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Objective: Suicide is a leading cause of death among youth aged 15-29, with rates of suicidal thoughts and behaviors increasing over the years. University students, facing the challenges of early adulthood alongside mental health issues, are particularly at risk. Effective prevention strategies are urgently needed, but knowledge gaps hinder intervention efforts. This study aimed to identify specific subgroups within Brazilian college students and examine their relationship with suicidal ideation (SI) and depression. Methods: Using academic and mental health indicators from a cross-sectional national survey (n=12,245), a latent class analysis was conducted to identify subgroups based on similar characteristics. Logistic regression was used to identify potential associations of identified classes with SI and depressive symptoms (DS). Results: Four distinct classes emerged: ordinary, psychologically distressed, dissatisfied, and binge drinkers. The psychologically distressed and dissatisfied subgroups were associated with higher odds of SI (OR = 7.90, 95%CI 1.94-32.22; 8.12, 95%CI 2.27-29.02, respectively) and DS (OR = 28.77, 95%CI 6.43-128.75; 13.63, 95%CI 3.47-53.59, respectively). Conclusion: Students facing academic adjustment and mental health issues are potentially vulnerable to SI and DS. Universities must monitor the impact of academic life on mental health, identify at-risk students, and provide appropriate support. Further research on suicide-related vulnerabilities can guide prevention strategies in educational settings.

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Objective: To analyze the interaction between depressive symptomatology, instrumental activities of daily living (IADLs), basic activities of daily living (BADLs), and cognitive impairment in a sample of Colombians over 60 years of age by binary logistic regression and structural equation modeling. Methods: Secondary analysis of data from the 2012 Salud, Bienestar y Envejecimiento survey, which included 1,957 people from Bogotá, Colombia. The sampling was probabilistic, clustered, and stratified. The instruments used were the Mini-Mental State Examination (MMSE), the Lawton-Brody Scale, the Barthel Index, and the Geriatric Depression Scale. Bivariate and multivariate analyses were performed. Results: Bivariate analyses revealed differences in performance between groups. The binary logistic regression model explained 42.3% of the variance. Based on these findings, a structural equation model (SEM) was developed, which yielded the following fit indices: chi-square minimum discrepancy (CMIN)/degrees of freedom (DF) = 4.81, goodness-of-fit index (GFI) = 0.98, comparative fit index (CFI) = 0.97, and root mean square error of approximation (RMSEA) = 0.04 (0.039; 0.049). The results show that IADL contribute most significantly to cognitive impairment, while depressive symptomatology and BADL contribute the least. Conclusion: These findings suggest that depressive symptomatology and impaired performance in IADL/BADL are key factors to address in cognitive impairment, which highlights their importance in the context of mental and physical healthcare for the older Colombian population.

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Objective: This study aimed to examine the peripapillary retinal nerve fiber layer (RNFL) thickness, macular thickness (MAC), ganglion cell layer (GCL) thickness, and inner plexiform layer (IPL) thickness using optical coherence tomography (OCT) in patients with euthymic bipolar disorder (BD) and recurrent major depressive disorder (MDD) in remission, and to compare these measurements with those of a healthy control group (CG). Methods: The study included 51 patients with BD, 50 patients with MDD, and 52 individuals in the CG. Comprehensive ophthalmologic examinations were performed on all participants, and only the right eye was analyzed. OCT findings were compared among the groups. Results: There were no significant differences among the groups in terms of age, gender, smoking status, RNFL, or IPL measurements. The CG showed significantly greater MAC central and inner temporal (IT) thickness compared to both the MDD and BD groups (all p < 0.05). However, there was no significant difference in MAC central thickness between the MDD and BD groups (p = 0.084). The MAC IT thickness was significantly greater in the MDD group than in the BD group (p = 0.046). MAC inner inferior thickness was significantly higher in the CG compared to both the MDD and BD groups (p = 0.003 and p < 0.001, respectively), with no significant difference between the MDD and BD groups (p = 0.141). GCL IT thickness was also significantly higher in the CG than in both patient groups (p = 0.049 and p = 0.044, respectively). Conclusion: The observed differences between the MDD and BD groups may reflect disorder-specific retinal structural changes. Further studies with larger sample sizes and longitudinal follow-up are needed to validate these findings and clarify the implications for retinal structure and function in mood disorders.

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Objective: To compare early intervention strategies for psychosis between community-based Psychosocial Care Centers (Centros de Atenção Psicossocial) and a specialized university service (Grupo de Atenção às Psicoses Iniciais) in Brazil, assessing early intervention fidelity, recovery-oriented practices, and professional stigma. Methods: The First Episode Psychosis Services Fidelity Scale, Recovery Self-Assessment, and a stigma questionnaire evaluated early intervention fidelity, recovery-oriented practices, and stigma. Data from both services were analyzed to examine correlations. Results: There was greater fidelity to early intervention strategies in the specialized university service, whereas the Psychosocial Care Centers scored higher in recovery-oriented practices. Despite their lower overall early intervention fidelity, the Psychosocial Care Centers already incorporated several components of early intervention. No significant differences in stigma levels were observed. Higher recovery-oriented practices correlated with fewer negative stereotypes, while greater early intervention fidelity correlated with fewer positive stereotypes. Conclusions: The findings highlight the complementary strengths of both service models. Although improving early intervention fidelity in Psychosocial Care Centers is a priority, their existing community-based structure and orientation toward recovery offer a strong platform for expanding these services. An integrated approach combining specialized early intervention strategies with robust recovery-oriented practices could optimize outcomes and reduce stigma.

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Objective: To explore suicidal behavior among transgender women by investigating the associations between resilience, social support, and experiences of gender discrimination and thoughts of self-harm, suicidal ideation, and suicide attempts among transgender women in Brazil. Methods: This study draws on cross-sectional data from the Brazilian Dinamizando a Inclusão e Valorizando as Atividades Saudáveis (DIVAS) study. A respondent-driven sampling method was used to recruit 2,470 participants. Fourteen discrimination domains were used in a latent class analysis model to separate the sample into classes. A multiple logistic regression model was used to assess the association of each outcome (i.e., recent thoughts of self-harm and suicidal ideation, lifetime suicidal ideation, and recent and lifetime suicide attempts) with gender discrimination, resilience, and social support scores. Results: Four classes of discrimination were obtained: low, medium-low, medium-high, and high. Higher levels of discrimination were associated with thoughts of self-harm and suicidal ideation (ORs from 1.26 to 2.39) and suicide attempts (ORs from 1.68 to 3.34), as well as lower levels of resilience (ORs from 1.79 to 4.08). However, higher levels of social support were associated with a lower chance of thoughts of self-harm or suicidal ideation (ORs from 0.66 to 0.43) and suicide attempts (ORs from 0.78 to 0.58). Conclusions: The clear link between discrimination, whether structural or interpersonal, and suicidal ideation found in this study calls for structural changes that address harassment in all forms against gender minorities.

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Objective: Recruitment challenges are inherent in clinical research and are particularly pronounced in older adults with depression, who often face unique barriers such as medical comorbidities and infrequent help-seeking behavior. Neurostimulation techniques, like deep transcranial magnetic stimulation (dTMS), are often unfamiliar to patients. The literature offers limited insight into the costs and practical guidance associated with recruitment strategies in dTMS trials. This study aimed to address these gaps by investigating the cost-effectiveness of various recruitment strategies for dTMS trials among older adults, in addition to potential facilitators and barriers to recruitment. Methods: This mixed-methods retrospective analysis examined recruitment data from our pilot study investigating the effects of dTMS in older adults with depression. We assessed diverse recruitment methods by analyzing enrollment rates and conducting an enrollment-cost analysis. Recruitment-related barriers and facilitators were identified through a theoretical thematic analysis. Results: Over 14 months, we received 185 referrals, resulting in 22 enrolled participants. Health care provider outreach to affiliated mental health clinics was the most effective recruitment method, with an enrollment-cost rate of 0.00189 (CAD 537.63/person enrolled). The second most effective recruitment method was Facebook, yielding an enrollment-cost rate of 0.00099 (CAD 925.93/person enrolled). Social support from research personnel was a potential facilitator of recruitment, while time-intensiveness and accessibility challenges were noted as potential barriers. Conclusion: Our findings highlight both health care provider outreach within mental health clinics and Facebook advertising as effective recruitment strategies. Future research is needed to evaluate recruitment-related facilitators and barriers to dTMS interventions for older adults with depression.

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Objective: Current treatments for schizophrenia (SZ) are often not effective for all symptoms, with sex-dependent effects poorly understood. Cannabidiol (CBD) and sodium nitroprusside (SNP) have emerged as potential prophylactic options. We evaluated their efficacy in preventing positive, negative, and cognitive deficits in a ketamine (KET) rodent model of SZ in both sexes. Methods: Wistar rats were pretreated with CBD and SNP (alone or combined) during brain development (postnatal days 12-32). After 10 days, SZ-like deficits were induced via KET. Behaviors were assessed using the open field test (OFT), sucrose preference test (SPT), and novel object recognition (NOR) test. Results: KET induced sex-dependent effects: females showed greater hyperlocomotion and long-term NOR memory deficits, while males exhibited reduced sucrose preference and short-term NOR impairments. CBD or SNP alone had limited efficacy, but their combination reduced hyperlocomotion and prevented NOR deficits in both sexes. Multivariate analysis revealed superior prophylactic effects in females, with unsupervised clustering showing distinct behavioral phenotypes between sexes. Conclusion: This study provides the first preclinical evidence of sex-dependent prophylactic efficacy of CBD-SNP in a SZ model, suggesting a promising therapeutic strategy.

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Objective: Although fluvoxamine is a well-established treatment for depressive disorders, real-world safety data remain limited. This study analyzed adverse drug events associated with fluvoxamine in the U.S. Food and Drug Administration’s Adverse Event Reporting System, a large-scale pharmacovigilance database, to assess the drug’s safety profile. Methods: The database was used to collect data on fluvoxamine-related adverse drug events from the first quarter of 2004 to the third quarter of 2024. Disproportionality analyses were performed using the reporting odds ratio, proportional reporting ratio, Bayesian confidence propagation neural network, and empirical Bayes geometric mean methods. Results: A total of 355 fluvoxamine-related adverse drug event reports were identified, spanning 26 different system organ classes and 67 preferred terms. Psychiatric disorders were the most frequently reported adverse drug events. Notably, signals for reproductive system and breast disorders, cardiac disorders, and eye disorders were stronger but were unrelated to the pharmacological properties of fluvoxamine, thus warranting special clinical attention. Disinhibition had the highest signal strength and requires vigilance. A considerable number of drug interactions were noted, leading to increased antipsychotic drug levels and extrapyramidal symptoms, such as slow speech, drooling, and tardive dyskinesia. Self-harm and suicidal behavior require appropriate clinical risk management. Additionally, significant symptoms of serotonin syndrome were observed, including tics, clonus, mydriasis, and myoclonus. Our study also discovered adverse drug events not previously documented in product labels, such as Cushing’s syndrome, papilledema, and increased intracranial pressure. Conclusion: This study provides a real-world pharmacovigilance analysis of fluvoxamine, identifying several rare adverse drug events and clinically significant symptoms, particularly neuroleptic malignant syndrome and serotonin syndrome. Our study offers important insights for the clinical safety assessment of fluvoxamine.

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Objective: To analyze the temporal and spatial trends of children and adolescents reporting a diagnosis of autism spectrum disorder upon school enrollment in Brazil between 2014 and 2023. Methods: This ecological study employed time series (Mann-Kendall test with Hamed-Rao modification) and spatial analyses (global Moran’s I). Enrollment data (2014-2023) were obtained from the Brazilian School Census (Censo Escolar), including self-reported autism spectrum disorder. Results: On a national level, reported autism spectrum disorder cases increased from 8.23 to 134.49 per 10,000 enrolled students (p < 0.001; slope ≈11.18). Consistent upward trends were also found on a state level (tau = 1, p < 0.001), except in São Paulo (tau = 0.78, p = 0.002). The largest and smallest increases were in Acre and São Paulo, respectively. Moran’s I increased from 0.1235 to 0.3233 (p = 0.001), indicating stronger spatial clustering, with local indicators of spatial association identifying persistent clusters in the southern/southeastern regions and emerging clusters in the northeastern region. Conclusion: There was a steep nationwide increase in reported autism spectrum disorder cases between 2014 and 2023, with most states trending upward. Spatial clustering strengthened (increase in Moran’s I), with local indicators of spatial association showing persistent clusters in the southern/southeastern regions and emerging clusters in the northeastern region, which indicates a need for region-specific policies and integrated care.

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Objective: Tourette syndrome is often comorbid with attention-deficit/hyperactivity disorder and is associated with inhibitory control deficits. However, the differences in whole-brain functional connectivity between Tourette syndrome with and without ADHD and their neural basis for inhibitory control remain unclear. This study examines functional connectivity differences between these groups and their association with inhibitory control. Methods: We recruited 52 children with Tourette syndrome (30 with Tourette syndrome only and 22 with Tourette syndrome + attention-deficit/hyperactivity disorder) from Beijing Children’s Hospital. Resting-state functional magnetic resonance imaging was used to construct individual functional connectivity networks, and inhibitory control was assessed using the Go/No-Go task. Group differences in whole-brain functional connectivity were analyzed using the network-based statistic approach, which identifies connected subnetworks showing significant differences between groups while controlling for multiple comparisons. Multivariate linear regression models were used to examine associations between functional connectivity and inhibitory control, adjusting for comorbid attention-deficit/hyperactivity disorder. Results: Compared to the Tourette syndrome only group, the Tourette syndrome + attention-deficit/hyperactivity disorder group showed decreased functional connectivity involving the default mode, somatomotor, and limbic networks. In both groups, inhibitory control was positively correlated with functional connectivity, predominantly involving the default mode, frontoparietal, somatomotor, and attention networks. The groups did not differ significantly in functional connectivity related to inhibitory control. Conclusions: Although differences in functional connectivity were observed between the Tourette syndrome and Tourette syndrome + attention-deficit/hyperactivity disorder groups, both had similar functional connectivity associated with inhibitory control. These findings highlight the neural impact of attention-deficit/hyperactivity disorder in Tourette syndrome and provide insights for future clinical interventions.

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Objective: To investigate the effects of the flourishing intervention (FI) vs. usual care (UC) on craving symptoms, mental health, and quality of life among hospitalized crack/cocaine users. Methods: A quasi-experimental mixed-methods study was conducted in a Brazilian psychiatric hospital. Participants were inpatients (n=119) undergoing detoxification and met ICD-10 criteria for crack/cocaine use disorders. The FI included 12 meetings (10 group sessions) on virtues and human values. Outcomes included crack/cocaine craving (primary), personal flourishing, depression, anxiety, impulsivity, quality of life, readiness to change, religiosity, and spirituality. Qualitative data were collected via semi-structured interviews. Results: Post-treatment, the FI group (n=79) had slightly lower scores on the Cocaine Craving Questionnaire-Brief (CCQ) measure (d = -0.21) compared to the UC group (n=40); the difference between the two groups on a Visual Analog Scale (VAS) of crack/cocaine craving (d = -0.03) was negligible. Within-group analyses for the FI group supported post-intervention improvements in craving (CCQ: d = -0.51; VAS: d = -0.61) and several secondary outcomes. Qualitative findings (n=30) highlighted the value of group therapy, motivation to quit drugs and to reach personal goals, positive emotions, and strengthening protective factors. Conclusion: This study provided preliminary evidence suggesting that the FI may be beneficial in reducing craving symptoms and promoting personal flourishing.

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Objective: To evaluate the item performance of the Center for Epidemiologic Studies Depression Scale. Methods: The participants were adults aged ≥ 50 years from the English Longitudinal Study of Ageing. Using classical test theory and item response theory, data from 11,612 participants were analyzed to estimate reliability, item discrimination (a), and item difficulty (b). Differential item functioning analyses were used to determine whether men and women responded differently to items despite similar depressive symptom levels. Results: The Center for Epidemiologic Studies Depression Scale demonstrated adequate internal consistency (α = 0.80; ω = 0.85), with marginal reliability (0.65). Around 60% of the participants reported at least one depressive symptom. All items showed moderate to high levels of discrimination (a > 0.66), with “slept restlessly” being the most frequently reported (b = 0.43), and “felt lonely” being the least (b = 1.59). Four items – “slept restlessly,” “felt lonely,” “felt sad,” and “could not get going” – had significant differential item functioning, with women more likely to report these items than men at equivalent symptom levels. Conclusion: The Center for Epidemiologic Studies Depression Scale items showed acceptable reliability and effectively captured varying depression severity. Despite some differential item functioning, no substantial gender-related measurement bias was found, supporting the scale’s use for screening in older adult populations.

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Objective: To evaluate the association between domain-based physical activity and C-reactive protein levels in people with moderate to severe depressive symptoms. Methods: We included data from the National Health and Nutrition Examination Survey, collected between 2017 and 2020. A total of 567 adults aged ≥ 18 years (347 women, mean age: 46.3 years) classified with moderate to severe depressive symptoms according to the Patient Health Questionnaire were included. The Physical Activity Questionnaire was used to assess total and domain-based physical activity levels. A negative binomial regression model was used for data analysis, adjusting for relevant confounders. Results: Leisure-time physical activity was associated with lower C-reactive protein levels (incidence rate ratio = 0.77; 95%CI 0.66-0.90; p < 0.001). Transportation-related and occupational physical activity were not associated with C-reactive protein levels. Conclusions: Leisure-time physical activity was associated with lower C-reactive protein levels in people with depressive symptoms, which suggests that promoting leisure-time physical activity could be an important strategy for reducing inflammation in individuals with depressive symptoms.

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Objective: Suicide is a major global health concern and one of the leading causes of preventable death. Currently, there is a lack of objective data to assess suicide risk in individuals with depression. This study explores the potential of voice analysis as an objective tool for suicide risk assessment and improved diagnostic accuracy. Methods: Ninety participants divided into three groups (Near-Term Suicidal, Depressed, and Control) provided audio recordings of standardized text readings. Mel-frequency cepstral coefficients, deep learning features (VGGish), formants, and prosodic features were extracted and analyzed using a machine learning model. Results: Among the analyzed voice features, Mel-frequency cepstral coefficients were more successful for the “high suicide risk or not” and “depression or high suicide risk” tasks, with an accuracy of 90.0% and 68.3%, respectively. For the “depression or not” task, VGGish representation achieved an accuracy of 73.3%. Conclusions: To our knowledge, this is the first study to employ VGGish features in the suicidality assessment. The findings demonstrate significant differences in vocal parameters across varying suicide risk levels, supporting the potential of voice analysis as a biomarker for suicide risk in depression. Given its non-invasive nature and real-time integration capability, voice analysis offers a promising approach for clinical applications.

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Objective: Despite growing research on the potential mental health benefits of psychedelics, there has been limited study of these drugs in populations with obsessive-compulsive disorder (OCD) and with Hispanic and Latin American (H/L) ancestry. Methods: Demographic and clinical assessments were conducted as part of the Latin American Trans-Ancestry INitiative for OCD genomics (LATINO) Study in H/L participants with OCD living throughout the Americas. Self-reported data on the prevalence of naturalistic psychedelic use and associated outcomes on OCD symptoms were collected in a subsample of 2,639 adults. Descriptive statistics and regression analyses were used to assess psychedelic use, predictors of use, and predictors of OCD symptom change attributed to psychedelics. Results: Across 11 countries, 9% of respondents reported using psychedelics or related substances for treatment. Most respondents (72%) had received conventional treatments for OCD (e.g., psychiatric medication and/or psychotherapy). Psilocybin, lysergic acid diethylamide (LSD), and 3,4-methylenedioxymethamphetamine (MDMA) were the most used psychedelics. Psychedelic users compared to non-users were more likely to be male, have received non-exposure and response prevention (ERP) therapy for OCD, and have a comorbid psychiatric diagnosis. Outcomes of psychedelic use for OCD-related symptoms varied widely by drug and were difficult to predict, but were reported as most favorable for “classic” serotonergic psychedelics. Conclusion: Real-world evidence suggests that H/L adults are exploring psychedelics as a treatment for OCD, though further work is needed to establish the conditions for safe and effective use in this population. Increased research and practical harm reduction in this area is critical as public interest in psychedelic drugs continues to surge.

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Objective: This study examines discharge location as a predictor for prolonged length of stay (LOS) in an inpatient psychiatric hospital. Methods: Retrospective study of 2,717 adult patients in an inpatient psychiatric hospital in New York. The outcome variable of LOS was < 25 days vs. ≥ 25 days. Multivariate logistic regression analysis was used. We adjusted for demographics, psychiatric diagnosis, medical history, and psychiatric history. Results: Discharge to supportive housing (OR: 2.34, 95%CI 1.89-2.89, p < 0.001), a long-term psychiatric facility (OR: 44.48, 95%CI 17.70-111.78, p < 0.001), nursing home/assisted living facility (OR: 10.38, 95%CI 4.49-24.01, p < 0.001), and substance abuse rehabilitation center (OR: 2.16, 95%CI 1.31-3.58, p = 0.003) were each significantly associated with increased odds for LOS ≥ 25 days. Discharge to a jail/correctional facility (OR: 0.43, 95%CI 0.19-0.93, p = 0.032) was significantly associated with decreased odds for LOS ≥ 25 days. No significant associations were found for medical/surgical floors and short-term psychiatric facilities. These significant findings for discharge locations persisted even adjusting for often-studied variables. Conclusion: As discharge location is associated with LOS, we recommend that mental health care providers begin safe discharge planning from the day of admission and involve a multidisciplinary team with the goal of stabilizing the patient as soon as possible.

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Objective: To estimate the potential impact of physical activity (PA) on the forecast prevalence and economic cost of dementia among Brazilian adults. Methods: We analyzed data from the 2019 Brazilian National Health Survey to estimate PA levels. Dementia-related costs in 2019 were combined with prevalence data from the Global Burden of Disease Study. We estimated dementia cases and costs that could be averted if physical inactivity (< 150 min/week of moderate-to-vigorous PA) were eliminated. A counterfactual scenario assessed the effect of small increases in moderate (MPA) or vigorous (VPA) activity per week in adults who currently engage in zero min/week of PA. Results: In 2019, 14.9% of dementia cases in Brazil were attributable to physical inactivity, corresponding to 569,548 preventable cases by 2050. This would translate into an avoidable economic burden of R$ 23.1 billion (US$ 9.3 billion), of which R$ 20.2 billion are direct healthcare costs. In adults with zero minutes of PA, increasing MPA or VPA by 10 min/day could prevent 219,412 and 420,180 cases of dementia and save R$ 8.5 and R$ 16.2 billion by 2050, respectively. Conclusion: In Brazil, one in seven dementia cases is linked to physical inactivity. Modest increases in PA could yield major health and economic benefits.

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Objectives: To characterize response trajectories in patients with major depressive disorder (MDD) and identify clinical and demographic predictors of symptom alleviation. Methods: This study was a secondary analysis of longitudinal data collected from 10 governances of China from November 9, 2016, to December 30, 2020. Depressive symptoms were mainly measured using the 17-item Hamilton Depression Rating Scale (HAMD-17). Group-based trajectory modeling was used to identify symptom trajectories from baseline to week 24. Results: A total of 1,438 participants were included. Two trajectories were identified: 74.27% of participants belonged to trajectory 1, labeled as the “rapid symptom reduction trajectory,” characterized by moderate depression followed by rapid symptom reduction after treatment; and 25.73% of participants belonged to trajectory 2, labeled as the “delayed symptom reduction trajectory,” characterized by severe depression and a gradual decline in symptoms over 24 weeks. Compared with those in the rapid symptom reduction trajectory, values (including the HAMD-17 total score at baseline, the proportion of female participants, and the duration of untreated episodes) were significantly higher in the delayed symptom reduction trajectory. Conclusions: Distinct response trajectories were identified in patients with MDD. Milder baseline severity, shorter untreated episodes, and male sex predicted rapid responses, aiding in treatment guidance. Chinese Clinical Trial Registry: Chinese Clinical Trial Registry (https://www.chictr.org.cn/): 05/09/2017 ChiCTR-INR-17012574 and 04/09/2017 ChiCTR-OOC-17012566

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Bipolar disorder is a severe and persistent mental health disorder characterized by recurrent fluctuations in mood, energy, and behavior. The global prevalence of bipolar disorder is estimated to be between 1% and 2%, not accounting for underdiagnosis. Given the importance of this condition and its management, we aimed to review the evidence as to whether mobile apps facilitate the management of bipolar disorder. Searches in PubMed, PsycINFO, Embase, Web of Science, and Scopus databases identified 33 studies, including 19 longitudinal studies, 11 cross-sectional studies, and two mixed-methods studies. We conclude that acceptance of mobile apps among health care professionals seems to depend on their reliability and efficient integration into the workflow. Patients are showing increasing interest in mobile apps for managing bipolar disorder, although digital literacy, economic limitations, and privacy and accessibility concerns still limit long-term adherence. In related research, methodological challenges, such as small sample sizes and the need for more robust study designs, indicate gaps in validating their effectiveness. When developing these apps, software companies need stronger scientific grounding, which shows the importance of collaboration among researchers, health care professionals, and industry to ensure that tools meet clinical demands.

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Objective: To develop national, evidence-based treatment guidelines for panic disorder (PD) in Brazil through an overview of systematic reviews. Methods: We searched PubMed, SciELO, and Cochrane for systematic reviews (with or without meta-analyses) of randomized controlled trials on PD (with or without agoraphobia) from 2004 to 2024. We assessed review quality with A MeaSurement Tool to Assess Systematic Reviews, version 2 (AMSTAR 2), and graded the certainty of evidence for each outcome with the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) approach. Using the PICO framework, we extracted response, remission, and dropout rates. Results: We identified 202 records; 84 met eligibility criteria, and nine were included (AMSTAR 2: high). Response, remission, and dropout risk were classified with GRADE. Selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine reuptake inhibitors (SNRIs), tricyclic antidepressants (TCAs), monoamine oxidase inhibitors, cognitive-behavioral therapy (CBT), and behavior therapy showed the most favorable profiles for efficacy and tolerability. Combining psychotherapy with antidepressants was also effective. Benzodiazepines demonstrated short-term efficacy and tolerability but are not recommended as first-line treatment due to dependency and long-term risk concerns. Conclusion: SSRIs, SNRIs, TCAs, and CBT can be recommended as first-line interventions for PD. Concomitant therapy may offer additional benefits. Future studies should prioritize long-term outcomes and strategies to minimize bias. Systematic review registration: PROSPERO CRD420251002430

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Objective: Since its development by Stunkard & Messik in 1985, the Three-Factor Eating Questionnaire has been used to study eating behaviors, producing scientific evidence on their association with body weight regulation, eating disorders, and mental health. The present systematic review aimed to provide a narrative synthesis of the literature regarding the relationship between cognitive restraint, uncontrolled eating, emotional eating, and mental health in adults. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, five databases were searched for articles published until March 18, 2023. Eligible research investigated eating behaviors, measured by revised versions of Three-Factor Eating Questionnaire, and mental health, measured by psychometric instruments. Results: A narrative synthesis of 40 cross-sectional articles suggested that anxiety, stress, food cravings, food addiction, and body dissatisfaction are highly associated with uncontrolled and emotional eating. Depression, negative affect, emotion dysregulation, and emotion avoidance were more frequently associated with emotional eating. Mindful and intuitive eating was negatively associated with uncontrolled and, especially, emotional eating. Cognitive restraint was inversely associated with depression but positively associated with disordered eating attitudes and body dissatisfaction. Conclusion: This review supports the importance of emotion regulation skills in interventions for maladaptive eating behaviors. Systematic review registration: PROSPERO CRD42023408053

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Objective: Non-invasive brain stimulation, including repetitive transcranial magnetic stimulation (rTMS) and transcranial direct current stimulation (tDCS), shows promise for psychiatric disorders in adults, but evidence in children and adolescents remains limited. The objective of this review was to evaluate the efficacy and safety of non-invasive brain stimulation for treating psychiatric disorders in children and adolescents. Methods: An umbrella review with a pre-registered International Prospective Register of Systematic Reviews protocol (CRD42023477743) was conducted. Meta-analyses were identified using MeSH-based searches in Embase, PubMed, PsycINFO, and Cochrane up to October 30, 2023. The PICO strategy guided study selection. Study quality was assessed using A Measurement Tool to Assess Systematic Reviews, version 2, and evidence certainty was rated with GRADEpro. Results: Of 757 records screened, five meta-analyses, including 49 clinical trials and 2,105 participants, after excluding overlapped samples, met the inclusion criteria: four investigating rTMS for depression and one investigating transcranial direct current stimulation for attention-deficit hyperactivity disorder. Among the four meta-analyses on repetitive transcranial magnetic stimulation for depression, three had similar PICO criteria, and we prioritized the most recent with the largest number of trials and patients for formal evaluation. One meta-analysis (low quality) reported significant improvement in depressive symptoms at 2 (mean difference = 4.68/GRADE = low) and 4 (mean difference = 5.53/GRADE = low) weeks post-rTMS, with a positive response rate (OR = 3.99/GRADE = very low) and minimal adverse effects. Another (critically low quality) found significant symptom improvement in first-episode depression using 10 Hz stimulation on the left dorsolateral prefrontal cortex (standardized mean difference = 1.63/GRADE = low), 1 Hz stimulation on right dorsolateral prefrontal cortex (standardized mean difference = 1.22/GRADE = high), and remission rates (= 1.35/GRADE = moderate). The dropout rate was low, with no serious adverse events reported. A third (low quality) reported symptom improvement in attention-deficit hyperactivity disorder with transcranial direct current stimulation (standardized mean difference = 0.363/GRADE = very low). Conclusion: Non-invasive brain stimulation appears to be a safe and effective treatment for psychiatric disorders in children and adolescents, but further high-quality randomized controlled trials are needed for clinical validation. Systematic review registration: PROSPERO, CRD42023477743

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Objective: This systematic review and meta-analysis assessed the efficacy of anti-Toxoplasma medications on schizophrenia spectrum disorders. Given the emerging evidence linking Toxoplasma gondii infection to schizophrenia, understanding these results may provide targeted treatments for patients with schizophrenia who are infected with T. gondii. Methods: A comprehensive search of PubMed, Scopus, and Lilacs databases following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines identified studies on anti-Toxoplasma antibiotics in schizophrenia or schizoaffective disorder. The inclusion criteria were primary observational studies and randomized controlled trials, and the risk of bias was assessed using appropriate tools. Meta-analyses of the standardized mean differences were conducted to compare Positive and Negative Syndrome Scale scores from baseline to post-treatment. Statistical analyses were performed in R 4.3.1. Funnel plots and Egger’s tests were applied to assess publication bias. Results: Of 5,491 screened studies, 19 met the inclusion criteria: 13 randomized controlled trials, four secondary analyses, one cross-sectional study, and one cohort study. A meta-analysis of the randomized controlled trials revealed that antibiotics had a small effect on symptom improvement (-3.12, 95%CI -5.82 to -0.41). Minocycline yielded mixed outcomes, showing improvements in negative symptoms and cognitive function in some studies but no effect on others. Other antibiotics, like azithromycin and artemisinin, showed limited benefits regarding T. gondii immunoglobulin G-positive patients, although artemether did not. No publication bias was detected. Conclusion: Anti-Toxoplasma antibiotics may offer potential benefits as adjunctive therapy for schizophrenia. However, the studies’ heterogeneity and methodological limitations make it difficult to draw conclusions. Large-scale randomized controlled trials are needed to further clarify the role of anti-Toxoplasma antibiotics in schizophrenia treatment. Systematic review registration: PROSPERO, CRD42024522694

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Objective: To evaluate the efficacy of mindfulness-based interventions for adults with obsessive-compulsive disorder. Methods: A systematic review and meta-analysis were conducted according to Cochrane Handbook guidelines. Two independent reviewers selected randomized controlled trials (RCTs) comparing mindfulness-based interventions with active control interventions, including cognitive/behavioral techniques and psychoeducation. The outcomes were obsessive-compulsive symptoms, dropout rates, anxiety, depressive symptoms, mindfulness skills, and quality of life. Results: A total of 6 RCTs (n = 499; mean age = 32.8 years; mean disorder duration = 9.83 years) were included, with interventions lasting from 2 to 48 weeks. The certainty of evidence ranged from low to high. Mindfulness did not significantly differ from cognitive-behavioral techniques (CBT) regarding reduced obsessive-compulsive symptoms (standardized mean difference [SMD] = -0.08; 95%CI -0.35-0.18), dropout rates (risk ratio = 1.00; 95%CI 0.69-1.43), anxiety (SMD = -0.28; 95%CI -0.57-0.00), or depression (SMD = -0.07; 95%CI -0.26-0.11). A small but clinically non-relevant improvement in mindfulness skills was observed (SMD = 0.24; 95%CI 0.01 to 0.48), although quality of life findings were inconsistent and could not be pooled for analysis. Conclusion: Mindfulness-based interventions did not differ significantly from CBT, which included well-established obsessive-compulsive disorder treatments such as exposure with response prevention, psychoeducation, and cognitive restructuring. Registration number: PROSPERO CRD42020200874.

Resumo em Inglês:

Objective: Given the interest in the potential effects of cannabis on medical students, this study aimed to establish the prevalence of recreational use in this population. Methods: We searched MEDLINE, LILACS, PubMed, Embase, PsycINFO/PsycArticles/APA Books, and SciELO for observational studies published before June 9, 2025 on the reported prevalence of cannabis use among medical students. We conducted subgroup analyses based on sex, study cycle, school type, decade of publication, and world region. Data were pooled using a random-effects model. Results: Our search identified 109 studies meeting the inclusion criteria, published between 1971 and 2025, encompassing data from 62,444 participants in 32 countries. The lifetime prevalence was 29.2%, 20.5% in the past year, 9.2% in the past month, and 5.1% in the past week. The global prevalence decreased from 38.4% in the 1970s (95%CI 19.2-57.7) to 18.1% in the 2000s (95%CI 13.6-23.8) and increased again to 30.4% in the 2020s (95%CI 19.2-41.6), driven by trends in Latin America, Asia, and Africa. The lowest prevalence was in Asia (11.5%, 95%CI 07.1-15.8) and the highest was in the U.S. and Canada (59.7%, 95%CI 53.1-66.3). Conclusion: Cannabis use is prevalent among medical students, with an increasing trend and regional variations. Targeted interventions are needed to raise awareness of the associated risks. Systematic review registration: PROSPERO, CRD42021272280

Resumo em Inglês:

Objective: This study aimed to determine the temperament and personality profile of children and adolescents with attention-deficit/hyperactivity disorder (ADHD) through a systematic review and meta-analyses of published data. Methods: We searched PubMed, PsycINFO, and Web of Science in October 2021 (the PubMed search was updated in September 2024) to identify case-control studies of children and adolescents (≤ 18 years of age) with and without ADHD that reported on temperament or personality. The association between temperament or personality domains and ADHD status was measured with standardized mean differences (SMD). Data across studies were pooled with inverse variance random-effects meta-analyses. Risk of bias was assessed with the Newcastle-Ottawa Scale. Results: A total of 31 studies including 2,525 children and adolescents with ADHD and 3,039 controls were included. The meta-analyses demonstrated that children and adolescents with ADHD had higher negative affectivity (SMD = 0.79, 95%CI 0.56 to 1.03) and lower effortful control (Rothbart’s construct) (SMD = -1.43, 95%CI -2.14 to -0.72), higher emotionality (SMD = 1.01, 95%CI 0.64 to 1.38) and higher activity (Buss & Plomin’s construct)(SMD = 0.96, 95%CI 0.74 to 1.17), lower distractibility (SMD = -0.74, 95%CI -1.22 to -0.26) and lower adaptability (Thomas & Chess’s construct)(SMD = -1.01, 95%CI -1.93 to -0.10), higher novelty seeking (SMD = 1.19, 95%CI 0.87 to 1.51) and lower persistence (Cloninger’s construct)(SMD = -1.07, 95%CI -1.33 to -0.81), and higher neuroticism (SMD = 0.92, 95%CI 0.37 to 1.48), higher extraversion (SMD = 0.27, 95%CI -0.13 to 0.67), and lower conscientiousness (five-factor model)(SMD = -0.95, 95%CI -1.85 to -0.04). As limitations, few studies reported all temperament or personality subscales, raising concerns about selective reporting and bias, while the heterogeneity of instruments and case/control definitions further challenged data pooling and interpretation. Consequently, the meta-analyses yielded limited evidence. Conclusion: Children and adolescents with ADHD have greater negative affectivity/emotionality and lower effortful control/persistence/conscientiousness. However, these findings were based on relatively few studies, and there was considerable between-study variability. Future research should investigate whether temperament or personality have clinical implications for those with ADHD.

Resumo em Inglês:

Objectives: The effects of transcranial direct current stimulation over the prefrontal cortex on reactive aggressive behavior are unclear. We conducted an updated systematic review and meta-analysis of randomized controlled trials comparing the effects of anodal transcranial direct current stimulation vs. sham stimulation on reactive aggressive behavior in healthy volunteers experimentally induced to aggressive behavior. Methods: We systematically searched the PubMed, Cochrane, Embase, and PsycInfo databases for randomized controlled trials comparing transcranial direct current stimulation to sham stimulation over the prefrontal cortex on reactive aggressive behavior. We computed the standardized mean difference (SMD) with 95%CIs for all statistical models. Heterogeneity was assessed using I 2 statistics. The statistical analyses were performed in R 4.5.1. Results: We included nine trials with 547 participants, of whom 272 (49.7%) underwent anodal transcranial direct current stimulation. There was no significant difference between anodal transcranial direct current stimulation and sham stimulation regarding reactive aggressive behavior (SMD -0.24; 95%CI [-0.54 to 0.05]; p = 0.09; I 2 = 52.4%). However, subgroup analysis showed that the effects of online (SMD -0.41; 95%CI [-0.61 to -0.20]; I 2 = 0%), and unilateral (SMD -0.44; 95%CI [-63 to -0.25]; I 2 = 0%) transcranial direct current stimulation differed significantly from sham stimulation. Conclusions: While anodal transcranial direct current stimulation had no significant effect on reactive aggressive behavior in healthy volunteers in the overall analysis, the results suggest that online and unilateral tDCS may have an impact. Given the heterogeneity of the studies and outcome measures, further research is needed to confirm these findings and better understand the role of transcranial direct current stimulation in modulating reactive aggressive behavior. Registration number: PROSPERO CRD420251002415.