The current mental health system faces an important yet not well-understood problem, which involves addictions that do not respond to treatment. The cases present with ongoing substance abuse, multiple treatment failures, psychiatric conditions, social instability, and work-related problems. The absence of standardized operational criteria creates problems with immediate patient identification, comparing research study results, and healthcare providers' efforts to create structured treatment plans. The article combines existing data about treatment-resistant addiction to create an initial framework that explains its medical characteristics, brain functions, social aspects, and treatment approaches. The research uses depression and schizophrenia treatment-resistant frameworks to develop functional criteria, which include multiple treatment failures, ongoing disability, complex medical conditions, and inadequate response to optimal treatment protocols. Healthcare providers can identify actual refractoriness using established criteria that help distinguish it from pseudo-resistance, which occurs due to incorrect medical diagnoses, insufficient medication exposure, or non-compliance with treatment instructions. The research presents typical medical signs that appear in people who do not respond to substance use treatment through their impulsive behavior, their inability to identify emotions, their background of trauma, their presence of multiple psychiatric conditions, and their exposure to poverty and prison life. The review evaluates present-day pharmacological treatments that combine GLP-1 receptor agonists with ketamine and cannabidiol, partial agonists, and neuromodulation methods (rTMS and tDCS), as well as psychotherapeutic approaches (ACT, DBT, MBRP, and CRA) to improve treatment outcomes. We propose an operational system that integrates diagnostic evaluation with medication treatment and psychotherapy services, brain function assessments, and social assistance programs. This model is focused on a team-based approach aimed at delivering personalized medical care. Patients' non-adherence is considered as a clinical issue rather than a factor of social labeling or exclusion. Empirical testing is needed to validate the proposed evaluation criteria, as well as treatment effectiveness in real-world settings should be confirmed to approve accessible and advanced care for all patients.
Psychiatric classification systems have evolved significantly over the past three decades. This article critically examines the transition from DSM-IV and ICD-10 to the more recent DSM-5-TR and ICD-11, analysing key conceptual shifts, including the redefinition of diagnostic criteria, the inclusion of emerging disorders, and the removal of outdated or stigmatizing categories. Particular attention is paid to the growing limitations of categorical models in capturing clinical heterogeneity and comorbidity. In response, dimensional approaches and precision psychiatry have gained prominence, aiming to integrate symptom severity, biomarkers, and neurobiological correlates into diagnostic decision-making. The manuscript explores future trajectories for psychiatric nosology, including the potential role of artificial intelligence, the recognition of novel syndromes such as eco-anxiety and digital addictions, and the need for culturally sensitive frameworks. It also provides stakeholder-specific recommendations-addressed to clinicians, researchers, policymakers, and educators-summarized in a dedicated table. These forward-looking strategies emphasize the importance of ethical, interdisciplinary, and inclusive practices in updating diagnostic systems. Ultimately, the future of psychiatric classification lies in striking a balance between scientific rigor, sociocultural relevance, and individual variability, ensuring that future manuals serve both clinical utility and human dignity.
Adolescent mental health remains an underexplored area in Paraguay despite its significant implications for public health. This study investigated the prevalence of self-injurious thoughts and behaviours as well as the associated psychosocial and demographic factors among Paraguayan adolescents. A cross-sectional study was conducted with 535 adolescents aged 12-18 years from Asunción and the Central Department, using validated instruments, including the PHQ-2 for depression, GAD-7 for anxiety, APCTSS for post-traumatic stress, and SDQ for emotional and behavioural issues. The findings revealed alarmingly high prevalence rates of anxiety (40.6%), depression (50.3%), and PTSD (64.5%), with females being disproportionately affected. Non-suicidal self-injury was reported by 30.5% of participants, with significantly higher rates among females. Factors such as bullying, loneliness, and food insecurity were strongly associated with self-harm and suicidal ideation. Logistic regression analysis identified female sex, depression, anxiety, and experiences of bullying as key predictors of self-injurious behaviours. These results highlight the urgent need for school-based mental health interventions, gender-sensitive policies, and trauma-informed care to mitigate the burden of adolescent mental-health disorders in Paraguay. Future studies should explore longitudinal trends and targeted prevention strategies to address this pressing public health concern.
A LRF exige que os gestores públicos adotem práticas de transparência, gestão de riscos e equilíbrio das contas, fazendo isso com o apoio de legislações e o amparo em manuais, como o Manual de Demonstrativos Fiscais (MDF), que é revisado anualmente. Além disso, os Tribunais de Contas também analisam a efetividade da Gestão Fiscal, emitindo pareceres e revisando relatórios como o Relatório Resumido de Execução Orçamentária (RREO) e o Relatório de Gestão Fiscal (RGF), por isso a necessidade de o gestor manter seus atos e fatos, em conformidade com a legislação. Esse trabalho, especificamente, se propõe a estudar a efetividade da Gestão Fiscal na Prefeitura de Manaus durante o biênio 2020-2021, na percepção da Controladoria-Geral do Município (CGM). Os objetivos específicos incluem analisar os mecanismos de controle da LRF aplicados em Manaus, comparar os dados dos RGFs desse período e validar os resultados a partir da percepção da alta administração do órgão de controle interno. A importância do estudo reside na análise da transparência pública e na contribuição dos mecanismos de controle para atingir metas fiscais com eficiência. A pesquisa é relevante para a economia e a contabilidade, pois esclarece como o equilíbrio das contas públicas é promovido e como se estabelecem o controle social e a transparência em nível municipal. A pesquisa trata-se de um estudo de caso com aplicação de entrevista direta, com a técnica face to face. Os resultados demonstram um comparativo entre os principais anexos de formam a consolidação dos indicadores da Gestão Fiscal, na Prefeitura de Manaus, corroborando para a aplicação dos recursos públicos de maneira eficaz e efetiva, contribuindo para a conformidade da Gestão Fiscal no biênio analisado.
Climate change is an escalating global health threat with significant implications for the field of psychiatry. This narrative review explores the anticipated psychiatric consequences of climate change over the next three decades, highlighting emerging challenges and potential opportunities for mental health care. Evidence links extreme weather events, heatwaves, and environmental degradation to increased rates of anxiety, depression, post-traumatic stress disorder, and suicide. Vulnerable groups include rural women, youth, and individuals with pre-existing mental disorders. The rise of eco-anxiety and climate-related depression points to the emergence of new clinical presentations that may warrant future inclusion in diagnostic frameworks such as the DSM and ICD. The review emphasizes the urgent need to adapt psychiatric training, strengthen healthcare systems, and implement climate-informed policies. Digital solutions, especially telepsychiatry, are vital for maintaining care delivery amid climate disruptions. Concurrently, advances in stress-related biomarkers offer promising avenues for early detection and prevention. Psychiatry must engage proactively in climate change mitigation and adaptation, promoting climate justice and equitable access to care. Addressing the mental health dimensions of climate change is crucial to building resilient psychiatric services capable of responding to the evolving environmental and societal landscape.
