detection Coefficient of the Leprosy and Pregnancy Association (DCLP) epidemiological index was constructed to help interpret the endemicity parameters. The disease was considered hyperendemic when greater than two cases per 10,000 inhabitants were identified. Results During the study period, 149 associations were detected, with 14 hyperendemic counties: seven in 2007, five in 2008 and two in 2009. The Carajás Integrated Region displayed the highest DCLP index in the period. Eldorado dos Carajás had the single highest DCLP index (5.7/10,000 inhabitants, 2008), whereas the DCLP index in Conceição do Araguaia was very high in all three years. However, most counties displayed low or medium DCLP indices. The annual averages were 0.31 DCLP (2007), bass; 0.30 (2008), bass and 0.19 (2009), bass. The average DCLP index was 0.26, which is considered low. Three clusters of medium endemicity were identified by the average DCLP in the study period. Conclusions The analyses indicated that the surveillance program is still unsatisfactory in Pará. The interpretation of the endemicity parameters enabled qualitative and quantitative analyses to determine the epidemiological panorama of this association. The identification of high endemicity requires further clarification. .

Principais agravos em gestantes na atenção básica de saúde / Major diseases in pregnant women at basic health

OBJETIVO: determinar a prevalência dos principais agravos que acometem as grávidas atendidas na Unidade de Atenção Básica de Saúde, no ano de 2011. MÉTODO: foram analisados 85 prontuários conforme as variáveis contidas no protocolo de pesquisa. O número de prontuários pesquisados foi obtido a partir da análise do universo de gestante cadastradas, por meio da Fórmula da Amostra Aleatória Simples. O protocolo contém questionamentos como a enfermidade apresentada pela gestante e o número de consultas pré-natais que esta já havia realizado. RESULTADOS: com os resultados obtidos constatou-se a maior prevalência de anemia (23,5%), seguida das vaginoses (15,2%) e em terceiro lugar a obesidade (9,4%). Notou-se a alta taxa de mulheres (48,2%) que não obtiveram o número mínimo (6) satisfatório de consultas pré-natais. Além de que a maior parte das mulheres enfermas (51,8%) recebeu o número ideal de consultas, constatando-se a baixa eficiência destas.A faixa etária de maior incidência dos agravos foi de 20 a 29 anos (54,1%), sendo a anemia o agravo à saúde mais presente nessa categoria. A maioria das gestantes era de cor parda (62,3%) e a enfermidade mais presente entre elas foram as vaginoses. CONCLUSÃO: o agravo encontrado mais frequente foi a anemia, seguida das vaginoses e da obesidade.

OBJECTIVE: determine the prevalence of the major diseases affecting pregnant women registered at the Basic Health Unit in 2011. METHOD: were analyzed 85 medical records as the variables contained in the research protocol. The number surveyed medical records was obtained from the analysis of Simple Random Sample Formula. The protocol contains questions like illness presented by the pregnant woman and the number of prenatal visits that had already performed. RESULTS: with the results was found a higher prevalence of anemia (23.5%), followed by vaginosis (15.2%) and thirdly obesity (9.4%). It was noted the high rate of women (48.2%) did not have the minimum number (6) satisfactory prenatal visits. Besides that 23.5% of women patients were using drugs not available through SUS, with 14% of these were single. The age group with the highest incidence of injuries was 20 to 29 years (54.1%) being the most serious health hazard present in this category to anemia. Most patients were of mixed ethnicity (62.3%) and disease was more prevalent among them to vaginosis. CONCLUSION: it is concluded that the most common injuries at study was the anemia, follow by vaginosis and obesity.

Álcool e outras drogas: conceitos básicos

Texto que compõe a unidade 1 do módulo 3 "Álcool e outras drogas" do Curso de Capacitação em Dependência Química, produzido pela UNA-SUS/UFMA. Aborda os padrões individuais de uso de drogas, a classificação das substâncias psicoativas de acordo com os efeitos no sistema nervoso central, bem como alguns dados epidemiológicos referentes à prevalência de dependência de álcool e drogas na população brasileira.

Dependência química: álcool

Texto que compõe a unidade 2 ­ parte I do módulo 3 "Álcool e outras drogas" do Curso de Capacitação em Dependência Química, produzido pela UNA-SUS/UFMA. Aborda os aspectos neurobiológicos e farmacocinéticos da dependência química, os transtornos e comorbidades relacionados ao uso do álcool, bem como o apoio da família do dependente na superação de dificuldades no modo de vida sem o uso de álcool.

Dependência química: tabaco

Texto que compõe a unidade 2 ­ parte II do módulo 3 "Álcool e outras drogas" do Curso de Capacitação em Dependência Química, produzido pela UNA-SUS/UFMA. Aborda como o tabaco age no organismo e as diversas complicações clínicas e sociais envolvidas.

Dependência química: maconha

Texto que compõe a unidade 3 do módulo 3 "Álcool e outras drogas" do Curso de Capacitação em Dependência Química, produzido pela UNA-SUS/UFMA. Aborda a epidemiologia e as comorbidades relacionadas ao uso da maconha, como os transtornos psicóticos, de humor, ansiedade, bem como o Transtorno de Déficit de Atenção e Hiperatividade (TDAH).