Leonardo Rodrigo Baldacara
@uft.edu.br
Universidade Federal do Tocantins
Professor
RESEARCH INTERESTS
Psychiatry
Psychiatric emergencies
Neuroimaging
Scopus Publications
Scholar Citations
Scholar h-index
Scholar i10-index
Scopus Publications
Leonardo Baldaçara, André Luiz de Carvalho Braule Pinto, Alexandre Paim Díaz, Marsal Sanches, and Antônio Geraldo da Silva
Elsevier BV
Bruno Paz Mosqueiro, Marianna de Abreu Costa, André C. Caribé, Fabrício H. A. Oliveira e Oliveira, Leandro Pizutti, Rogério R. Zimpel, Leonardo Baldaçara, Antônio Geraldo da Silva, and Alexander Moreira-Almeida
EDITORA SCIENTIFIC
OBJECTIVE
To present an evidence-based guideline for clinical practice in Brazil with regard to religiosity and spirituality in mental healthcare.
METHODS
A systematic review was conducted to identify potentially eligible articles indexed in the PubMed, PsycINFO, SciELO, LILACS and Cochrane databases. A summary of recommendations and the level of evidence was produced in accordance with the Oxford Centre for Evidence-Based Medicine.
RESULTS
The systematic review identified 6,609 articles, 41 of which satisfied all the inclusion criteria. Obtaining the spiritual history (SH) was found to be an essential part of a compassionate and culturally sensitive approach. It represents a way of obtaining relevant information about patients' R/S, potential conflicts that could have an impact on adherence to treatment and to improve patient satisfaction. Consistent evidence shows that reported perceptual experiences do not represent reliable characteristics for differentiating between anomalous experiences and psychopathology. Negative symptoms, cognitive and behavioral disorganization, and functional impairment are more helpful characteristics for distinguishing these experiences from mental disorders.
CONCLUSION
Considering the importance of R/S for many patients, SH should be routinely included in mental health care. Anomalous experiences are highly prevalent, requiring a sensitive and evidence-based approach to the differential diagnosis between these experiences and mental health symptoms.
Leonardo Baldaçara, Artur Ramos, and João Maurício Castaldelli-Maia
Informa UK Limited
Leonardo Baldaçara, Verônica da Silveira Leite, Ana Luiza Silva Teles, and Antônio Geraldo da Silva
FapUNIFESP (SciELO)
INTRODUCTION Mental illnesses contribute to the total number of sick people in the world. Between 2000 and 2012, the World Health Organization (WHO) estimated that 64 million worldwide disability-adjusted life years (DALYs) were lost due to mental and behavioral problems among women of reproductive age (15–49 years)1. For women, the proportioc. cn of DALYs lost is greatest during their prime reproductive years. These results emphasize the need to consider perinatal (i.e., prenatal and postnatal) mental illnesses2. Depressive and anxiety disorders are the most frequent psychiatric problems in pregnant and postpartum women, with a prevalence of approximately 10 and 13%, respectively2. In lowand high-income countries (LMICs), the prevalence is higher, with prenatal rates of nearly 16% and postnatal rates of about 20%2. Perinatal mental morbidity can have severe repercussions for everyone involved. Perinatal mental illnesses may be related to maternal difficulties and an increased risk of poor neonatal and developmental outcomes. Also, an increase in pregnancy-related comorbidities is worrisome, which can lead to more severe outcomes2. In the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)3, they are not recognized as a distinct clinical diagnostic entity. In DSM-5, postpartum psychosis is categorized as a “short psychotic illness”3. The International Classification of Diseases 11th Revision (ICD-11) classifies postpartum psychosis as one of the syndromes associated with pregnancy or the puerperium (beginning approximately 6 weeks after delivery) that involves significant mental and behavioral characteristics, such as delusions, hallucinations, or other psychotic symptoms4. Mood symptoms, including depression and/or mania, are almost always present as well. If the patient’s symptoms are consistent with the diagnostic criteria for a certain mental condition, then that disorder must also be ascribed (ICD-11)4. The prevalence of prenatal psychosis was reported by one study to be 5 in 1,000 newborns, whereas the incidence of perinatal psychosis ranged from 0.89 to 2.6 in 1,000 women throughout the investigations2,5. In this update, the objective is to present the differential diagnosis and treatment of postpartum psychosis.
Lucas Alves Pereira, Antônio Geraldo da Silva, Curt Hemanny, Rogério de Jesus, Maíra Moromizato, Túlio Vieira, Murilo Souza, Manuela Garcia Lima, and Leonardo Baldaçara
EDITORA SCIENTIFIC
Abstract Introduction Few instruments are available in Brazil to evaluate psychomotor activity in psychiatric emergency, clinical, and research settings. This study aimed to perform a cross-cultural adaptation of the Behavioral Activity Rating Scale (BARS) into Brazilian Portuguese and assess the adapted scale’s psychometric properties. Method An expert consensus committee conducted a translation and back-translation of the original scale, resulting in the BARS-BR. Four pairs of physicians administered the BARS-BR and the Sedation-Agitation Scale (SAS) to patients in a hospital psychiatry emergency room and patients in the hospital’s psychiatric wards. The BARS-BR was compared to the SAS to assess concurrent validity and internal consistency was evaluated with the Bland-Altman technique. Results In the emergency room, the correlation coefficients between the first and second assessments were rho = 0.997 and rho = 1.0, respectively. In the hospital wards, the correlation coefficient between the pair of evaluators was rho = 0.951. There were strong correlations between the BARS-BR score of the first examiner and the SAS score of the second examiner (rho = 0.903) and between the SAS score of the first examiner and the BARS-BR score of the second examiner (rho = 0.893). Conclusion The BARS-BR showed good psychometric properties, and we recommend its use because it constitutes an easy method for assessment of changes in psychomotor activity. Further studies are suggested to evaluate adoption and comprehension of the BARS-BR scale by all classes of healthcare professionals.
Leonardo Baldaçara, César Augusto Trinta Weber, Miriam Gorender, Roberta R. Grudtner, Sandra Peu, Ana Luiza Silva Teles, Ives Passos Cavalcante, João Quevedo, and Antônio Geraldo da Silva
EDITORA SCIENTIFIC
Crisis hotlines are direct communication systems, usually telephone-based, set up to prevent suicide. However, few studies have evaluated their effectiveness. The present study aims to perform a systematic review, using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, of the effectiveness of interventions through direct communication systems to reduce the number of suicides or suicide attempts. We searched the MEDLINE, Cochrane, SciELO, and ClinicaTrials.gov databases, and used the 2011 Oxford Centre for Evidence-Based Medicine Levels of Evidence classification. The literature search yielded 267 studies, of which 35 fulfilled the selection criteria. Although significant heterogeneity was found among studies, there is evidence that direct telephone interventions are effective when included in broader preventive protocols and provided by trained staff. Despite the limitations, which included heterogeneity of samples, designs, and outcome measures, we were able to design a protocol for the use of remote services to prevent suicide and suicide attempts. A hotline or similar system could be an effective intervention for broader suicide prevention programs. However, further research is necessary to specify which protocol components are key to enhance effectiveness. Systematic review registry number: PROSPERO CRD42020206517
Leonardo Baldaçara
Frontiers Media SA
COPYRIGHT © 2023 Baldaçara. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. Editorial: Current challenges and evidence-based medicine in psychiatric emergencies
Gabriel Urbanin, Wagner Meira, Alexandre Serpa, Danielle de Souza Costa, Leonardo Baldaçara, Ana Paula da Silva, Rafaela Guatimosim, Anísio Mendes Lacerda, Eduardo Araújo Oliveira, Andre Braule,et al.
JMIR Publications Inc.
Background Human behavior is crucial in health outcomes. Particularly, individual behavior is a determinant of the success of measures to overcome critical conditions, such as a pandemic. In addition to intrinsic public health challenges associated with COVID-19, in many countries, some individuals decided not to get vaccinated, streets were crowded, parties were happening, and businesses struggling to survive were partially open, despite lockdown or stay-at-home instructions. These behaviors contrast with the instructions for potential benefits associated with social distancing, use of masks, and vaccination to manage collective and individual risks. Objective Considering that human behavior is a result of individuals' social and economic conditions, we investigated the social and working characteristics associated with reports of appropriate protective behavior in Brazil. Methods We analyzed data from a large web survey of individuals reporting their behavior during the pandemic. We selected 3 common self-care measures: use of protective masks, distancing by at least 1 m when out of the house, and handwashing or use of alcohol, combined with assessment of the social context of respondents. We measured the frequency of the use of these self-protective measures. Using a frequent pattern–mining perspective, we generated association rules from a set of answers to questions that co-occur with at least a given frequency, identifying the pattern of characteristics of the groups divided according to protective behavior reports. Results The rationale was to identify a pool of working and social characteristics that might have better adhesion to behaviors and self-care measures, showing these are more socially determined than previously thought. We identified common patterns of socioeconomic and working determinants of compliance with protective self-care measures. Data mining showed that social determinants might be important to shape behavior in different stages of the pandemic. Conclusions Identification of context determinants might be helpful to identify unexpected facilitators and constraints to fully follow public policies. The context of diseases contributes to psychological and physical health outcomes, and context understanding might change the approach to a disease. Hidden social determinants might change protective behavior, and social determinants of protective behavior related to COVID-19 are related to work and economic conditions. Trial Registration Not applicable.
Antônio Geraldo da Silva and Leonardo Baldaçara
EDITORA SCIENTIFIC
Position statement of the Brazilian Psychiatric Association on the use of cannabis in psychiatric treatment Antônio Geraldo da Silva,0000-0000-0000-0000 Leonardo Baldaçara0000-0000-0000-0000 Associação Brasileira de Psiquiatria, Rio de Janeiro, RJ, Brazil. Faculdade de Medicina, Universidade do Porto, Porto, Portugal. Programa de Pós-Graduação em Medicina Molecular, Faculdade de Medicina, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil. Curso de Medicina, Universidade Federal do Tocantins (UFT), Palmas, Tocantins, Brazil.
Giovanna Tandaya Grandi, Raquel Prudente de Carvalho Baldaçara, Itágores Hoffman I Lopes Sousa Coutinho, and Leonardo Baldaçara
FapUNIFESP (SciELO)
ABSTRACT BACKGROUND: New medical schools and new medical residencies in Brazil, mainly in its interior, were opened under the justification of collaborating towards distribution of these healthcare professionals and specialist doctors across the national territory. However, this proposal did not guarantee that medical practitioners would become established in the place where they graduated and specialized. OBJECTIVE: To calculate, through interviews, how many specialists who graduated in the state of Tocantins stayed there after finishing their medical residency; and to analyze the factors that made them stay or leave the place. DESIGN AND SETTING: Cross-sectional exploratory study conducted at a Brazilian federal public higher education institution. METHODS: All graduates from medical residencies in Tocantins, who graduated between 2013 and 2019, were contacted by telephone and, after obtaining consent, an interview was conducted. The interviews took place between June 2020 and January 2021. RESULTS: The permanence of medical residency graduates in the state increased from 50% in an earlier study to 55.8% in the current study, thus showing a situation of stability. In addition, we detected some reasons for staying or not. In a multivariate analysis, only working in the state capital was related to staying in the state of Tocantins, showing a 5.6 times greater chance. CONCLUSIONS: The percentage of those who remained was just over 50%, even some years after implementation of the first programs. Most specialists remained working for the state health department, with a smaller proportion in municipal health departments, and were concentrated in the state capital.
André Luiz de Carvalho Braule Pinto, Rafaela Ferreira Guatimosim, Fabiano Franca Loureiro, Alexandre Luiz de Oliveira Serpa, Danielle Souza Costa, Alexandre Paim Diaz, Rui Mateus Joaquim, Leonardo Rodrigo Baldaçara, Gustavo dos Santos Alves Maria, Antônio Geraldo da Silva,et al.
American Psychological Association (APA)
Although the Impact Event Scale-Revised is widely used, its factor structure is still controversial. In addition, its longitudinal measurement invariance (LMI) remains uninvestigated. In this sense, we carried out three studies to investigate its psychometric properties. In Study 1, we evaluated the factorial structure of the scale comparing the different models existing in the literature in Brazilian samples who responded to the instrument during the COVID-19 pandemic. In Study 2, we provide support for a five-factor model throughout convergent validity with psychological distress and sleep problems, and criterion validity between people with diagnostic of mental disorders. Finally, we evaluated the LMI over a 6-month interval. The results indicated that the five-factor model has excellent goodness of fit and holds strict longitudinal invariance. Additionally, internal consistency and stability coefficients indicate that the scale is appropriate to measure posttraumatic stress symptomatology) in nonclinical samples across multiple assessments. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
Cintia de Azevedo-Marques Périco, Roberto Mendes dos Santos, Leonardo Rodrigo Baldaçara, Camila Santos Símaro, Renata Costa Junqueira, Maria Olivia Pozzolo Pedro, and João Mauricio Castaldelli-Maia
Revista da Associacao Medica Brasileira (1992) FapUNIFESP (SciELO)
OBJECTIVES
This study aimed to identify the infrastructure (e.g., availability, resources, and staff), basic metrics, and problems (e.g., network, overcrowding, resources, and infrastructure) of the psychiatric emergency services in Brazil.
METHODS
This is a cross-sectional study assessing psychiatric services (n=29) listed by the Brazilian Psychiatric Association in 2019.
RESULTS
Almost all the units reported 24 h/7-day availability having psychiatrists, nurses, and social workers, with 8.8 (SE=2.2) and 2.8 (SE=0.3) consultations and hospitalizations per day, respectively. Separated room for contention was reported by the minority of the services (38%). The most commonly reported problems were insufficient structure for child/adolescent care (83%), increasing patient demand (72%), housing referral for homeless (72%), excessive prescription demand (69%), short-term room overcrowding (59%), court orders for inpatient treatment (59%), lack of vacancies for inpatients hospitalization (59%), and referral to primary care (56%).
CONCLUSIONS
Similar to the United States, the Brazilian psychiatric emergency units are decreasing and encompass the shortcomings of the Brazilian mental health care network.
Leonardo Baldaçara, Antônio Geraldo da Silva, Lucas Alves Pereira, Leandro Malloy-Diniz, and Teng Chei Tung
Frontiers in Psychiatry Frontiers Media SA
The prevalence of mental health problems in the general population during a public calamity is high. In calamities, the number of patients who present with mental disorder outbreaks or crises may increase, but the necessary support systems to help them may be impaired if they have not been planned for. Although there are several models for addressing psychiatric emergencies, the general rules are the same, especially when it comes to making these services easily available to the affected population. In this article, we seek to review and present recommendations for the management of psychiatric emergencies in situations of public calamity, including disasters, physical and medical catastrophes, epidemics, and pandemics.
Leonardo Baldaçara, Gislene A. Rocha, Verônica da S. Leite, Deisy M. Porto, Roberta R. Grudtner, Alexandre P. Diaz, Alexandrina Meleiro, Humberto Correa, Teng C. Tung, João Quevedo,et al.
Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999) FapUNIFESP (SciELO)
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
Leonardo Baldaçara, Roberta R. Grudtner, Verônica da S. Leite, Deisy M. Porto, Kelly P. Robis, Thiago M. Fidalgo, Gislene A. Rocha, Alexandre P. Diaz, Alexandrina Meleiro, Humberto Correa,et al.
Revista brasileira de psiquiatria (Sao Paulo, Brazil : 1999) FapUNIFESP (SciELO)
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
Maycon Klerystton B. Tavares, Romulo L. P. de Melo, Bianca F. da Rocha, Débora J. Andrade, Danielle R. Evangelista, Márcia C. T. S. Peres, Leonardo R. Baldaçara, Thiago DeSouza-Vieira, Elisangela V. Assis, and José Bruno N. F. Silva
MDPI AG
Although dating applications (apps) have become popular among young adults, there is a dearth of information regarding the sexual health implications among Brazilian college students. This study examined risky sexual behavior and attitudes of dating app users, based on their sex in Brazil’s Legal Amazon. Three hundred and fifty-nine students reported their sociodemographic data, dating app use, and sexual behaviors and attitudes through self-administered questionnaires. Bivariate analyses and analysis of variance (ANOVA) with Bonferroni post-hoc tests were performed. Dating app use was reported by 238 (66.3%) subjects, most of whom had an encounter and sex with a casual partner. Women frequently requested condom use. Trust in one’s partner or having repeated encounters were the main reasons for engaging in risky sexual behavior. Men had a greater number of sexual partners and less protective attitudes. Sexual health awareness by apps was not reported by 97% of women, and most of them were not tested for sexually transmitted infections. A positive attitude toward sexual health was not a predictor of safe sex. Important similarities and differences regarding risky sexual behaviors and attitudes were observed between the sexes, many of which correlated with increased sexual vulnerability during the sexual encounters arranged through the dating apps. This cross-sectional study supports efforts on sexual health promotion and sexual education implementation in the face of growing usage of apps among young adults for sexual matters.
Antônio Geraldo da Silva, Leonardo Baldaçara, Daniel A. Cavalcante, Nicoli Abrão Fasanella, and Antônio Pacheco Palha
Frontiers Media SA
Psychiatric emergencies are severe behavioral changes secondary to worsening mental illness. Such situations present a risk to the patient and other people, so they need immediate therapeutic intervention. They are associated with feelings of fear, anger, prejudice, and even exclusion. The attitudes of professionals and factors related to the workplace culture in health can help to perpetuate stereotypes and interfere with the quality of care. Stigma has undesirable consequences in patients with mental disorders. Certain measures can reduce stigma and provide a more dignified way for patients to recover from the crisis. This article aims to discuss the causes of stigma, ways of dealing with it, and achievements that have been made in psychiatric emergency care settings.
Marlos Vasconcelos Rocha, Fabiana Nery-Fernandes, Leonardo Baldaçara, Andrea Parolin Jackowski, Lucas De Castro Quarantini, Giovanna Ladeia-Rocha, César De Araujo Neto, Irismar Reis De Oliveira, André Caribé, and Ângela Miranda-Scippa
Open Access Text Pvt, Ltd.
Leonardo Baldaçara, Alexandre P. Diaz, Verônica Leite, Lucas A. Pereira, Roberto M. dos Santos, Vicente de P. Gomes Júnior, Elie L.B. Calfat, Flávia Ismael, Cintia A.M. Périco, Deisy M. Porto,et al.
EDITORA SCIENTIFIC
Objective: To present the essential guidelines for pharmacological management of patients with psychomotor agitation in Brazil. Methods: This is a systematic review of articles retrieved from the MEDLINE (PubMed), Cochrane Database of Systematic Reviews, and SciELO databases published from 1997 to 2017. Other relevant articles in the literature were also used to develop these guidelines. The search strategy used structured questions formulated using the PICO model, as recommended by the Guidelines Project of the Brazilian Medical Association. Recommendations were summarized according to their level of evidence, which was determined using the Oxford Centre for Evidence-based Medicine system and critical appraisal tools. Results: Of 5,362 articles retrieved, 1,731 abstracts were selected for further reading. The final sample included 74 articles that met all inclusion criteria. The evidence shows that pharmacologic treatment is indicated only after non-pharmacologic approaches have failed. The cause of the agitation, side effects of the medications, and contraindications must guide the medication choice. The oral route should be preferred for drug administration; IV administration must be avoided. All subjects must be monitored before and after medication administration. Conclusion: If non-pharmacological strategies fail, medications are needed to control agitation and violent behavior. Once medicated, the patient should be monitored until a tranquil state is possible without excessive sedation. Systematic review registry number: CRD42017054440.
Leonardo Baldaçara, Flávia Ismael, Verônica Leite, Lucas A. Pereira, Roberto M. dos Santos, Vicente de P. Gomes Júnior, Elie L.B. Calfat, Alexandre P. Diaz, Cintia A.M. Périco, Deisy M. Porto,et al.
EDITORA SCIENTIFIC
Objective: To present the essential guidelines for non-pharmacological management of patients with psychomotor agitation in Brazil. Methods: These guidelines were developed based on a systematic review of articles published from 1997 to 2017, retrieved from MEDLINE (PubMed), Cochrane Database of Systematic Review, and SciELO. Other relevant articles identified by searching the reference lists of included studies were also used to develop these guidelines. The search strategy used structured questions formulated using the PICO model, as recommended by the Guidelines Project of the Brazilian Medical Association. Recommendations were summarized according to their level of evidence, which was determined using the Oxford Centre for Evidence-based Medicine system and critical appraisal tools. Results: We initially selected 1,731 abstracts among 5,362 articles. The final sample included 104 articles that fulfilled all the inclusion criteria. The management of agitated patients should always start with the least coercive approach. The initial non-pharmacological measures include a verbal strategy and referral of the patient to the appropriate setting, preferably a facility designed for the care of psychiatric patients with controlled noise, lighting, and safety aspects. Verbal de-escalation techniques have been shown to decrease agitation and reduce the potential for associated violence in the emergency setting. The possibility of underlying medical etiologies must be considered first and foremost. Particular attention should be paid to the patient’s appearance and behavior, physical signs, and mental state. If agitation is severe, rapid tranquilization with medications is recommended. Finally, if verbal measures fail to contain the patient, physical restraint should be performed as the ultimate measure for patient protection, and always be accompanied by rapid tranquilization. Healthcare teams must be thoroughly trained to use these techniques and overcome difficulties if the verbal approach fails. It is important that healthcare professionals be trained in non-pharmacological management of patients with psychomotor agitation as part of the requirements for a degree and graduate degree. Conclusion: The non-pharmacological management of agitated patients should follow the hierarchy of less invasive to more invasive and coercive measures, starting with referral of the patient to an appropriate environment, management by a trained team, use of verbal techniques, performance of physical and mental assessment, use of medications, and, if unavoidable, use of the mechanical restraint. Systematic review registry number: CRD42017054440.
Leonardo Baldaçara and Raquel Prudente de Carvalho Baldaçara
FapUNIFESP (SciELO)
ABSTRACT CONTEXT AND OBJECTIVE: Few studies have assessed the impact of medical residencies on the public healthcare system. The aim here was to assess the number of specialists who remained in the state of Tocantins after finishing the medical residency program during the first two years of the first programs (2013 and 2014). DESIGN AND SETTING: Cross-sectional and exploratory study conducted at the Federal University of Tocantins in Brazil. METHODS: All graduates of medical residency programs in Tocantins, of the years 2013 and 2014, were interviewed by telephone and e-mail between May and July 2014. RESULTS: Information was obtained from 37 graduates from medical residency. Seventeen (50.0%) were working in the state public healthcare system and only six (17.6%) in a municipal service in June 2014. Considering only the 24 doctors who had never worked in the state of Tocantins before their residency, it was observed that two who graduated in 2013 (20.0%) and five who graduated in 2014 (35.7%), i.e. seven out of the total number (29.2%), had established their homes in Tocantins. CONCLUSIONS: The number of graduates from medical residency who stayed in the state of Tocantins in 2013 and 2014 was small. However, this was related to the absence of other programs for continuation of the specialization. The state healthcare system was primarily responsible for employment of these doctors within public services. On the other hand, hiring by municipal services was extremely low.
Leonardo Baldaçara, Célia Araújo, Idaiane Assunção, Ivaldo da Silva, and Andrea Parolin Jackowski
FapUNIFESP (SciELO)
Background Brain-imaging studies in post-traumatic stress disorder (PTSD) have consistently revealed alterations in brain structure and function and this is correlated to symptomatology. However, few studies have investigated the role of biomarkers in PTSD some specific groups, as police officers. Objective To evaluate prefrontal and limbic volumes, and cortical thickness of police officers exposed to trauma during work who developed post-traumatic stress disorder, resilient matched controls (without PTSD), and compared to healthy civilians. Methods Prefrontal and limbic volumes, and cortical thickness of 12 police officers with PTSD, 12 resilient police officers, and 12 healthy civilians who underwent brain MRI were analyzed. Results Differences in limbic structures volume were not significative after Bonferroni correction. A significant reduction in cortical thickness on right rostral cingulate, right and left middle frontal gyrus, left superior frontal, left lingual, calcarine and cuneus were observed in PTSD group in comparison to controls was observed. Discussion Although preliminary, our results suggested not only the association between cortical thickness and PTSD, but also indicated that patients and controls have anatomical differences.
Antônio Fagundes da Costa Júnior, Leonardo Rodrigo Baldaçara, Sílvio Alves da Silva, Ana Célia de Freitas Ramos Tavares, Ederson de Freitas Orsolin, Vinícius Barros Prehl, Fernando Hirohito Beltran Gondo, and Hernani Lopes Santana
FapUNIFESP (SciELO)
Resumo Contexto O consumo de crack é um dos grandes desafios em saúde pública, e o uso dessa droga tem efeitos diretos na saúde de seus usuários. Objetivos Avaliar o perfil das alterações vasculares em pacientes com dependência de crack em Centro de Atenção Psicossocial para Álcool e Drogas (CAPS-AD) e observar os possíveis efeitos vasculares periféricos. Métodos Trata-se de um estudo observacional, descritivo, de corte transversal. Os pacientes da amostra foram submetidos a um questionário objetivo para avaliar questões demográficas, padrão de uso da droga, coexistência de diabetes melito, hipertensão arterial ou tabagismo, exame físico e ecográfico. Os dados foram sumarizados e analisados estatisticamente com teste qui-quadrado ou teste exato de Fisher. Resultados A média de idade da amostra foi de 33,29 (±7,15) anos, e 74% eram do gênero masculino. A média de idade de início de uso da droga foi de 23,4 (±7,78) anos, com tempo médio de uso de 9,58 (±5,64) anos. O consumo médio diário de pedras de crack foi de 21,45 (±8,32) pedras. A alteração de pulsos em membros inferiores foi mais frequente em mulheres. A prevalência do espessamento da parede arterial nos membros inferiores foi de 94,8%. O tempo de uso da droga apresentou associação estatística (p = 0,0096) com alteração do padrão de curva espectral das artérias dos membros inferiores. Conclusões Há alterações vasculares periféricas em usuários de crack. O tempo de uso da droga exerceu um maior impacto nesse sistema, o que sugere associação entre o uso do crack e a diminuição de fluxo arterial.
Leonardo Baldaçara, Hugo Cogo-Moreira, Bruna Leal Parreira, Thaynne Almeida Diniz, Jaqueline Jerônimo Milhomem, Camila Campitelli Fernandes, and Acioly Luiz Tavares Lacerda
Physicians Postgraduate Press, Inc
OBJECTIVE
We performed a double-blind, randomized, placebo-controlled trial to assess the efficacy of topiramate in the treatment of crack cocaine dependence.
METHOD
Sixty men who were dependent on cocaine (DSM-IV) (exclusive use of crack cocaine) were selected. The subjects were randomly assigned to either a topiramate group (subjects received 50-200 mg of topiramate per day for 12 weeks) or a control group (subjects received placebo). The initial daily treatment dose was 50 mg, and this dose was increased weekly at increments of 25 to 50 mg, based on the subject's tolerability, to a maximum of 200 mg. All of the subjects also participated in motivational interviews and group therapy. The primary outcome measures were detection of benzoylecgonine in the urine, study retention, frequency of cocaine smoking, amount of cocaine use, and mean amount of money spent on cocaine per week. The study was conducted from February 2013 to February 2014.
RESULTS
Twenty-nine subjects in the topiramate group and 29 subjects in the control group completed the study. Longitudinal assessment revealed that retention was not significant (odds ratio [OR] = 1.072, P = .908) between the 2 groups. Negative results from a urine test for benzoylecgonine (a cocaine metabolite), which is a measure of cocaine abstinence, were more frequently obtained from the topiramate group (OR = 8.687, P < .001). Topiramate reduced the quantity of cocaine used (mean reduction = -3.108 g, P < .001), the frequency of cocaine use (mean = -0.784 times per week, P = .005), and the amount of money spent on cocaine (mean [US dollars] = -$25.38, P = .015; this variable did not achieve statistical significance after Bonferroni correction) compared with the placebo during the 12 weeks (or 84 days) of the assessment. However, the differences in reductions between the 2 groups in the quantity of cocaine used, the frequency of cocaine use, and money spent on cocaine over time (time × group interaction) were present only during the first 4 weeks, and none of these variables by 12 weeks. The studied groups did not differ with regard to secondary end points, such as study dropout and the number of subjects who reported side effects.
CONCLUSIONS
The present findings indicate that topiramate is effective and safe and thus reinforce previous data suggesting that topiramate is a potentially useful treatment for crack cocaine dependence. However, we found that topiramate is only useful as an adjunctive treatment during the first 4 weeks of the treatment. Future studies with larger samples are needed to confirm these results.
TRIAL REGISTRATION
Registro Brasileiro de Ensaios Clínicos (ReBEC) RBR-3vwfjs and UTN: U1111-1131-4443.
Marina Garriga, Isabella Pacchiarotti, Siegfried Kasper, Scott L. Zeller, Michael H. Allen, Gustavo Vázquez, Leonardo Baldaçara, Luis San, R. Hamish McAllister-Williams, Konstantinos N. Fountoulakis,et al.
Informa UK Limited
Abstract Background Psychomotor agitation is associated with different psychiatric conditions and represents an important issue in psychiatry. Current recommendations on agitation in psychiatry are not univocal. Actually, an improper assessment and management may result in unnecessary coercive or sedative treatments. A thorough and balanced review plus an expert consensus can guide assessment and treatment decisions. Methods An expert task force iteratively developed consensus using the Delphi method. Initial survey items were based on systematic review of the literature. Subsequent surveys included new, re-worded or re-rated items. Results Out of 2175 papers assessing psychomotor agitation, 124 were included in the review. Each component was assigned a level of evidence. Integrating the evidence and the experience of the task force members, a consensus was reached on 22 statements on this topic. Conclusions Recommendations on the assessment of agitation emphasise the importance of identifying any possible medical cause. For its management, experts agreed in considering verbal de-escalation and environmental modification techniques as first choice, considering physical restraint as a last resort strategy. Regarding pharmacological treatment, the “ideal” medication should calm without over-sedate. Generally, oral or inhaled formulations should be preferred over i.m. routes in mildly agitated patients. Intravenous treatments should be avoided.