Papers by Luísa Weber Bisol
Translational psychiatry, Apr 5, 2024
Dear Editor, I appreciate the insightful work presented in the article "Predicting suicide risk i... more Dear Editor, I appreciate the insightful work presented in the article "Predicting suicide risk in 137,112 people with severe mental illness in Finland: external validation of the Oxford Mental Illness and Suicide tool (OxMIS)" by Sariaslan et al. [1]. However, certain methodological considerations warrant attention. Firstly, the exclusive focus on individuals diagnosed with schizophrenia-spectrum disorder (SCZS) and bipolar disorder (BD) raises questions about the omission of borderline personality disorder (BPD) and major depressive disorder (MDD), both known for elevated suicide risk (45.1% and 19.7%; in contrast with 12.9% of suicide risk to SCZS). A meta-review [2] in which one of the authors was Fazel, highlighted higher suicide risks in these conditions (BPD and MDD), prompting inquiry into their exclusion. Secondly, the observed threefold higher prevalence of SCZS compared to BD in Finnish sample contradicts epidemiological data that estimate prevalence of SCZS is around 0.32% [3] and BD is 2.4% [4]. An explanation for this discrepancy is crucial for the study's validity and generalizability. Thirdly, the exclusion of mood stabilizers from analysis, despite their fundamental role in the treatment of patients with BD, raises concerns. In that paper, the variable "mood stabilizer" was used in the topic "recent medication". It is difficult to understand why mood stabilizers were withdrawn in the analysis by Sariaslan et al. [1] since 26% of the sample had BD and it is well-recognized that the first-line treatment of BD is a mood stabilizer [5]. Given the documented antisuicidal properties of lithium, its omission necessitates clarification [6]. Fourthly, the disparity in the number of episodes/patients/year between the Swedish [7] and Finnish [1] populations demands explanation. In Sweden, the number of episodes was 574,018 in 75,158 between 2001 and 2008, the number of episodes/patients/ years is 0.95. In Finland, the number of episodes was 5,261,732 in 137,112 between 1996 and 2017, the number of episodes/ patients/years is 1.74. The 83% increase in the Finnish population suggests potential influencing factors, warranting exploration, such as the role of mood stabilizers. Lastly, the amalgamation of inpatient and outpatient episodes overlooks the nuanced outcomes associated with each. A more detailed analysis, distinguishing between inpatient and outpatient episodes, would enhance the study's precision and clinical relevance [8]. In conclusion, while acknowledging the valuable insights provided, addressing these concerns is essential for ensuring the robustness and applicability of the findings. Clarifications and adjustments in subsequent analyses would strengthen the impact of this research on understanding and predicting suicide risk in individuals with severe mental disorders.
Zenodo (CERN European Organization for Nuclear Research), Oct 30, 2020
Introduction: Bipolar disorder (BD) in young people is frequently associated with suicidal behavi... more Introduction: Bipolar disorder (BD) in young people is frequently associated with suicidal behavior. The main objective of this research is to evaluate if university students who have BD show more suicidal behavior than those who do not have BD. Materials and Methods: 583 university students from Fortaleza, Brazil, participated in this study. Volunteers over 18 years of age who were attending public or private universities from March to December 2019 were able to participate. A sociodemographic and clinical questionnaire and the Mood Disorder Questionnaire (MDQ) were filled out. According to MDQ, participants were classified into three groups: 1) individuals without BD (n=318); 2) individuals with subthreshold BD symptoms (n=160); 3) individuals with BD (n=105). Results: Compared to those who do not have BD, individuals with BD had four times less plans for the future (x 2 =16.00; p=0.000), considered four times life less worth living (x 2 =13.44; p=0.001), assumed two times more frequently death as welcome if it comes (x 2 =19.10; p=0.000), thought two times more about getting hurt (x 2 =75.32; p=0.000), had seven times more specific plans to die (x 2 =39.93; p=0.000) and had four times more suicide attempts (x 2 =33.50; p=0.000). Conclusions: Suicidal behavior was four times more prominent in university students with BD than in those who did not have BD.
Research, Society and Development, Mar 24, 2022
Low temperature, high relative humidity and higher precipitation are associated with a higher num... more Low temperature, high relative humidity and higher precipitation are associated with a higher number of deaths from COVID-19 Baixa temperatura, alta umidade relativa e maior precipitação estão associadas a um maior número de mortes por COVID-19 Las bajas temperaturas, la alta humedad relativa y las mayores precipitaciones se asocian a un mayor número de muertes por COVID-19
Research, Society and Development
Background: Meteorological variables play a major role in the transmission of infectious diseases... more Background: Meteorological variables play a major role in the transmission of infectious diseases such as coronavirus disease 2019 (COVID-19). Objective: To analyze the correlation between climatic variables and COVID-19 deaths/cases. Methods: An exploratory-descriptive study based on secondary data on deaths, cases of COVID-19 and climatic variables from March 2020-May 2021 in Fortaleza, Brazil. Data from the COVID-19 surveillance system of the Ministry of Health were used. The climatic indicators were extracted from the National Institute of Meteorology. The variables under study were temperature (minimum, mean and maximum in °C), relative air humidity (%), total precipitation (mm) and total daily insolation (h). Pearson's correlation and the linear regression model were used for statistical analysis. Correlations were considered significant when P ≤ 0.05 and a 95% confidence interval was adopted. Results: All meteorologic variables were correlated with deaths from COVID-19, ...
Scientia Medica, 2017
AIMS: To estimate the prevalence of bipolar disorder in a sample of older adults and to examine a... more AIMS: To estimate the prevalence of bipolar disorder in a sample of older adults and to examine associated socio-demographic and clinical factors. METHODS: Cross-sectional population-based study of individuals aged 60 years or older registered with the Family Health Strategy in Porto Alegre, Rio Grande do Sul, Brazil, selected randomly from 30 different basic health units. Participants were subjected to diagnostic assessment for bipolar disorder and suicide risk using the Mini International Neuropsychiatric Interview Plus 5.0.0. Categorical variables were described as absolute and relative frequencies. Quantitative variables were expressed as means and standard deviations. The Pearson chi-square or Fisher's exact tests were used as appropriate to evaluate potential associations between the independent variables suicide attempt and risk of suicide. To control for possible confounders and assess variables independently associated with the outcome of interest, the strength association among different risk factors was assessed by means of prevalence ratios, which were estimated with a controlled Poisson model or multivariate Poisson regression. The significance level was set at 5% (p≤0.05). RESULTS: The sample comprised 550 older adults. The lifetime prevalence of bipolar disorder in the sample was 5.8% and the point prevalence was 1.5%. In those with bipolar disorder, 59.4% were type I and 40.6% type II. Significant associations were observed between bipolar disorder regardless of type and female gender (prevalence rate [PR] 2.42, 95% confidence interval [CI] 1.01-5.81), living with a partner (PR 2.52, 95%CI 1.21-5.24), history of suicide attempt (PR 3.16, 95%CI 1.53-6.25), and suicide risk (PR 2.98, 95%CI 1.47-6.06). When analyzed each type of bipolar disorder, statistically significant associations were found between age under 70 years and type I bipolar disorder; having companion and type II bipolar disorder; and risk of suicide was associated with both types of bipolar disorder. CONCLUSIONS: Regardless of the type of bipolar disorder, women and those living with a partner were more affected. History of suicide attempts and suicide risk were more frequent in elderly subjects with bipolar disorder than in those without the disorder.
2Medico Residente do Servico de Psiquiatria do HSL-PUCRS. Pesquisador do GPESM, IGG, PUCRS. 3 Med... more 2Medico Residente do Servico de Psiquiatria do HSL-PUCRS. Pesquisador do GPESM, IGG, PUCRS. 3 Medico Psiquiatra do Servico de Psiquiatria do HSL-PUCRS. Pesquisador do GPESM, IGG, PUCRS. Preceptor de Residencia Medica em Psiquiatria do HSL-PUCRS. Preceptor do Ambulatorio de Neuropsiquiatria do Envelhecimento (AMPEG), IGG, PUCRS. 4 Medico-Psiquiatra. Preceptor de Residencia Medica em Psiquiatria e do Ambulatorio de Neuropsiquiatria Geriatrica do HSL-PUCRS. Pesquisador do GPESM, IGG, PUCRS. 5 Medica Psiquiatra. Doutora em Ciencias Biologicas/Bioquimica pela Universidade Federal do Rio Grande do Sul. Preceptora da Residencia Medica em Psiquiatria do HSL-PUCRS. 6 Medico Psiquiatra do Servico de Psiquiatria do HSL-PUCRS. Preceptor de Residencia Medica em Psiquiatria do HSL-PUCRS. 7 Professor do Departamento de Psiquiatria e Medicina Legal da Faculdade de Medicina da PUCRS. Mestre em Clinica Medica pela PUCRS. Psicanalista pela Sociedade Psicanalitica de Porto Alegre e pela International P...
Journal of Psychopharmacology, 2021
The paper by Lucchese et al. (2021), published in Journal of Psychopharmacology, January 9th 2021... more The paper by Lucchese et al. (2021), published in Journal of Psychopharmacology, January 9th 2021, provides important information about the use of subcutaneous esketamine in real-world patients. However, some points need to be clarified: First, the majority of patients received the doses of 1 mg/kg, but the paper does not make clear whether those patients were the same who presented a better response. Second, the best response was observed in patients with comorbidity anxiety disorder. The diagnostic and statistical manual of mental disorders – fourth edition (DSM-IV) was used as the diagnostic criteria to include and exclude patients, anxiety disorders in this version of the DSM included post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD), we do not comprehend why the diagnostic and statistical manual of mental disorders – fifth edition (DSM-5) was not used since it was published in 2013 and data were collected between 2017 and 2018 (American Psychiatric Association, 1994, 2013). Moreover, these patients with anxiety disorders were in use of benzodiazepines (BZD)? How many of them had PTSD or OCD? Third, Table 2 is misleading, mostly because it suppresses two of the duration parameter classes used in the Maudsley Staging Method (MSM), which are acute and subacute (Fekadu et al., 2009). For complete data analysis, all the classes should have been shown in Table 2 including the number of treatment failures. Fourth, why were chosen, out of all categories in the DSM-IV, only anxiety disorders to be reported, was because it was the only one to be statistically significant? Fifth, why most of the chosen patients have such a high body mass index (BMI) (mean = 29 and SD = 7.5)? The relation between treatment response and BMI was not made clear, as it was not shown if patients with a lower BMI responded equally to the ones with high BMI. It is important to make this clear, since there are pharmacokinetic differences in the bioavailability between patients with high rates of fat and ones with lower rates. In addition, there may be different drug effects, considering the different metabolic rates between these two groups. Lastly, six patients dropped out of the trial, but the reasons were not revealed, was it side effects, lack of efficacy?
GSC Advanced Research and Reviews, 2020
Introduction: Bipolar disorder (BD) in young people is frequently associated with suicidal behavi... more Introduction: Bipolar disorder (BD) in young people is frequently associated with suicidal behavior. The main objective of this research is to evaluate if university students who have BD show more suicidal behavior than those who do not have BD. Materials and Methods: 583 university students from Fortaleza, Brazil, participated in this study. Volunteers over 18 years of age who were attending public or private universities from March to December 2019 were able to participate. A sociodemographic and clinical questionnaire and the Mood Disorder Questionnaire (MDQ) were filled out. According to MDQ, participants were classified into three groups: 1) individuals without BD (n=318); 2) individuals with subthreshold BD symptoms (n=160); 3) individuals with BD (n=105). Results: Compared to those who do not have BD, individuals with BD had four times less plans for the future (x2=16.00; p=0.000), considered four times life less worth living (x2=13.44; p=0.001), assumed two times more freque...
Jornal Brasileiro de Psiquiatria, 2020
Objective To examine the prevalence of generalized anxiety disorder (GAD) and its associations wi... more Objective To examine the prevalence of generalized anxiety disorder (GAD) and its associations with sociodemographic and health factors. Methods A cross-sectional study with a population-based sample of 578 individuals aged 60 years or older from the Family Health Strategy (FHS) program of Porto Alegre, RS, Brazil. Home visit screening and general data collection were made by trained Community Health Workers (CHWs). Diagnoses of psychiatric disorders were made by board-certified psychiatrists using the Mini International Neuropsychiatric Interview plus (MINIplus) in the Hospital São Lucas of the Pontifical University of Rio Grande do Sul (PUCRS). Results GAD was found in 9% of the sample (n = 52; CI 95% = 6.9-11.6). The main results of the multivariate analysis show associations between GAD and retirement (PR: 0.43, CI: 0.25-0.76), history of falls (PR: 2.52, CI: 1.42-4.49), cohabitation with four or more people (PR: 1.80, CI: 1.04-3.13), having more than one hospitalization in the ...
Journal of Affective Disorders, 2015
Akiskal proposed the &amp... more Akiskal proposed the "rule of three" for behavioral indicators with high specificity for bipolarity in patients with major depression episodes. We evaluated these distinctive behaviors in controls and subjects with major depression or bipolar disorder. data was collected in the BRAINSTEP project with questions on general behaviors, style and talents. Univariate analysis was first conducted in 36,742 subjects and confirmatory multivariate analysis in further 34,505 subjects (22% with a mood disorder). Odds ratios were calculated adjusting for age. Univariate analysis showed that 29 behavioral markers differentiated bipolar subjects from those with unipolar depression. The most robust differences in those with bipolarity (ORs >4) were ≥3 religion changes, ≥3 marriages, cheating the partner regularly, having ≥60 lifetime sexual partners, pathological love, heavy cursing, speaking ≥3 foreign languages, having ≥2 apparent tattoos, circadian dysregulation and high debts. Most behaviors were expressed in a minority of patients (usually around 5-30%) and usually the "rule of three" was the best numerical marker to distinguish those with bipolarity. However, multivariate analysis confirmed 11 of these markers for differentiating bipolar disorder from unipolar depression (reversed circadian rhythm and high debts for both genders, ≥3 provoked car accidents and talent for poetry in men, and frequent book reading, ≥3 religion changes, ≥60 sexual partners, pathological love ≥2 times, heavy cursing and extravagant dressing style in women). Self-report data collection only. These behavioral markers should alert the clinician to perform a thorough investigation of bipolarity in patients presenting with a depressive episode.
International Journal of Neuropsychopharmacology, 2013
Intravenous ketamine (0.5 mg/kg) produces robust, rapid and long-lasting antidepressant effects, ... more Intravenous ketamine (0.5 mg/kg) produces robust, rapid and long-lasting antidepressant effects, but is unpractical. Sublingual administration of ketamine renders better bioavailability (∼30%) and less conversion to norketamine than oral administration. We evaluated the therapeutic effects and tolerability of very low dose sublingual (VLDS) racemic ketamine (10 mg from a 100 mg/ml solution for 5 min and swallowed), repeatedly administered every 2–3 d or weekly, in 26 out-patients with refractory unipolar or bipolar depression. According to patients' reports, VLDS ketamine produced rapid, clear and sustained effects, improving mood level and stability, cognition and sleep in 20 patients (77%), with only mild and transient light-headedness as a common side-effect (no euphoria, psychotic or dissociative symptoms). Remission remained in some patients after stopping ketamine. Thus, VLDS ketamine may have broad spectrum effects beyond its antidepressant properties, with rapid onset of...
Child Abuse & Neglect, 2015
The association between childhood trauma and personality traits has been poorly characterized and... more The association between childhood trauma and personality traits has been poorly characterized and reported. Our aim was to evaluate whether distinct types of childhood abuse and neglect are associated with various personality dimensions using data from a large webbased survey. A total of 12,225 volunteers responded anonymously to the Internet versions of the Temperament and Character Inventory-Revised (TCI-R) and the Childhood Trauma Questionnaire (CTQ) via our research website, but only 8,114 subjects (75.7% women, mean age 34.8 ± 11.3 yrs) who met the criteria for validity were included in the analysis. Childhood trauma was positively associated with harm avoidance and was negatively associated with self-directedness and, to a lesser extent, with cooperativeness. The associations were robust with emotional abuse and neglect but were non-significant or mild with physical trauma. Emotional neglect was associated with reduced reward dependence and persistence. All types of abuse, but not neglect, were associated with increased novelty seeking scores. Reporting of childhood trauma, especially of an emotional nature, was associated with maladaptive personality traits. Further investigation of the effects of different types of childhood trauma on psychological and neurobiological parameters is warranted.
Otolaryngology–Head and Neck Surgery, 2004
of defect, like the ones described with these 2 patients with nasal myiasis is quite rare.
Otolaryngology–Head and Neck Surgery, 2004
Objectives: Evaluate the prevalence of fungal rhinosinusitis(FRS) in patients with chronic rhinos... more Objectives: Evaluate the prevalence of fungal rhinosinusitis(FRS) in patients with chronic rhinosinusitis (CR) submitted to endoscopic sinus surgery, identify the main species of fungi and compare the signs and symptoms, laboratory and radiologic evidences in patients with allergic fungal rhinosinusitis (AFRS) and fungal ball (FB). Methods: Sixty-two 6.7%) patients with the diagnosis of FRS, confirmed by direct fungal exam, cultural or histological exams were selected from 865 patients with CR submitted to endoscopic sinus surgery from January 1988 to December 2002. Patients were classified according to surgical findings and histological exam as FB, saprophyt infection, invasive FRS, AFRS, or indolent FRS. Results: FB was diagnosed in 33 patients (53.2%) and AFRS in 24 (38.7%). Comparing preoperative finds, only the use of topical corticosteroids, the history of intolerance to aspirin and asthma, were different among these groups, being more frequent in AFS (P Ͻ 0.001). The presence of nasal polyps in patients with AFRS (78.2%) was also higher (P Ͻ 0.001). More patients with AFRS showed bone erosion, microcalcifications (P Ͻ 0.001), and mucosal thickness (P ϭ 0.02) on CT scan compared to fungal ball patients. The other signs and symptoms, laboratory and radiologic finds, and fungal species were similar in both groups. Conclusion: The presence of fungi as an etiologic factor of CR in patients with surgical indication is important and must be confirmed by cultural and histological examination. Symptoms like nasal obstruction, nasal secretion, postnasal drip, cough, facial pressure, sore throat, facial pain, olfatory symptoms, fatigue, or the presence of allergic rhinitis cannot differentiate AFRS from FB. Only CT scan and the presence of nasal polyposis can elevate preoperative suspection of AFRS.
Otolaryngology–Head and Neck Surgery, 2004
The tinnitus is a prevalent symptom occurring in about 10% to 20% of the population, but just 5% ... more The tinnitus is a prevalent symptom occurring in about 10% to 20% of the population, but just 5% of them attribute to tinnitus some degree of discomfort. Many hypotheses try to explain why only few patients complain about tinnitus and the majority of them habituate easily to this symptom. The depression's diagnosis associated with the tinnitus can be one of the factors involved. The objective of this work is to screen depression in patients with chronic tinnitus. Methods: We studied 70 patients with chronic tinnitus of different etiologies; 27 were men and the average age was 55.9 years. We used the Beck Inventory (BID-II) with a cut point of 17 (sensibility of 0.83 and specificity of 0.89 in a previous study with patients with chronic disease)for depression screening. Results: 35.7% of the patients had a positive screening for depression. There were no differences when evaluated sex and age. Conclusion: Previous studies that used others methods had pointed to a higher prevalence of depression in patients with tinnitus than in the general population, estimated in 5 a 15%. Our results agree with them and demonstrate the need of depression investigation in patients with tinnitus to improve their quality of life.
Journal of Psychopharmacology, 2008
Patients with hyperthymic and cyclothymic temperaments often develop symptoms that fail to meet d... more Patients with hyperthymic and cyclothymic temperaments often develop symptoms that fail to meet diagnostic criteria for bipolar disorders. These patients can be conceived as having bipolar disorder NOS (not otherwise specified), a bipolar spectrum disorder, cyclothymic disorder or cluster B personality traits. Here, we describe four of these patients with mild to moderate symptoms affecting mood, behaviour, emotional reactivity and sleep. Treatment with low-dose quetiapine (25—75 mg/day at night) lead to sustained symptom remission. Two of them were on quetiapine monotherapy. Such low doses occupy a minority of D2 and 5-HT2 receptors, which may nevertheless be of therapeutic value in mild cases. Alternatively, other mechanisms more likely to occur at low doses, such as antagonism of H1, α(1B)-adrenergic and other serotonin receptors, as well as reduction cortisol secretion, may be involved in the therapeutic efficacy of quetiapine.
Journal of Clinical Psychopharmacology, 2008
Schizophrenia itself and the use of antipsychotic medication is associated with a high level of s... more Schizophrenia itself and the use of antipsychotic medication is associated with a high level of sexual dysfunction. 1 However, the underlying responsible mechanisms remain poorly understood. We present the case of a female patient with increased libido linked to the use of the atypical antipsychotic drug aripiprazole.
The Journal of Clinical Psychiatry, 2008
Journal of Affective Disorders, 2013
Background: Several complex mechanisms including biological, psychological and social factors may... more Background: Several complex mechanisms including biological, psychological and social factors may contribute to the development of bodily symptoms. Affective temperaments may represent heritable subclinical manifestations of mood disorders, and the concept of ego defense mechanisms has also provided a model for the comprehension of psychopathology. The relationship between affective temperaments, defensive functioning and somatic symptom severity remains unknown. Methods: We obtained data from a subsample of the Brazilian Internet Study on Temperament and Psychopathology (BRAINSTEP). Participants completed the Affective and Emotional Temperament Composite Scale (AFECTS), the Defense Style Questionnaire (DSQ-40) and the Symptom Checklist-90-Revised (SCL-90-R). SCL-90-R Somatization scale was used as outcome variable. Results: Among 9937 participants (4472 male; 45%), individuals with dysphoric, cyclothymic and depressive temperaments and those who adopted displacement, somatisation and passive aggression as their predominant defense mechanisms presented high somatic symptom severity. Participants with dysphoric temperament and those with higher displacement scores were more likely to endorse numerous bodily symptoms after controlling for age, gender, education and depressive symptoms. Moderator analysis showed that the relationship of dysphoric temperament with somatic symptom severity was much more powerful in people who adopted displacement as their predominant defense. Limitations: The data was collected from a convenience web-based sample. The study was crosssectional. There was no information on the presence of established physical illness. Conclusions: Affective temperaments and defense mechanisms are associated with somatic symptom severity independently of depressive symptoms. These two personality theories provide distinct but interacting views for comprehension of somatic symptom formation.
Journal of Affective Disorders, 2010
Background: Tobacco use has been associated with externalized personality traits. Our aim was to ... more Background: Tobacco use has been associated with externalized personality traits. Our aim was to evaluate the association of smoking with emotional and affective temperaments in a large sample. Methods: In this cross-sectional web-based survey, volunteers completed the Combined Emotional and Affective Temperament Scale (CEATS), which assesses emotional (fear, drive, anger, and control) and affective temperaments (e.g. cyclothymic, irritable), and questions about smoking. Results: Among the 5379 subjects (1370 males), there were 60% non-smokers, 17% quitters and 23% current smokers. Non-smokers had higher fear and control and lower anger than quitters and smokers, and higher drive than smokers. Quitters had higher drive and control and lower anger than smokers. Smoking was lower among apathetics, depressives, euthymics and hyperthymics and higher in cyclothymics and labiles. Lower drive and higher anger were associated with heavier smoking. Less adaptive temperament was related to higher prevalence of and heavier smoking. Limitations: The data was collected from a convenience sample by the internet, and most volunteers assessed the instrument through a psychoeducational website for bipolar spectrum disorders, leading to a higher proportion of cyclothymics; the assessment of smoking habits was limited to two questions; the study was cross-sectional. Conclusions: Smoking was associated with lower fear, control and drive, higher anger and unstable externalized affective temperaments. Lower control and higher anger were associated with being a heavy smoker and current smoking. Assessment of temperament may help decision about treatments for smoking cessation.
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Papers by Luísa Weber Bisol