Advertisement

Attenuated Psychosis Syndromes Among Brazilian Youth and Young Adults: Early Identification and Intervention

  • Graccielle R. Cunha
  • Elson M. Asevedo
  • Elisa Brietzke
  • Rodrigo A. Bressan
  • Ary Gadelha
Chapter

Abstract

Although research in early stages of mental disorders has been consistently increasing in Brazil, most findings are related to neurobiological processes associated with ultrahigh risk symptoms. Alterations in sleep patterns and peripheral blood biomarkers have been the main focus of original papers. There is currently no cohesive strategy for addressing this issue in the public health system, and the only existing service is linked to a university, PRISMA (Program of Recognition and Intervention in At-Risk Mental States subjects), a center providing specialized assessment and care for help-seeking individuals presenting with an attenuated psychosis syndromes (APS). The center is located in a central region of São Paulo functioning inside the Schizophrenia Program from the Federal University of São Paulo (UNIFESP).

Brazil has a very heterogenic and diverse population. In this context, instead of facing particular culturally relevant assessment and intervention approaches, the primary challenge is the multifaceted clinical presentation and inconsistent resources available for treatment. Furthermore, the nature of recent reforming of the Brazilian psychiatric system, a general lack of available services, limited access to specialized literature in the public health system, and inadequate mental health literacy among the general population may represent barriers to referrals. Several strategies have been implemented to improve referrals, like contact between PRISMA and primary healthcare services, training programs for teachers, lectures and partnerships with psychology clinics from other universities, and training programs for psychiatric residents during their formal academic education. Collaboration with other programs around the world has been critical to strengthening research and clinical knowledge.

Keywords

Psychosis At-risk mental states Ultra high risk Adolescents Attenuated psychosis syndromes 

References

  1. Andrés-Hyman, R. C., Ortiz, J., Añez, L. M., Paris, M., & Davidson, L. (2006). Culture and clinical practice: Recommendations for working with Puerto Ricans and other Latinas (os) in the United States. Professional Psychology Research and Practice, 37(6), 694.CrossRefGoogle Scholar
  2. Asevedo, E., Cunha, G. R., Zugman, A., Mansur, R. B., & Brietzke, E. (2012). N-acetylcysteine as a potentially useful medication to prevent conversion to schizophrenia in at-risk individuals. Review of Neuroscience, 23(4), 353–362.  https://doi.org/10.1515/revneuro-2012-0039CrossRefGoogle Scholar
  3. Brietzke, E., Neto, A., Gadelha, A., Dias, Á., Mansur, R. B., & Bressan, R. A. (2011). Early intervention in psychosis: A map of clinical and research initiatives in Latin America. Revista Brasileira de Psiquiatria, 33, s213–s224.PubMedCrossRefGoogle Scholar
  4. de Araújo, T. C. B. C., Moreira, V., & Cavalcante Júnior, F. S. (2008). Sofrimento de Sávio: Estigma de ser doente mental em Fortaleza. Fractal: Revista de Psicologia, 20(1), 119–128.Google Scholar
  5. Del-Ben, C. M., Vilela, J. A. A., de S Crippa, J. A., Hallak, J. E. C., Labate, C. M., & Zuardi, A. W. (2001). Confiabilidade de “Entrevista Clínica Estruturada para o DSM-IV – Versão Clínica” traduzida para o português. Revista Brasileira de Psiquiatria, 23, 156–159.CrossRefGoogle Scholar
  6. Gonçalves, P. D., Martins, P. A., Gordon, P., & Louzã, M. (2012). Prodromal questionnaire: Translation, adaptation to Portuguese and preliminary results in ultra-high risk individuals and first episode psychosis. Jornal Brasileiro de Psiquiatria, 61(2), 96–101.CrossRefGoogle Scholar
  7. Higuchi, C., Bressan, R. A., Gadelha, A., & Brietzke, E. (2016). Peripheral immuno-inflammatory abnormalities in ultra-high risk of developing psychosis. Schizophrenia Research, 176, 191–195.PubMedCrossRefGoogle Scholar
  8. Jorge, M. S. B., & Bezerra, M. (2004). Inclusão e exclusão social do doente mental no trabalho: Representações sociais. Texto Contexto Enferm, 13(4), 551–558.CrossRefGoogle Scholar
  9. Klosterkötter, J., Schultze-Lutter, F., Wieneke, A., Picker, H., & Steinmeyer, E. (2001). Introduction and Reliability of the first version of the Schizophrenia Prediction Instrument (SPI-A). Paper presented at the Schizophrenia research.Google Scholar
  10. Loch, A. A., Hengartner, M. P., Guarniero, F. B., Lawson, F. L., Wang, Y.-P., Gattaz, W. F., & Rössler, W. (2011). Psychiatrists’ stigma towards individuals with schizophrenia. Archives of Clinical Psychiatry (São Paulo), 38(5), 173–177.CrossRefGoogle Scholar
  11. Mansur, R. B., Zugman, A., Asevedo, E. M., da Cunha, G. R., Bressan, R. A., & Brietzke, E. (2012). Cytokines in schizophrenia: Possible role of anti-inflammatory medications in clinical and preclinical stages. Psychiatry and Clinical Neurosciences, 66(4), 247–260.  https://doi.org/10.1111/j.1440-1819.2012.02354.xPubMedCrossRefGoogle Scholar
  12. Martin, D., Andreoli, S. B., Pinto, R. M. F., & Barreira, T. M. H. D. M. (2011). Living conditions of people with psychotic disorders living in slums in Santos, Southeastern Brazil. Revista de Saúde Pública, 45(4), 693–699.PubMedCrossRefGoogle Scholar
  13. Mascayano, F., Tapia, T., Schilling, S., Alvarado, R., Tapia, E., Lips, W., & Yang, L. H. (2016). Stigma toward mental illness in Latin America and the Caribbean: A systematic review. Revista Brasileira de Psiquiatria, 38(1), 73–85.PubMedCrossRefGoogle Scholar
  14. Mateus, M. D., Mari, J. J., Delgado, P. G., Almeida-Filho, N., Barrett, T., Gerolin, J., … Weber, R. (2008). The mental health system in Brazil: Policies and future challenges. International Journal of Mental Health Systems, 2(1), 1.CrossRefGoogle Scholar
  15. Moreno, R., & Moreno, D. (1998). Escalas de avaliação clínica em psiquiatria e psicofarmacologia: Escalas de avaliação para depressão de Hamilton (HAM-D) e Montgomery-Asberg (MADRS). Revista de Psiquiatria Clínica (São Paulo), 25(5), 1–17.Google Scholar
  16. Morosini, P., Magliano, L., Brambilla, L., Ugolini, S., & Pioli, R. (2000). Development, reliability and acceptability of a new version of the DSM-IV Social and Occupational Functioning Assessment Scale (SOFAS) to assess routine social functioning. Acta Psychiatrica Scandinavica, 101(4), 323–329.PubMedGoogle Scholar
  17. Paula, C. S., Lauridsen-Ribeiro, E., Wissow, L., Bordin, I. A., & Evans-Lacko, S. (2012). How to improve the mental health care of children and adolescents in Brazil: Actions needed in the public sector. Revista Brasileira de Psiquiatria, 34(3), 334–351.PubMedCrossRefGoogle Scholar
  18. Peluso, É. T. P., & Blay, S. L. (2011). Public stigma and schizophrenia in Sao Paulo city. Revista Brasileira de Psiquiatria, 33(2), 130–136.PubMedCrossRefGoogle Scholar
  19. Ronzani, T. M., Higgins-Biddle, J., & Furtado, E. F. (2009). Stigmatization of alcohol and other drug users by primary care providers in Southeast Brazil. Social Science & Medicine, 69(7), 1080–1084.CrossRefGoogle Scholar
  20. Santoro, M. L., Gadelha, A., Ota, V. K., Cunha, G. R., Asevedo, E., Noto, C. S., … Belangero, S. I. (2015). Gene expression analysis in blood of ultra-high risk subjects compared to first-episode of psychosis patients and controls. World Journal of Biological Psychiatry, 1–6.  https://doi.org/10.3109/15622975.2015.1048724PubMedCrossRefGoogle Scholar
  21. Tanaka, O. Y., & Lauridsen-Ribeiro, E. (2006). A challenge for primary health care: Mental health care implementation. Cadernos de Saúde Pública, 22(9), 1845–1853.PubMedCrossRefGoogle Scholar
  22. Vieira, M. A., Gadelha, A. A., Moriyama, T. S., Bressan, R. A., & Bordin, I. A. (2014). Evaluating the effectiveness of a training program that builds teachers’ capability to identify and appropriately refer middle and high school students with mental health problems in Brazil: An exploratory study. BMC Public Health, 14(1), 1.CrossRefGoogle Scholar
  23. Wagner, L. C., Torres-González, F., Geidel, A. R., & King, M. B. (2011). Existential questions in schizophrenia: Perception of patients and caregivers. Revista de Saúde Pública, 45(2), 401–408.PubMedCrossRefGoogle Scholar
  24. Yung, A. R., Yung, A. R., Pan Yuen, H., Mcgorry, P. D., Phillips, L. J., Kelly, D., … Killackey, E. (2005). Mapping the onset of psychosis: The comprehensive assessment of at-risk mental states. Australian and New Zealand Journal of Psychiatry, 39(11–12), 964–971.PubMedPubMedCentralCrossRefGoogle Scholar
  25. Zanini, M., Castro, J., Coelho, F. M., Bittencourt, L., Bressan, R. A., Tufik, S., & Brietzke, E. (2013). Do sleep abnormalities and misaligned sleep/circadian rhythm patterns represent early clinical characteristics for developing psychosis in high risk populations? Neuroscience and Biobehavioral Reviews, 37(10), 2631–2637.PubMedCrossRefGoogle Scholar
  26. Zanini, M. A., Castro, J., Cunha, G. R., Asevedo, E., Pan, P. M., Bittencourt, L., … Brietzke, E. (2015). Abnormalities in sleep patterns in individuals at risk for psychosis and bipolar disorder. Schizophrenia Research, 169(1–3), 262–267.  https://doi.org/10.1016/j.schres.2015.08.023PubMedCrossRefGoogle Scholar
  27. Zugman, A., Pan, P. M., Gadelha, A., Mansur, R. B., Asevedo, E., Cunha, G. R., … Bressan, R. A. (2013). Brain tumor in a patient with attenuated psychosis syndrome. Schizophrenia Research, 144(1–3), 151–152.  https://doi.org/10.1016/j.schres.2012.11.036PubMedCrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Graccielle R. Cunha
    • 1
  • Elson M. Asevedo
    • 1
  • Elisa Brietzke
    • 1
  • Rodrigo A. Bressan
    • 1
  • Ary Gadelha
    • 1
  1. 1.Universidade Federal de São PauloSão PauloBrazil

Personalised recommendations