Browsing by Author "Noto, Cristiano"

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    Differences of affective and non-affective psychoses in early intervention services from Latin America
    (2022) Cerqueira, Raphael; Ziebold, Carolina; Cavalcante, Daniel; Oliveira, Giovany; Vásquez, Javiera; Undurraga, Juan; González, Alfonso; Nachar, Ruben; López, Carlos; Noto, Cristiano; Crossley, Nicolas; Gadelha, Ary
    Background: Psychosis presentation can be affected by genetic and environmental factors. Differentiating between affective and non-affective psychosis (A-FEP and NA-FEP, respectively) may influence treatment decisions and clinical outcomes. The objective of this paper is to examine differences between patients with A-FEP or NA-FEP in a Latin American sample. Methods: Patients from two cohorts of patients with a FEP recruited from Brazil and Chile. Subjects included were aged between 15 and 30 years, with an A-FEP or NA-FEP (schizophrenia-spectrum disorders) according to DSM-IV-TR. Sociodemographic data, duration of untreated psychosis and psychotic/mood symptoms were assessed. Generalized estimating equation models were used to assess clinical changes between baseline-follow-up according to diagnosis status. Results: A total of 265 subjects were included. Most of the subjects were male (70.9 %), mean age was 21.36 years. A-FEP and NA-FEP groups were similar in almost all sociodemographic variables, but A-FEP patients had a higher probability of being female. At baseline, the A-FEP group had more manic symptoms and a steeper reduction in manic symptoms scores during the follow- up. The NA-FEP group had more negative symptoms at baseline and a higher improvement during follow-up. All domains of The Positive and Negative Syndrome Scale improved for both groups. No difference for DUP and depression z-scores at baseline and follow-up. Limitations: The sample was recruited at tertiary hospitals, which may bias the sample towards more severe cases. Conclusions: This is the largest cohort comparing A-FEP and NA-FEP in Latin America. We found that features in FEP patients could be used to improve diagnosis and support treatment decisions.
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    Intervención Temprana en Psicosis, una perspectiva clínica
    (2021) Undurraga, Juan; Gaspar, Pablo; Nachar, Ruben; Díaz, Camila; Rivera, Guillermo; Noto, Cristiano
    Identificar a aquellas personas que tienen un mayor riesgo para desarrollar trastornos psiquiátricos severos e intervenir precozmente para evitar el desarrollo de éstos o mejorar su pronóstico en el largo plazo, ha sido el motor principal de los programas de intervención temprana. Hoy sabemos que existen estrategias de intervención sistematizadas que permiten disminuir la transición a psicosis en esta población. Asimismo, sabemos que las intervenciones clínicas en los primeros años desde el inicio de los síntomas, mejoran la respuesta al tratamiento y el pronóstico funcional en el largo plazo de nuestros pacientes. Sin embargo, estas intervenciones son complejas y requieren de grupos interdisciplinarios con un enfoque flexible, para dar respuestas apropiadas a cada etapa de la enfermedad, que incluyan a los pacientes, familiares y a la comunidad. Esta revisión narrativa tiene como objetivo revisar el conocimiento actual sobre la intervención temprana desde una perspectiva clínica y proponer un acercamiento contingente y progresivo en la población de alto riesgo y psicosis temprana.
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    Structural brain abnormalities in schizophrenia in adverse environments: examining the effect of poverty and violence in six Latin American cities
    (2021) Crossley, Nicolas; Zugman, Andre; Reyes, Francisco; Czepielewski, Leticia; Castro, Mariana; Diaz, Ana; Pineda, Julian; Reckziegel, Ramiro; Gadelha, Ary; Jackowski, Andrea; Noto, Cristiano; Alliende, Luz; Iruretagoyena, Bárbara; Ossandon, Tomas; Ramírez, Juan; Castañeda, Carmen; González, Alfonso; Nachar, Ruben; León, Pablo; Undurraga, Juan; De la Fuente, Camilo; Bressan, Rodrigo; ANDES Network
    Background: Social and environmental factors such as poverty or violence modulate the risk and course of schizophrenia. However, how they affect the brain in patients with psychosis remains unclear. Aims: We studied how environmental factors are related to brain structure in patients with schizophrenia and controls in Latin America, where these factors are large and unequally distributed. Method: This is a multicentre study of magnetic resonance imaging in patients with schizophrenia and controls from six Latin American cities. Total and voxel-level grey matter volumes, and their relationship with neighbourhood characteristics such as average income and homicide rates, were analysed with a general linear model. Results: A total of 334 patients with schizophrenia and 262 controls were included. Income was differentially related to total grey matter volume in both groups (P = 0.006). Controls showed a positive correlation between total grey matter volume and income (R = 0.14, P = 0.02). Surprisingly, this relationship was not present in patients with schizophrenia (R = -0.076, P = 0.17). Voxel-level analysis confirmed that this interaction was widespread across the cortex. After adjusting for global brain changes, income was positively related to prefrontal cortex volumes only in controls. Conversely, the hippocampus in patients with schizophrenia, but not in controls, was relatively larger in affluent environments. There was no significant correlation between environmental violence and brain structure. Conclusions: Our results highlight the interplay between environment, particularly poverty, and individual characteristics in psychosis. This is particularly important for harsh environments such as low- and middle-income countries, where potentially less brain vulnerability (less grey matter loss) is sufficient to become unwell in adverse (poor) environments.

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