Bruno Braga Montezano

Introduction: Bipolar disorder (BD) is a chronic psychiatric illness characterized by recurrent manic and depressive episodes, affecting 2% of the global population. It is associated with premature mortality, including cardiovascular disease (CVD)‐related mortality. Although clinically important, the absolute burden and incidence of cardiovascular outcomes in BD remain incompletely characterized. This systematic review and meta‐analysis synthesized observational evidence on CVD prevalence and incidence in adults with BD. Methods: Following PRISMA guidelines and prospectively registered in PROSPERO (CRD42023484712), we searched PubMed, Web of Science, Embase, Scopus, and PsycInfo, screening 11,909 records. Thirty‐two observational studies in adults with BD were included after Newcastle–Ottawa Scale assessment. Data were extracted on overall CVD, coronary artery disease, cerebrovascular disease, peripheral arterial disease, comorbidities, and psychotropic exposure. Pooled prevalence and incidence rate ratios were calculated using random‐effects models when data were comparable. Results: The pooled CVD prevalence in BD was 7.70% (95% CI: 5.07–11.52), with coronary artery disease at 6.89% (95% CI: 4.05–11.47), cerebrovascular disease at 4.45% (95% CI: 2.13–9.05), and peripheral arterial disease at 3.30% (95% CI: 1.66–6.45). However, prevalence estimates showed extreme heterogeneity and should be interpreted as broad indicators of absolute burden rather than precise estimates for a single BD population. In controlled incidence studies, BD was associated with increased CVD incidence (IRR 1.66, 95% CI: 1.32–2.08), with elevated coronary and cerebrovascular estimates. Clinical variable analyses involving medication use, lifestyle factors, and cardiometabolic comorbidities were not feasible because reporting was insufficient and noncomparable. Conclusion: Adults with BD show substantial cardiovascular burden and increased incidence. However, extreme heterogeneity, limited incidence data, observational designs, and insufficient moderator reporting limit the precision and generalizability of pooled estimates. These findings support integrated cardiovascular screening in BD populations and future prospective studies. Trail Registration: PROSPERO CRD42023484712

Trends Psychiatry Psychother, vol.0, nAheadOfPrint, p.0-0, 2025

Trends Psychiatry Psychother, vol.0, nAheadOfPrint, p.0-0, 2024

BACKGROUND Single session intervention (SSI) have been shown to be an effective strategy for reducing emotional distress. Enhanced psychoeducation (EP), which includes empathic listening, risk stratification, symptom monitoring, and habit modification, is particularly suitable for SSIs. OBJECTIVE This study aimed to investigate the predictors of responses to an online EP intervention among professionals from essential services during the COVID19 in Brazil with the aim of reducing emotional distress. METHODS This study analyzed data from the TELEPSI Project from April 2020 to December 2021. We included all participants who received SSIs with high levels of emotional distress (T-scores above 70 on the PROMIS for anxiety, depression, or irritability). RESULTS The final sample consisted of 460 subjects, 89.1% female and 81.1% health professionals, of which 300 subjects underwent reassessment in one month (65% retention). Participants with harmful use of social networks, spending time on social media, playing video games, smoking, drinking alcohol, using drugs, and spending time with pets showed a less pronounced decrease in symptoms. In contrast, participants who played instruments or had already received psychological treatment showed a greater magnitude of decrease in symptoms. CONCLUSIONS This study highlights the impact of lifestyle factors on SSI efficacy. These results underscore the importance of considering individual lifestyle factors when implementing SSIs, and contribute to a growing body of evidence supporting the tailored application of psychoeducational strategies in mental health interventions, particularly in high-stress environments.

Background and Objectives: Bipolar disorder is a chronic condition affecting millions of people worldwide. Currently, there is some evidence to suggest that cannabis use during adolescence may be an environmental risk factor for its onset, however inconsistencies have been observed across the literature. Considering this, we aimed to assess whether early lifetime cannabis is associated with subsequent bipolar disorder in young adults between 18 and 22 years of age.Methods: Using data from the 1993 Pelotas (Brazil) birth cohort (n = 5249), cannabis exposure was examined at age 18 by self‐report, and bipolar disorder diagnosis was measured at age 22 using the Mini International Neuropsychiatric Interview (MINI). In order to control the analysis, we considered socioeconomic status index, sex, skin color, physical abuse by parents and lifetime cocaine use.Results: A total of 3781 individuals were evaluated in 2015 aged 22 years, of whom 87 were diagnosed with the bipolar disorder onset after the age of 18. Lifetime cannabis use predicted bipolar disorder onset at 22 years old (OR 1.82, 95% CI [1.10, 2.93]), and the effect remained after adjusting for socioeconomic status, sex, skin color, and physical abuse by parents (OR 2.00, 95% CI [1.20, 3.25]). However, this association was attenuated to statistically non‐significant after further adjustment for all available covariates, including lifetime cocaine use (OR 1.79, 95% CI [0.95, 3.19]). We also found similar results for early cocaine use, where the association with bipolar disorder onset did not maintain significance in the multivariate model (OR 1.35, 95% CI [0.62, 2.86]). Otherwise, when we considered cannabis or cocaine lifetime use as a unique feature, our findings showed that the adolescent exposure to cannabis or cocaine increased the odds by 1.95 times of developing bipolar disorder at 22 years age, even when controlling for all other study variables (OR 2.14, 95% CI [1.30, 3.47]). Finally, our models suggest that cocaine use may potentially exert a major influence on the effect of lifetime cannabis use on bipolar disorder onset, and that physical abuse by parents and sex may modify the effect of cannabis use for later bipolar disorder onset.Conclusion: Based on our findings, early cannabis exposure predicted bipolar disorder onset in young adults, but this association was confounded by cocaine use. Contrary to schizophrenia, cannabis as a sole exposure was not associated with bipolar disorder onset after adjusting for control variables.

Objective: From a preventive perspective, this study reviewed the literature on protective factors against depressive symptoms in high-risk children and adolescents. Methods: We conducted a thorough search of the PubMed, APA, EMCare, and Embase databases for studies published between 1946 and August 25, 2023. We included only longitudinal studies that analyzed protective factors for depressive symptoms in high-risk children or adolescents, excluding cross-sectional studies, reviews, and pre-clinical studies. Results: A total of 29 studies with 62,405 participants were analyzed and 38 protective factors were identified. Positive individual characteristics, family factors, peer relationships, school-related aspects, neighborhood characteristics, and intrinsic religiosity were associated with improved depression outcomes. Conclusion: These findings have important implications for preventive strategies in this population. Addressing protective factors can help prevent depression and enhance lifetime mental health.