OBJECTIVE:Understanding the molecular mechanisms of autism spectrum disorder (ASD) and its psychiatric comorbidities, including bipolar disorder (BD), is pivotal for uncovering pathways that shape neurodevelopmental trajectories and clinical heterogeneity. We aimed to identify ASD-specific gene-expression signatures and disrupted biological processes in prefrontal cortex, contrasting them with those observed in BD. METHODS:We performed a comparative transcriptomic analysis of RNA-seq datasets from postmortem prefrontal cortex samples of individuals with ASD or BD and controls. Differential expression was assessed with DESeq2, including batch as a covariate in the BD model. Functional interpretation used Gene Ontology over-representation analysis, KEGG Gene Set Enrichment Analysis and gene-concept network visualization. RESULTS:ASD samples showed 45 differentially expressed genes (DEGs), mainly downregulated non-coding RNAs, particularly small nuclear RNAs and small nucleolar RNAs. Enrichment analysis indicated a convergent profile related to RNA processing, spliceosome assembly and spliceosomal activity. In contrast, BD showed 12 candidate DEGs, mostly upregulated protein-coding genes. BD enrichment involved metal ion response and detoxification, amine and peptide hormone responses, vascular regulation and hydrolase activity, with genes associated with neuroinflammation such as SERPINA3 and CHI3L1 contributing to this profile. No shared DEGs or enriched GO Biological Process terms were observed between ASD and BD. CONCLUSION:These results support transcriptomic divergence in the prefrontal cortex, with ASD characterized by spliceosomal dysregulation, contrasting with metal ion response, vascular regulation and inflammation-associated signals in BD. Our findings provide a transcriptomic framework for future studies investigating disorder-specific molecular mechanisms and candidate signatures in ASD and BD.
INTRODUCTION:Autism Spectrum Disorder (ASD) is a lifelong condition; however, literature regarding its manifestation in old age remains scarce. OBJECTIVE:To synthesize descriptive studies on the clinical characteristics of ASD in the elderly, aiming to improve diagnosis and quality of life. METHODOLOGY:This is a scoping review based on the Joanna Briggs Institute guidelines and reported according to PRISMA-ScR. Searches were conducted in MEDLINE/PUBMED and SCIELO databases, covering the period from 2011 to 2026, focusing on descriptive studies with participants aged over 50 years. Ultimately, 18 articles were selected and analyzed. RESULTS:The evolution of autism symptoms proved to be complex and non-linear; while some behaviors and psychiatric symptoms tend to decline with age, social difficulties may persist or worsen. From a cognitive perspective, data suggest an aging pattern parallel to neurotypicals, although there are reports of specific deficits in working memory and attention. An alarming burden of psychiatric comorbidities was identified, highlighting depression and high rates of suicidality, as well as significant clinical comorbidities. CONCLUSION:Older adults with ASD constitute a vulnerable population. There is an urgent need for prospective longitudinal studies to adequately map the aging trajectories of this population.
INTRODUCTION:Serum vitamin D (25(OH)D) concentration has been associated with PPD in previous studies. However, whether there is a dose-response relationship and if its supplementation during pregnancy can improve symptoms after delivery remains unclear. METHODS:Five databases were searched on September 27, 2025. Cohort studies were included for dose-response meta-analysis (DRMA), while randomized controlled trials (RCTs) were included for meta-analysis (MA) of supplementation. The outcome for MA of supplementation was postpartum Edinburgh Postnatal Depression Scale (EPDS) score using the effect measure of mean difference (MD), while the outcome for DRMA was the odds ratio (OR) of PPD after delivery. Certainty was assessed using GRADE for MA of supplementation. RESULTS:Only two prospective cohort studies were included for DRMA and two RCTs were included for MA of supplementation. There was a significant log linear dose-response relationship between 25(OH)D serum concentration and developing PPD with β = -0.0256 (95% CI = -0.0454 to -0.0057). Every 10 nmol/L increase was associated with OR = 0.77 (95% CI = 0.63 to 0.94). Meta-analysis found a significant reduction in EPDS scores at 4 weeks after delivery (MD = -2.70; 95% CI = -3.68 to -1.71; low certainty). CONCLUSION:Vitamin D serum concentration during pregnancy might be log linearly associated with developing PPD after delivery and its supplementation during pregnancy may improve PPD symptoms at 4 weeks postpartum. However, findings should be interpreted cautiously as evidence is limited to the small number of studies.
OBJECTIVE:To systematically synthesize evidence on the psychobiological effects of music therapy and structured musical interventions on biomarkers in individuals with mental disorders, within a psychoneuroimmunological framework. METHODS:This systematic review and meta-analysis followed PRISMA 2020 guidelines. Searches were performed in PubMed, LILACS, PsycINFO, and Cochrane Library up to October 2025. Studies with individuals aged ≥16 years, psychiatric diagnoses, and both psychological and biomarker outcomes were eligible. Ten studies met inclusion criteria. Random-effects meta-analysis was conducted for sufficient, comparable data. RESULTS:Cortisol was the only biomarker with sufficient data for meta-analysis (n=4). Results showed no significant effect on cortisol levels (SMD = -0.18; 95% CI = -0.96 to 0.59), with substantial heterogeneity (I² = 88.7%). Exploratory analyses indicated more consistent responses in autonomic and inflammatory biomarkers than endocrine markers. Psychological outcomes showed greater improvement consistency across studies, even without short-term physiological changes. Findings must be interpreted cautiously due to the limited number of studies and high heterogeneity. CONCLUSION:Psychobiological effects of music therapy and musical interventions vary by intervention, design, and population. Despite heterogeneity and limited quantitative data, findings support the clinical relevance of these interventions. More standardized, biomarker-informed research is needed to clarify underlying mechanisms.
OBJECTIVE:To investigate whether participation in a multicomponent physical exercise program is associated with longitudinal changes in craving, cognition, and self-esteem among inpatients with crack cocaine use disorder. METHODS:This prospective, naturalistic, non-randomized longitudinal study included 37 inpatients with crack cocaine use disorder classified into an exercise group (EG, n = 21) or non-exercise group (NEG, n = 16) based on participation in the institutional exercise program. Assessments were conducted at baseline, week 5, and week 10. Outcomes included global cognition (MMSE), executive function (TMT-A/B), self-esteem (RSE), and craving (CCQ-Brief). Longitudinal data were analyzed using repeated-measures models. RESULTS:No significant group-by-time interactions were observed for cognition or self-esteem, although both groups improved over time. In the primary analysis, a significant group-by-time interaction was observed for craving (p = 0.034), with greater reductions in the exercise group, particularly during the first five weeks. However, this interaction was attenuated after adjustment for age and duration of crack cocaine use. CONCLUSIONS:Participation in multicomponent exercise was associated with greater reductions in craving in the primary analysis, although this finding was attenuated after adjustment for baseline group differences. Improvements in cognition and self-esteem were observed in both groups, suggesting shared effects of structured care and abstinence. These findings support further investigation of exercise as a complementary strategy in substance use disorder treatment.
OBJECTIVE:To evaluate whether bullying, physical aggression, and peer rejection cluster among Brazilian adolescent students and whether aggressive-behavior cluster pairs are associated with leisure-time physical activity according to sex. METHODS:This cross-sectional study analyzed data from PeNSE 2019, including 157,921 adolescents aged 13 to 17 years. Bullying, physical aggression, and rejection in the previous 30 days were dichotomized as present or absent. Clustering was assessed using observed/expected ratios (O/E) and 99% confidence intervals. Logistic regression models estimated associations between aggressive-behavior cluster pairs and sufficient leisure-time physical activity, defined as ≥300 min/week. RESULTS:Bullying, physical aggression, and rejection were reported by 39.41%, 14.60%, and 26.69% of adolescents, respectively. The simultaneous occurrence of all three behaviors exceeded expectation in the overall sample (O/E = 127.69), boys (O/E = 122.05), and girls (O/E = 170.23). In boys, physical aggression plus rejection was associated with lower odds of sufficient leisure-time physical activity (aOR = 0.99, 99%CI: 0.97-0.99). In girls, physical aggression plus rejection (aOR = 0.88, 99%CI: 0.86-0.89), bullying plus rejection (aOR = 0.97, 99%CI: 0.96-0.98), and bullying plus physical aggression (aOR = 0.98, 99%CI: 0.97-0.99) were associated with lower odds of sufficient leisure-time physical activity. CONCLUSION:Aggressive behaviors clustered among Brazilian adolescents and were associated with leisure-time physical activity, particularly among girls. Because this study was cross-sectional and several effect sizes were small, findings should be interpreted as associations rather than causal effects.
BACKGROUND:Coping strategies are essential for managing stress and emotional well-being, particularly in high-demand settings like healthcare. In high-demand contexts such as the COVID-19 pandemic, coping strategies may play a critical role in shaping mental health outcomes. Understanding how specific strategies relate to psychiatric symptoms is critical for effective interventions. METHODS:This cross-sectional study analyzed baseline data from 3,075 essential workers enrolled in the TelePSI project, a nationwide randomized controlled trial of brief telepsychotherapy. Participants reported coping strategies from a list of 22 options (in a yes/no format). Psychiatric symptoms-depression, anxiety, and irritability-were measured using PROMIS scales. Exploratory factor analysis (EFA) was used to identify coping dimensions, followed by correlation analyses. RESULTS:The most frequent strategies were watching YouTube (58.3%) and eating sweets (41.6%). EFA revealed two distinct factors: maladaptive (e.g., substance use, overeating) and adaptive strategies (e.g., physical activity, healthy eating). Maladaptive strategies showed weak positive correlations with psychiatric symptoms, while adaptive strategies showed weak negative correlations. Participants with higher symptom severity were more likely to report maladaptive behaviors. DISCUSSION:The findings reveal associations between coping patterns and mental health outcomes. Adaptive strategies were associated with lower psychological distress, while maladaptive behaviors showed the opposite pattern, indicating the multifactorial nature of mental health in crisis situations.
OBJECTIVE:Autism spectrum disorder (ASD) is clinically heterogeneous, and adult presentations, especially among individuals requiring Level 1 support, may be subtle, shaped by adaptation, and obscured by comorbidity and diagnostic overshadowing. We review the historical evolution of autism-related constructs and their implications for recognising and interpreting ASD in adults. METHODS:We conducted a narrative review in MEDLINE (PubMed). Searches combined "autism", "autism spectrum disorder", and "ASD" with predefined constructs (central coherence, theory of mind, social skills, sensory processing differences, repetitive behaviours, restricted and intense interests, executive functions, alexithymia, sleep disturbances, motor abnormalities, and camouflaging). A second search focused on adult autism (adulthood, autistic adults, late diagnosis, and compensatory mechanisms). Grey literature was also considered; publications available up to December 2025 were included. RESULTS:The literature reflects a progressive refinement of the autism construct from descriptive behavioural syndromes to mechanism-oriented models that better accommodate phenotypic variability across development. In adults, these constructs help explain how pragmatic-communication difficulties, rigidity, intense interests, sensory reactivity, and executive-attentional differences can coexist with preserved language and intelligence. Recognition of compensatory strategies and social camouflaging helps explain delayed or missed diagnoses and associated distress. Shifts in diagnostic boundaries and awareness complicate inference from apparent prevalence increases. CONCLUSION:A historically grounded, construct-based framework can improve recognition of clinically meaningful adult ASD, sharpen differential diagnosis amid comorbidity, and support nuanced interpretation of changing diagnostic practices and epidemiological findings. It may inform individualized assessment and support planning as occupational, relational, and adaptive demands increase across adulthood substantially.
OBJECTIVE:Prolonged Grief Disorder (PGD), characterized by persistent yearning, loss of meaning, and identity disruption, was recently recognized as a mental disorder in the DSM-5-TR. Despite its significant impact on functioning, no validated instruments exist to measure PGD in Brazilian Portuguese. This study aimed to translate, culturally adapt, and validate the Brazilian version of the Prolonged Grief 13 Revised (PG-13-R), an instrument aligned with DSM-5-TR criteria for assessing PGD symptoms. METHODS:The study sample comprised 286 bereaved individuals with a mean age of 30.75 years (SD = 12.65), predominantly females (80%). Exploratory Factor Analysis and correlation analysis with depressive and prolonged grief symptoms were performed. RESULTS:The results demonstrated an adequate content validation index for all items. EFA indicated a unidimensional construct, and the scale showed an excellent internal consistency (Cronbach's alpha = 0.90, McDonald's omega = 0.90) and concurrent validity. CONCLUSIONS:These findings indicate the reliability and validity of the Brazilian PG-13-R for assessing PGD symptoms.
OBJECTIVE:The constant access to online content has raised concerns worldwide. Excessive engagement with digital platforms can contribute to significant mental health challenges, including increased levels of depression, anxiety, and stress. This phenomenon is related to impairments in neuroanatomical areas leading to adverse outcomes. The study aimed to analyze the associations between internet addiction (IA), depression, anxiety, stress, and a diversity of sociodemographic variables, including gender, social media use, employment status, sleep, and physical activity patterns. METHODS:A sample of 618 adolescents and young adults in southern Brazil was analyzed (mean age: 23.34). Participants filled an online form and statistical analysis was conducted. RESULTS:The results show that depression, anxiety, and stress levels were higher in women (p < 0.001), whereas IAT scores did not reach statistical significance, despite being higher in women (p = .06). Those who are employed may have lower levels of IA; poor sleep habits are associated with higher internet addiction and social media use is associated with poorer mental health and IA (p < 0.001). CONCLUSION:Mental health support and internet use limits should be offered to the general population in terms of prevention and treatment of these conditions.
OBJECTIVE:Suicidal thoughts and behaviors (STBs) are common among medical students, but larger, diverse studies are needed, especially in low- and middle-income countries. This study aims to assess the prevalence and factors associated with STBs among Brazilian medical students. METHODS:A survey of 1,026 Brazilian medical students gathered data on sociodemographics, STBs, depressive (PHQ-9) and anxiety symptoms (GAD-7), university stressors, learning environment, religiosity, and hazing. Prevalence and regression analyses identified associated factors, and latent class analysis (LCA) identified distinct risk groups. RESULTS:Lifetime prevalence rates were 62.7% for passive thoughts of death, 39.6% for suicidal ideation, and 12.7% for lifetime suicide attempts, with 4.4% reporting at least one attempt in the past year. Anxiety symptoms were associated with all suicidal outcomes. Depressive symptoms, university stressors, and poorer learning environment were associated with higher suicidal ideation scores, while male sex and higher intrinsic religiosity were inversely associated with depressive symptoms. In the LCA, all religiosity dimensions differed significantly across classes, with the highest levels in the Low-Risk group. Hazing victimization and non-cisgender identity were associated with suicidal behaviors. LCA identified three groups: Low-Risk (42.4%) with minimal suicidal thoughts, distress, and higher religiosity; Moderate-Risk (41.1%) with intermediate levels; High-Risk (16.5%) with severe suicidal thoughts, depression, anxiety, university stress, poor environment, and hazing. CONCLUSIONS:Based on our findings, interventions designed to address suicidality in this population may benefit from focusing on modifiable institutional factors (learning environment, university stressors, hazing) alongside individual mental health support, particularly for minority students.
INTRODUCTION:Teaching psychiatric semiology faces challenges such as the limited availability of real patients for educational purposes and a shortage of specialized instructors. This systematic review investigated the applications of Large Language Models (LLMs), exemplified by ChatGPT, to address these gaps. METHODS:Studies published between November 2022 and September 17, 2025, were identified through searches in PubMed/MEDLINE, Scopus, Web of Science, IEEE Xplore, EBSCO, BVS, and EMBASE databases. Two independent reviewers conducted the systematic review following the PRISMA 2020 checklist, and the methodological quality of the included studies was individually assessed using the Mixed Methods Appraisal Tool (MMAT). RESULTS:Of the 1,549 studies initially identified, two met the inclusion criteria, involving medical students and educators in Canada and Switzerland. LLMs demonstrated performance comparable to human experts in creating diagnostic tests and clinical vignettes but exhibited occasional simplifications and algorithmic biases. Participants reported positive perceptions of the tools' efficiency and practicality, but emphasized the need for specialized supervision and attention to potential privacy issues and superficiality in complex cases. CONCLUSIONS:LLMs show potential as valuable supplementary resources for teaching psychiatric semiology, especially in settings with shortages of teachers and available patients for training. However, their limitations, including cultural and algorithmic biases, potential privacy risks, and superficial content generation, require close monitoring by experienced professionals. Although current evidence is preliminary, prospects are promising, highlighting the need for more robust and long-term studies to evaluate the educational use of LLMs.
BACKGROUND:Network analysis offers a novel framework for understanding the dynamic interconnections among symptoms, moving beyond traditional approaches to identify central symptoms that drive illness courses and treatment response. Recent studies have used this method to examine how symptoms group together and influence one another in unipolar depression; however, its application to bipolar disorder (BD) remains limited. OBJECTIVES:This review systematically examines literature that applied network analysis methodology to BD to investigate central symptoms and their interrelationships within this condition. METHODS:A systematic search of PubMed, Web of Science, PsycINFO, Embase, and Scopus databases was conducted from inception to January 2026 to identify studies that applied network analysis to examine mood symptom centrality in individuals with BD. RESULTS:Eleven studies met the inclusion criteria, encompassing diverse BD populations including young adults, and mixed-age samples across different illness phases. Across depressive symptom networks, depressed mood, low energy, and negative self-concept emerged as central nodes, while high energy, pressured speech, and elevated self-esteem were most central in networks of manic symptoms. Methodological and reporting heterogeneity, including variations in network estimation techniques, sample characteristics, and symptom assessment instruments, limited the comparability of findings. CONCLUSION:These findings advance understanding of central symptoms and network structures in BD, revealing consistent patterns across depressive and manic symptom networks. Identifying key symptom patterns and their interconnections may inform future symptom-targeted research and enhance understanding of symptom dynamics in BD.
INTRODUCTION:Recent evidence suggests that reduced peripheral levels of brain-derived neurotrophic factor (BDNF) may be involved in the pathophysiology of bipolar disorder (BD), although its relevance in young populations remains uncertain. This systematic review synthesized studies that evaluated serum BDNF levels in children and adolescents with BD, examining its potential as a risk marker. METHODS:Following PRISMA 2020 guidelines and a protocol registered in PROSPERO, searches were conducted in the Cochrane, MEDLINE, SciELO, and Scopus databases. Studies including participants aged 0-19 years diagnosed with BD according to DSM criteria were included. Studies with mixed samples (adults, children and adolescents) without separate age-group analyses were excluded. RESULTS:After screening and eligibility assessment, seven studies were included. Five of them included a control group, from which a meta-analysis was performed. Moderate methodological heterogeneity was observed and corrected after sensitivity analysis, reinforcing the robustness of the findings, although no statistically significant difference in serum BDNF levels was found between patients with bipolar disorder and controls. CONCLUSION:Current evidence does not support BDNF as a diagnostic biomarker for pediatric BD. Future studies with greater sample power and methodological standardization are needed to clarify its role in the risk and course of early-onset bipolar disorder.
OBJECTIVE:Major Depressive Disorder (MDD) is a multifactorial psychiatric disease influenced by a combination of genetic and environmental factors. Among the genes linked to MDD, the Melanocortin 1 Receptor (MC1R), Catechol-O-Methyltransferase (COMT), Brain-Derived Neurotrophic Factor (BDNF), and the serotonin transporter (5-HTT) are of particular interest due to their critical roles in stress regulation and neural function. Despite their biological significance, the contribution of specific polymorphisms within these genes to MDD risk remains understudied. METHODS:This retrospective observational case-control study included 87 Colombian patients diagnosed with MDD according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). The control group comprised Latino/admixed individuals without, sourced from the gnomAD v2.1.1 database. The complete coding region of the MC1R gene and three polymorphisms: 5-HTTLPR Insertion/Deletion 44 bp, BDNF-c.196G>A, and COMT-c.472G>A were genotyped using PCR and Sanger sequencing. RESULTS:The polymorphisms rs885479 and rs4680 were identified as protective factors against MDD, while the polymorphisms rs796296176, rs779504604, rs1805005 were associated with an increased risk of developing MDD (OR:22.87, OR:51.26, OR: 1.97, respectively). CONCLUSION:Several of the analyzed polymorphisms (rs796296176, rs779504604, rs1805005) increase the risk for MDD. Notably, we provide novel evidence of these polymorphisms in MC1R as a risk to MDD.
OBJECTIVES:To analyze the feasibility and impacts of parental training programs aimed at reducing challenging behaviors and minimizing food selectivity patterns in children with autism spectrum disorder (ASD). METHODS:An open clinical trial was conducted with 23 children with ASD and their families. The intervention lasted 12 weeks and consisted of online sessions with caregivers, who were divided into two groups: Challenging Behaviors and Food Selectivity. Pre- and post-intervention assessments included the Hamilton Depression Rating Scale, the Autism Behavior Checklist (ABC), and the Brief Autism Mealtime Behavior Inventory (BAMBI). Caregivers also completed daily logs regarding their children's behavioral and feeding challenges. RESULTS:There was a reduction in challenging behaviors after the intervention (μ=50.06) compared to the pre-intervention period (μ=67.81; ρ=0.001), as well as a decrease in food selectivity (μ=45.14 post vs. μ=57.71 pre; ρ=0.012). CONCLUSIONS:Both interventions demonstrated preliminary evidence of feasibility and potential positive effects for children with ASD.
BACKGROUND:Autism Spectrum Disorder (ASD) is a neurodevelopmental condition characterized by difficulties in communication, deficits in social interaction, and repetitive behavioral patterns. Global prevalence estimates range from 1% to 2%, with variations attributed to cultural, social, and methodological factors. In Africa, research remains limited and highly heterogeneous, largely due to scarce diagnostic resources, persistent stigma, and the absence of consistent public policies. METHODS:A systematic search was conducted across PubMed, Embase, Scopus, and PsycInfo for articles published up to May 2025. Cross-sectional studies conducted in school-based or community populations were included. The analysis followed PRISMA guidelines, and the protocol was registered with PROSPERO (CRD420251138668). A random-effects model using the Freeman-Tukey transformation for variance stabilization was employed for statistical synthesis. RESULTS:Seven studies from Egypt, Kenya, Uganda, and Nigeria, comprising 71,341 participants, were included. Across included studies, reported ASD prevalence ranged from 0.54% to 23.8%. When pooled and stratified by methodological criteria, clinically confirmed ASD prevalence was 1% (95% CI, 0.0-1.0%), whereas high-risk screening prevalence was 4% (95% CI, 0.0-16.0%), with very high between-study heterogeneity (I² = 99.8%). CONCLUSION:Despite substantial methodological heterogeneity, ASD prevalence estimates in Africa appear comparable to those reported in high-income countries. The marked disparity between high-risk screening prevalence and confirmed diagnoses highlights the urgent need to expand diagnostic confirmation services and strengthen training for primary healthcare professionals to bridge the gap between risk identification and definitive diagnosis across the continent.
INTRODUCTION:Adults with Autism Spectrum Disorder (ASD) often present with core symptoms and co-occurring conditions that require multidisciplinary support. The objective of this study is to describe the sociodemographic and clinical profile of a sample of Brazilian adults with ASD, with a focus on the prevalence of co-occurring mental health disorders and the investigation of gender-related disparities. METHODS:A total of 117 adults with a previous diagnosis of ASD (60.7% female; mean age = 31.84, SD = 10.03; age range: 18-61 years) were recruited by convenience sampling. Participants completed a sociodemographic and clinical history questionnaire. We analyzed associations between co-occurring mental health disorders and biological sex. RESULTS:Most participants had completed at least high school (95.7%). Co-occurring neurodevelopmental disorders were present in 35.9% of the sample. ADHD was the most common (30.8%). Co-occurring mental health disorders were reported by 75.2% of participants, with anxiety disorders being the most frequent (71.8%). A statistically significant gender disparity was observed, showing that women had a significantly higher prevalence of at least one mental health disorder (85.9% vs. 58.7%), anxiety (83.1% vs. 54.3%), and depression (62% vs. 37%) compared to men. CONCLUSION:While not generalizable due to the convenience sampling method, these results contribute to a growing body of evidence on the high rates of co-occurring mental health disorders in adults with ASD, especially in women. This study supports the call for an expanded research agenda in Brazil to better understand the clinical reality and guide future support strategies for this population.
