Leonardo Rodrigo Baldacara

RESEARCH INTERESTS

Psychiatry
Psychiatric emergencies
Neuroimaging

Scopus Publications

Effectiveness of short term acute electroconvulsive therapat three Brazilian sites: an observational cohort study
Leonardo Baldaçara, Mateus José Abdalla Diniz, Matheus Nycolas Barbosa de Andrade, Tiago Nunes de Araújo, and Alfredo Minervino
FapUNIFESP (SciELO)
ABSTRACT BACKGROUND: Electroconvulsive therapy (ECT) remains a target of prejudice, and finding places to administer it remains a challenge. The main reason for the recommendation of ECT is its effectiveness, especially when compared with other treatments for severe and refractory patients. OBJECTIVES: This study aimed to assess the response rates across a broader patient sample undergoing ECT in three distinct Brazilian states. DESIGN AND SETTING: This observational cohort study was conducted at the following three sites: Universidade Federal do Tocantins (by partnership with Hospital Geral de Palmas, Palmas-TO), Pax Instituto de Psiquiatria (Goiânia – GO), and Clínica Animus (Joao Pessoa – PB). METHODS: A total of 212 patients who received ECT at three different Brazilian services were assessed for improvement in symptoms in the first week after treatment and 30 and 60 days after treatment completion. RESULTS: Safety and efficacy of ECT was well established, as evidenced by the zero mortality rate among the study participants, with side effects observed in only 10.5% of cases. The immediate response rate was impressive at 95.8%, and the response rate after 30 and 60 days was 90.6% and 87.7%, respectively. The regression analysis highlighted session frequency as a key determinant of positive responses. CONCLUSION: The effectiveness of short term ECT (two months) is one of the greatest among psychiatric treatments. Future research should focus on predictive models for treatment responses to enable personalized approaches.


Rapid tranquilization in a psychiatric emergency room: A naturalistic cohort study in 12 h
Leonardo Baldaçara, André Luiz de Carvalho Braule Pinto, Alexandre Paim Díaz, Marsal Sanches, and Antônio Geraldo da Silva
Elsevier BV



Brazilian Psychiatric Association consensus on the ideal infrastructure and team for psychiatric emergency services
Leonardo Baldaçara, Flávia Ismael, Daniel Kawakami, Gislene Alves da Rocha, Elie Leal de Barros Calfat, Deisy Mendes Porto, Beatriz Ferroli Cavalcante, Beatriz Plotegher Zaramella, Flávio Veloso Ribeiro, Roberto Mendes dos Santos,et al.
EDITORA SCIENTIFIC
INTRODUCTION An integral part of Brazil's public health system, the psychiatric emergency service (PES) has been instrumental in improving qualified support for crisis situations of mental disorders, equitable, universally accessible, and humanized. The purpose of this article is to present a systematic review and consensus about the physical area and facilities, and ideal team qualified for psychiatric emergencies services on both Brazilian settings. METHODS The authors conducted a literature search using electronic databases such as MEDLINE (PubMed), Scielo, the Cochrane Database, and documents from the WHO, the Brazilian Ministry of Health, and others deemed relevant by experts. A total of 6839 manuscripts were found, but only 46 were selected. The analysis of article content summarizes consensus statements using the Delphi method and a series of interactive versions to provide a final report. RESULTS Changes to PES are evaluated considering various experiences and models. The authors highlighted that The Emergency Care Network (ECN) must be coordinated with qualified management, effective implementation of integration of all health equipment's and units. PES must have adequate infrastructure; qualified staff, including a psychiatrist; sufficient consultation and observational spaces; tools and resources for differential diagnosis; training for all staff members; and communication with the health care network to facilitate referrals following patient discharge are all necessary. CONCLUSION These standardized models need to be available to public health managers so that they can guide the installation of new services and adjust the existing ones, always looking for improvement. The authors propose requirements for PES as a model to be passed over.


Brazilian Psychiatric Association treatment guidelines for generalized anxiety disorder: perspectives on pharmacological and psychotherapeutic approaches
Leonardo Baldaçara, Ana Beatriz Paschoal, Aldo Felipe Pinto, Fabiano Franca Loureiro, Luiz Antonio Vesco Gaiotto, Diogo de Lacerda Veiga, Thales Marcon Almeida, Diogo Cesar dos Santos, Leandro Fernandes Malloy-Diniz, Marcelo Feijó de Mello,et al.
EDITORA SCIENTIFIC
OBJECTIVE To combine elements of a systematic review and critical review to produce best evidence synthesis for the treatament of GAD. METHOD There was included systematic reviews, metanalysis, and randomized controlled trials. Descriptor used was "generalized anxiety disorder", resulting in 4860 articles and 7 other studies, of which 59 were selected. RESULTS Antidepressants and benzodiazepines are indicated, as well as pregabalin. From, atypical antipsychotics quetiapine has been studied. Cognitive behavior therapy (third wave of behavioral and cognitive therapies) as well as individual CBT proven to be effective. CONCLUSION There is extensive literature on many effective treatments for GAD. The present work summarizes the therapeutic possibilities, emphasizing those available in the Brazil. Further studies are still needed to compare other available medications, to assess psychotherapies in more depth, new treatments and specially to assess the ideal time for maintaining therapy.


Interfaces between oncology and psychiatry
Ana Luiza Silva Teles, Leonardo Baldaçara, Antônio Geraldo da Silva, Verônica da Silveira Leite, Ana Lucia Paya Benito, and Flávio Veloso Ribeiro
FapUNIFESP (SciELO)



Brazilian Psychiatric Association Consensus for the Management of Acute Intoxication: general management and specific interventions for drugs of abuse
Leonardo Baldaçara, Amanda de Gouvêa Pettersen, Verônica da Silveira Leite, Flávia Ismael, Carolina Pereira Motta, Railson Alves Freitas, Nicoli Abrazo Fasanella, Lucas Alves Pereira, Maria Elisa Lima Barros, Leonardo Barbosa,et al.
EDITORA SCIENTIFIC
Abstract Objectives To present the Brazilian Psychiatric Association’s Consensus on the Management of Acute Intoxication. Methods A group of experts selected by the Brazilian Psychiatric Association searched for articles on the MEDLINE (by PubMed) and Cochrane databases, limited to human studies and acute intoxication. Working groups reviewed these materials for appropriateness to the topic and the quality of the work. A survey was conducted using the Delphi method to produce a table of agreed recommendations presented at the end of the systematic review. Three survey rounds were held to reach consensus. Results Support for intoxication should start with Initial Management: Resuscitation/Life Support/Differential Diagnosis. For this, the group proposed the following sequence of assessments: A (airway), B (breathing), C (circulation), D.1 (disability), D.2 (differential diagnosis), D.3 (decontamination), D.4 (drug antidotes), E (enhanced elimination). The group of experts then presented specific interventions for the main drugs of abuse. Conclusions Management of intoxication with drugs of abuse is complex and requires systematic protocols. The group suggests adoption of the A-B-C-D-E technique first, with constant investigation. Then, specific conduct and support until remission of intoxication. The literature is still scarce in evidence on the subject. Therefore, this consensus was necessary. We believe that at present this document can help psychiatric, general, and emergency physicians deal with emergency psychiatric episodes due to acute intoxication. This work could stimulate future studies on the topic.


Brazilian Psychiatric Association guidelines on the integration of spirituality into mental health clinical practice: Part 1. Spiritual history and differential diagnosis
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.


Managing drug-induced psychosis
Leonardo Baldaçara, Artur Ramos, and João Maurício Castaldelli-Maia
Informa UK Limited



Puerperal psychosis: an update
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.


Translation, cross-cultural adaptation, and validation of the Behavioral Activity Rating Scale (BARS) for the Brazilian population
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.


Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 3. Suicide prevention hotlines
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


Editorial: Current challenges and evidence-based medicine in psychiatric emergencies
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


Social Determinants in Self-Protective Behavior Related to COVID-19: Association Rule–Mining Study
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.


Position statement of the Brazilian Psychiatric Association on the use of cannabis in psychiatric treatment
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.


Can medical residency keep young specialists in the place where they graduate? Cross-sectional and exploratory study of the first seven years after implementation of medical residency programs in the State of 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.


Longitudinal Invariance and Validity of the Impact of Event Scale–Revised Under COVID-19 Pandemic in a Brazilian Sample
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).


Psychiatric emergency units in Brazil: a cross-sectional study
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.


The Management of Psychiatric Emergencies in Situations of Public Calamity
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.


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


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


Dating applications, sexual behaviors, and attitudes of college students in Brazil’s legal Amazon
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.


The Impact of Mental Illness Stigma on Psychiatric Emergencies
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.


Prefrontal gray matter volume in adults bipolar I outpatients is associated with history of suicide attempts?
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.



Brazilian guidelines for the management of psychomotor agitation. Part 2. pharmacological approach
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.


Brazilian guidelines for the management of psychomotor agitation. Part 1. non-pharmacological approach
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.

RECENT SCHOLAR PUBLICATIONS

Treinamento sistemtico em emergncias psiquitricas para profissionais de sade: um ensaio de brao nico
L Baldaara, LA Pereira, MEL Barros, FV Ribeiro, AG da Silva
Revista Neurocincias 33, 1-15 2025



Effectiveness of short term acute electroconvulsive therapy at three Brazilian sites: an observational cohort study
L Baldaara, MJA Diniz, MNB Andrade, TN Arajo, A Minervino
Sao Paulo Medical Journal 143 (2), e2023292 2025



PERFIL DOS ATENDIMENTOS POR EMERGNCIAS PSIQUITRICAS EM UM PRONTO SOCORRO GERAL
MS Lagares, MEC de Lima, LMC de Lima, LR Baldaara
Revista ft 2024



Brazilian Psychiatric Association consensus on the ideal infrastructure and team for psychiatric emergency services
L Baldaara, F Ismael, D Kawakami, GA da Rocha, ELB Calfat, DM Porto, ...
Brazilian Journal of Psychiatry 46, e20243567 2024



Brazilian Psychiatric Association Consensus for the Management of Acute Intoxication: general management and specific interventions for drugs of abuse
L Baldaara, AG Pettersen, VS Leite, F Ismael, CP Motta, RA Freitas, ...
Trends in psychiatry and psychotherapy 46, e20220571 2024



Brazilian Psychiatric Association treatment guidelines for generalized anxiety disorder: perspectives on pharmacological and psychotherapeutic approaches
L Baldaara, AB Paschoal, AF Pinto, FF Loureiro, LAVG Antonio, ...
Brazilian Journal of Psychiatry 46, e20233235 2024



Diretrizes da Associao Brasileira de Psiquiatria para o manejo do comportamento suicida: hotlines para a preveno de suicdio: traduo revisada e ampliada de: https://doi
L Baldaara, RR Grudtner, CAT Weber, ME Gorender, SPP da Silva, ...
Debates em Psiquiatria 14, 1-23 2024



Diretrizes da Associao Brasileira de Psiquiatria para o manejo do comportamento suicida: fatores de risco e de proteo: traduo revisada e ampliada de: https://doi. org/10
L Baldaara, EL de Barros Calfat, CAM Prico, GA da Rocha, ...
Debates em Psiquiatria 14, 1-32 2024



Interfaces between oncology and psychiatry
ALS Teles, L Baldaara, AG Silva, VS Leite, ALP Benito, FV Ribeiro
Revista da Associao Mdica Brasileira 70 (suppl 1), e2024S129 2024



Rapid tranquilization in a psychiatric emergency room: A naturalistic cohort study in 12 h
L Baldaara, ALCB Pinto, AP Daz, M Sanches, AG da Silva
Psychiatry Research Communications 4 (2), 100168 2024



Prevalncia das sequelas relacionadas sndrome da ps-COVID-19: Uma reviso integrativa da literatura
APC Trajano, ACP Matos, KGF Guedes, L Baldaara, ...
Research, Society and Development 13 (5), e7613545803-e7613545803 2024



A gesto de emergncias psiquitricas em situaes de calamidade pblica
L Baldaara, AG da Silva, LA Pereira, LF Malloy-Diniz, TC Tung
Debates em Psiquiatria 14, 1-34 2024



Tricyclic antidepressants: an update
L Baldaara, R Freitas, RP de Carvalho Baldaara
Research, Society and Development 13 (4), e4413445539-e4413445539 2024



Aspectos neurocognitivos do alcoolismo
LF Caixeta, L da Silva Prestes, TB de Oliveira, EA Silveira, MA Barbosa, ...
Debates em Psiquiatria 14, 1-27 2024



Duloxetine: an update
L Baldaara
Research, Society and Development 13 (3), e7313345331-e7313345331 2024



Brazilian Psychiatric Association consensus for the Management of Psychiatric Emergencies in Pregnancy and Postpartum period
L Baldaara, R Gd, F Ismael, I Vasconcelos, C Ribeiro, E Calfat, C Rosa, ...
2024



Manifestaes psiquitricas da encefalite autoimune
L Caixeta, FMC Marques, I Dangoni Filho, CM Vargas, DS Diniz, ...
Debates em Psiquiatria 13, 1-28 2023



A quetiapina: 3 medicamentos em uma nica molcula: uma breve reviso e atualizao
L Caixeta, CM Vargas, Y Lucio, L Baldaara, SMM dos Reis Alfaia, ...
Debates em Psiquiatria 13, 1-20 2023



Fentipos e fenocpias bipolares e sua variao no ciclo vital
L Caixeta, MPR Chaves, L Baldaara
Debates em Psiquiatria 13, 1-22 2023



Pharmacological treatment of post-traumatic stress disorder: a treatment guide based on a systematic literature review
C do Prado Nascimento, HZ Couto, L Baldaara, AG da Silva, ...
Debates em Psiquiatria 13, 1-72 2023

MOST CITED SCHOLAR PUBLICATIONS

Assessment and management of agitation in psychiatry: expert consensus
M Garriga, I Pacchiarotti, S Kasper, SL Zeller, MH Allen, G Vazquez, ...
The world journal of biological psychiatry 17 (2), 86-128 2016
Citations: 389



Cerebellum and psychiatric disorders
L Baldaara, JGF Borgio, ALT Lacerda, AP Jackowski
Brazilian Journal of Psychiatry 30, 281-289 2008
Citations: 221



Is cerebellar volume related to bipolar disorder?
L Baldaara, F Nery-Fernandes, M Rocha, LC Quarantini, GGL Rocha, ...
Journal of affective disorders 135 (1-3), 305-309 2011
Citations: 134



Rapid tranquilization for agitated patients in emergency psychiatric rooms: a randomized trial of olanzapine, ziprasidone, haloperidol plus promethazine, haloperidol plus
L Baldaara, M Sanches, DC Cordeiro, AP Jackowski
Brazilian Journal of Psychiatry 33, 30-39 2011
Citations: 103



The impact of mental illness stigma on psychiatric emergencies
ANG Da Silva, L Baldaara, DA Cavalcante, NA Fasanella, AP Palha
Frontiers in psychiatry 11, 573 2020
Citations: 99



Afastamentos por transtornos mentais entre servidores pblicos federais no Tocantins
LA Oliveira, LR Baldaara, MZB Maia
Revista Brasileira de Sade Ocupacional 40 (132), 156-169 2015
Citations: 91



Reduced cerebellar left hemisphere and vermal volume in adults with PTSD from a community sample
L Baldaara, AP Jackowski, A Schoedl, M Pupo, SB Andreoli, MF Mello, ...
Journal of psychiatric research 45 (12), 1627-1633 2011
Citations: 89



Brazilian guidelines for the management of psychomotor agitation. Part 1. Non-pharmacological approach
L Baldaara, F Ismael, V Leite, LA Pereira, RM Dos Santos, VP Gomes, ...
Brazilian Journal of Psychiatry 41, 153-167 2018
Citations: 62



Cerebellar volume in patients with dementia
L Baldaara, JGF Borgio, WAS Moraes, ALT Lacerda, MBMM Montao, ...
Brazilian Journal of Psychiatry 33, 122-129 2011
Citations: 55



HIV/AIDS-related visceral leishmaniasis: a clinical and epidemiological description of visceral leishmaniasis in northern Brazil
LCP Albuquerque, IR Mendona, PN Cardoso, LR Baldaara, ...
Revista da Sociedade Brasileira de Medicina Tropical 47 (1), 38-46 2014
Citations: 49



Brazilian guidelines for the management of psychomotor agitation. Part 2. Pharmacological approach
L Baldaara, AP Diaz, V Leite, LA Pereira, RM Dos Santos, VP Gomes, ...
Brazilian Journal of Psychiatry 41 (4), 324-335 2019
Citations: 46



Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 1. Risk factors, protective factors, and assessment
L Baldaara, GA Rocha, VS Leite, DM Porto, RR Grudtner, AP Diaz, ...
Brazilian Journal of Psychiatry 43, 525-537 2020
Citations: 43



Common psychiatric symptoms among public school teachers in Palmas, Tocantins, Brazil. An observational cross-sectional study
L Baldaara, F Silva, JGD Castro, GCA Santos
So Paulo Medical Journal 133 (5), 435-438 2015
Citations: 40



Efficacy of topiramate in the treatment of crack cocaine dependence: a double-blind, randomized, placebo-controlled trial
L Baldaara, H Cogo-Moreira, BL Parreira, TA Diniz, JJ Milhomem, ...
The Journal of clinical psychiatry 77 (3), 6282 2016
Citations: 39



Emergncias psiquitricas
L Baldaara, CT Teng
Publicaes ABP documentos e vdeos= ABP Publications documents and videos 3 2016
Citations: 38



Brazilian Psychiatric Association guidelines for the management of suicidal behavior. Part 2. Screening, intervention, and prevention
L Baldacara, RR Grudtner, V da S Leite, DM Porto, KP Robis, TM Fidalgo, ...
Brazilian Journal of Psychiatry 43, 538-549 2020
Citations: 36



Prevalence of allergen sensitization, most important allergens and factors associated with atopy in children
RPC Baldacara, MFM Fernandes, L Baldacara, WT Aun, JF Mello, ...
Sao Paulo Medical Journal 131 (05), 301-308 2013
Citations: 33



Reduction of anterior cingulate in adults with urban violence-related PTSD
L Baldaara, A Zugman, C Arajo, H Cogo-Moreira, ALT Lacerda, ...
Journal of affective disorders 168, 13-20 2014
Citations: 30



Relationship between structural abnormalities in the cerebellum and dementia, posttraumatic stress disorder and bipolar disorder
L Baldaara, JGF Borgio, C Arajo, F Nery-Fernandes, ALT Lacerda, ...
Dementia & Neuropsychologia 6, 203-211 2012
Citations: 26



Prevalncia do uso de drogas psicotrpicas por estudantes de medicina da Universidade Federal do Tocantins/Prevalence of psychotropic drug use by medical students from
DPA de Moraes, GMR de Medeiros, FAXB Caldas, LA Oliveira, ...
Arquivos mdicos dos hospitais e da faculdade de cincias mdicas da Santa 2013
Citations: 18