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, Alfredo Minervino Sao Paulo Medical Journal, 2025 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.
Interfaces between oncology and psychiatry Ana Luiza Silva Teles, Leonardo Baldaçara, Antônio Geraldo da Silva, Verônica da Silveira Leite, Ana Lucia Paya Benito, et al. Revista Da Associacao Medica Brasileira, 2024
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, et al. Brazilian Journal of Psychiatry, 2024 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, et al. Brazilian Journal of Psychiatry, 2024 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.
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, et al. Trends in Psychiatry and Psychotherapy, 2024 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.
Managing drug-induced psychosis Leonardo Baldaçara, Artur Ramos, João Maurício Castaldelli-Maia International Review of Psychiatry, 2023
Puerperal psychosis: an update Leonardo Baldaçara, Verônica da Silveira Leite, Ana Luiza Silva Teles, Antônio Geraldo da Silva Revista Da Associacao Medica Brasileira, 2023
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, et al. Revista Da Associacao Medica Brasileira, 2022
Behavior disorder after encephalitis caused by dengue Leonardo Baldaçara, Juliane Rosa Ferreira, Luiz Carlos Prestes Seixas Filho, Ranielly Ribeiro Venturini, Olívia Maria Veloso Costa Coutinho, et al. Journal of Neuropsychiatry and Clinical Neurosciences, 2013
Cerebellar volume in patients with dementia Leonardo Baldaçara, João Guilherme Fiorani Borgio, Walter André dos Santos Moraes, Acioly Luiz Tavares Lacerda, Maria Beatriz Marcondes Macedo Montaño, et al. Revista Brasileira De Psiquiatria, 2011
Cerebellum and psychiatric disorders Leonardo Baldaçara, João Guilherme Fiorani Borgio, Acioly Luiz Tavares de Lacerda, Andrea Parolin Jackowski Revista Brasileira De Psiquiatria, 2008
Drug eruptions associated with ziprasidone Revista De Psiquiatria Clinica, 2005
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