Marcelo Zappitelli - Academia.edu (original) (raw)

Papers by Marcelo Zappitelli

BEPA Boletim Epidemiológico Paulista, May 25, 2023

Introdução: A literatura tem demonstrado variada morbidade psiquiatrica em criancas e adolescente... more Introdução: A literatura tem demonstrado variada morbidade psiquiatrica em criancas e adolescentes com coreia de Sydenham, apontando para uma maior frequencia tanto de transtorno obsessivo-compulsivo e tiques como de quadros de ansiedade, depressao e hiperatividade com deficit de atencao. A presente pesquisa vem contribuir para o maior conhecimento desta morbidade psiquiatrica associada a coreia reumatica em jovens do nosso meio Objetivos: Avaliar a sintomatologia psiquiatrica em um grupo de criancas e adolescentes com coreia de Sydenham, identificando os transtornos psiquiatricos e os problemas de Saúde mental presentes, verificando se tal sintomatologia remitia com a melhora do quadro coreico. Verificar possiveis alteracoes em exames de ressonancia magnetica de cranio e cintilografia cerebral. Verificar a influencia de fatores estressores sobre a Saúde mental de criancas e adolescentes com coreia de Sydenham. Metodo: Desenho do estudo: serie de casos. A amostra constituiu-se por t...

Purpose: To conduct two studies with children and adolescents, aiming to identify psychiatric dis... more Purpose: To conduct two studies with children and adolescents, aiming to identify psychiatric disorders in the offspring of bipolar parents type I, and to evaluate temperament and character traits in patients with major depressive disorder (MDD). Methods: Study 1: The study involved a case series comprising 35 children and adolescents (20 males/15 females) aged 6 to 17 years (mean age: 12.5±2.9 years). All participants were assessed using the diagnostic interview The Schedule for Affective Disorders and Schizophrenia for School-Age Children – Present and Lifetime Version (K-SADS- PL). Psychiatric family history and demographics were also evaluated. Study 2: A case-control study comprising 41 MDD children and adolescents (8-17 years) matched by gender and age to 40 healthy controls (HC). All participants were diagnostically assessed with the K-SADS-PL. Temperament and character traits were measured by the parent and child versions of The Junior Temperament and Character Inventory (JT...

Journal of child and adolescent psychopharmacology, 2015

I n the past 20 years, different screening measures have been developed to identify children earl... more I n the past 20 years, different screening measures have been developed to identify children early who are at risk for bipolar disorder (BD), such as the Child Behavior Checklist-Mania scale (CBCL-MS) developed by Papachristou and colleagues (Papachristou et al. 2013). It comprises 19 CBCL items, and has high internal consistency and satisfactory accuracy detected in a general population sample of 2230 Dutch adolescents. The aims of the present study were to identify 6-17-year-olds at risk for BD in a population-based sample (n = 474) and to examine the potential association of mania symptom severity according to CBCL-MS with co-occurring child psychopathology and maternal anxiety/depression. Mothers of 6-17-year-olds were interviewed in a cross-sectional study conducted in a low-income urban community in southeast Brazil. The study was based on a probabilistic sample of clusters of eligible households (women ages 15-49 years, son/daughter < 18 years), with one mother-child pair randomly selected per household (n = 813; response rate: 82.4%). Based on CBCL-MS total raw score percentiles, our sample was classified into three categories for mania: Clinical (> 97), borderline (93-97), and no mania (< 93). The current study considered the presence of psychopathology other than mania when any CBCL narrow-band scale (Anxious/ Depressed, Withdrawn/Depressed, Somatic Complaints, Social Problems, Thought Problems, Attention Problems, Rule-Breaking Behavior, and Aggressive Behavior) or any CBCL broad-band scale (Internalizing Behavior Problems, Externalizing Behavior Problems, and Total Behavior Problems) had t scores in the clinical range. This definition of psychopathology does not imply psychiatric diagnoses, as CBCL is a screening measure of emotional/ behavioral problems that do not require the presence of impairment in global functioning. The Brazilian version of CBCL showed high sensitivity among pediatric outpatients and children referred to psychiatric evaluation (Bordin et al. 2013). Also, the Self-Reporting Questionnaire (SRQ-20) was applied to assess maternal anxiety/ depression. The SRQ-20 was validated for the Brazilian population with a cutoff point > 7 (Mari and Williams 1986). According to CBCL-MS, 3.0% of the participants had clinicallevel mania and 4.9% had borderline-level mania. The greater the severity of mania, the higher the rate of co-occurring psychopathology (clinical-level mania, 92.9%; borderline-level mania, 87.0%; no mania, 33.4%; linear association, p < 0.001) (Table 1).

Background Mood disorders have a multifactorial etiology comprising genetics and environmental as... more Background Mood disorders have a multifactorial etiology comprising genetics and environmental aspects in a complex interplay between them. Depression and bipolar disorder have been increasingly diagnosed in children and adolescents in the recent years. A meta-analysis about the epidemiology of bipolar disorder in youth showed that the overall rate was 1.8%. Concerning depression in youth the lifetime prevalence varies from 3% in children to almost 20% in adolescents. Objective To describe a treatment and research program (PROACTH) for children and adolescents with mood disorders (depressive and bipolar disorder). Method The program operates from Monday through Friday. Patients are referred to the program from primary care health services. On admission, patients were screened with standardized instruments. After that, the patients were submitted to pharmacological and psychosocial interventions. Finally, the follow-up period depends on each patient illness evolution. Also, the team encompasses child psychiatrists, systemic family therapists, psychologists and social workers. Results The combination of pharmacotherapy and psychosocial interventions (individual psychotherapy and family therapy) led to a decrease of symptoms and a better psychosocial functioning. Conclusion In spite of the complex interplay between genetic and environmental factors usually found in children with mood disorders, timely and appropriate interventions are efficacious to achieve a favourable outcome.

European Psychiatry, 2013

Background The diagnosis of bipolar disorder in children and adolescents has increased in clinica... more Background The diagnosis of bipolar disorder in children and adolescents has increased in clinical settings throughout the last two decades. Its prevalence is around 1.8% being similar in different countries. However, how it is diagnosed is still a challenge due to its variability of clinical presentations, overlapping with other more commonly psychiatric disorders and high rates of comorbidities. Therefore, it is still important to report cases in order to enhance our knowledge about this complex field of the mental health in childhood and adolescence. Objective To present clinical characteristics and follow-up of a 12 year-old adolescent who met DSM-IV criteria for bipolar disorder NOS. Method To describe the clinical trajectory from the diagnosis to the outcomes of the mentioned case, focusing on the main symptoms and family functioning. Results The combination of mood stabilizers, family interventions and individual psychodynamic therapy resulted in an improvement of the global ...

Background: The state of São Paulo has 41,055,761 inhabitants, which corresponds to more than one... more Background: The state of São Paulo has 41,055,761 inhabitants, which corresponds to more than one fifth of the Brazilian population. In recent years, the mental health system in the state has undergone important structural changes. The association between government actions and initiatives on the part of mental health professionals, service users, and their families resulted in a broad transformation of the mental health system, intended to support the change from a hospital-based system to a communitybased services. Objectives: To check the number of psychiatric beds and their distribution across the state, and to assess outpatient mental health services with more than one mental health professional in the staff, in the state of São Paulo, excluding the capital city. Method: With reference to psychiatric beds, initial data from PNASH – 2005 were evaluated. Also, a cross-sectional study was carried out to assess outpatient services in the state of São Paulo. A semi-structured questi...

Cadernos de Pós-Graduação em Distúrbios do Desenvolvimento

Introdução: Pesquisas apontam que as características próprias das crianças com transtornos do esp... more Introdução: Pesquisas apontam que as características próprias das crianças com transtornos do espectro autista (TEA) como as dificuldades na comunicação e na interação social, o comportamento estereotipado e o restrito repertório de interesses e atividades produzem impacto na família exigindo dos pais ajustes na dinâmica familiar. A condição crônica desse transtorno, a demanda por cuidados especializados em longo prazo e o nível de dependência dessas crianças sobrecarregam os pais aumentando seu nível de estresse. Objetivo: Atender pais de crianças com TEA através de uma intervenção grupal de base psicodinâmica. Método: Grupo psicoterápico de base psicodinâmica com duração de uma hora semanal formado por mães de crianças com TEA, por um período de seis meses (novembro de 2016 a maio de 2017). O conteúdo discutido em cada sessão foi transcrito e analisado qualitativamente. Resultados e conclusões: Esse artigo relata as reflexões sobre o impacto e o significado do TEA na vida das famílias e o desafio de serem pais de uma criança que tem dificuldades na comunicação e déficit relacional. Estabeleceu-se um espaço de reflexão e de elaboração que permitiu um maior entendimento de questões específicas que envolvem o TEA e suas implicações no funcionamento familiar. Palavras chaves: transtorno do espectro autista, relações familiares, psicoterapia de grupo.

Rev Adm Saude, Jun 1, 2006

Neuroradiology, Jun 17, 2003

Clinics, 2011

BACKGROUND: Recent studies have demonstrated high rates of psychopathology in the offspring of pa... more BACKGROUND: Recent studies have demonstrated high rates of psychopathology in the offspring of parents with bipolar disorder. The aim of this study was to identify psychiatric diagnoses in a sample of children of bipolar parents. METHOD: This case series comprised 35 children and adolescents aged 6 to 17 years, with a mean age of 12.5¡2.9 years (20 males and 15 females), who had at least one parent with bipolar disorder type I. The subjects were assessed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime version (K-SADS-PL). Family psychiatric history and demographics were also evaluated. RESULTS: Of the offspring studied, 71.4% had a lifetime diagnosis of at least one psychiatric disorder (28.6% with a mood disorder, 40% with a disruptive behavior disorder and 20% with an anxiety disorder). Pure mood disorders (11.4%) occurred less frequently than mood disorders comorbid with attention deficit hyperactivity disorder (17.1%). Psychopathology was commonly reported in second-degree relatives of the offspring of parents with bipolar disorder (71.4%). CONCLUSIONS: Our results support previous findings of an increased risk for developing psychopathology, predominantly mood and disruptive disorders, in the offspring of bipolar individuals. Prospective studies with larger samples are needed to confirm and expand these results.

Comprehensive Psychiatry, 2013

To evaluate temperament and character traits using the Junior Temperament and Character Inventory... more To evaluate temperament and character traits using the Junior Temperament and Character Inventory (JTCI) in children and adolescents with major depressive disorder (MDD) in comparison with healthy control subjects (HC), and to verify if comorbidity with disruptive behavioral disorders and being currently depressed influence JTCI scores. A case-control study comprising 41 MDD children/adolescents matched to 40 HC by gender and age (8-17years). All participants were assessed diagnostically with the Kiddie Schedule for Affective Disorders and Schizophrenia - Present and Lifetime (K-SADS-PL). Temperament and character traits were measured with the parent and child versions of JTCI, and depression was evaluated with the Children&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s Depression Rating Scale (CDRS). According to child and parent data, MDD subjects had significantly higher scores on harm avoidance and novelty seeking, and lower scores on reward dependence, persistence, self-directedness and cooperativeness compared with HC. According to parent data only, MDD subjects significantly differed from HC on self-transcendence (lower spirituality scores and higher fantasy scores). Comorbidity with disruptive behavioral disorders exerted influence on almost all dimensions, in general increasing the mean differences between MDD and HC subjects. Also, being currently depressed did not influence the results, except for reward dependence according to parent data. The cross-sectional nature of the study and its limited sample size. MDD children/adolescents have a different temperament and character profile compared to HC subjects. This study supports previous findings of trait-like characteristics of harm avoidance and self-directedness.

Neuroradiology, 2003

Sydenham chorea (SyC), chorea minor, Saint Vitus' dance or rheumatic encephalitis, is a pecu... more Sydenham chorea (SyC), chorea minor, Saint Vitus' dance or rheumatic encephalitis, is a peculiar manifesta-tion of rheumatic fever (RF) that can be used to diagnose the disease even when it is isolated. It manifests itself as a hypotonic and hyperkinetic syndrome, clinically ...

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