BackgroundWorld population growth is projected to be concentrated in megacities, with increases in social inequality and urbanization-associated stress. São Paulo Metropolitan Area (SPMA) provides a forewarning of the burden of mental disorders in urban settings in developing world. The aim of this study is to estimate prevalence, severity, and treatment of recently active DSM-IV mental disorders. We examined socio-demographic correlates, aspects of urban living such as internal migration, exposure to violence, and neighborhood-level social deprivation with 12-month mental disorders.Methods and ResultsA representative cross-sectional household sample of 5,037 adults was interviewed face-to-face using the WHO Composite International Diagnostic Interview (CIDI), to generate diagnoses of DSM-IV mental disorders within 12 months of interview, disorder severity, and treatment. Administrative data on neighborhood social deprivation were gathered. Multiple logistic regression was used to evaluate individual and contextual correlates of disorders, severity, and treatment. Around thirty percent of respondents reported a 12-month disorder, with an even distribution across severity levels. Anxiety disorders were the most common disorders (affecting 19.9%), followed by mood (11%), impulse-control (4.3%), and substance use (3.6%) disorders. Exposure to crime was associated with all four types of disorder. Migrants had low prevalence of all four types compared to stable residents. High urbanicity was associated with impulse-control disorders and high social deprivation with substance use disorders. Vulnerable subgroups were observed: women and migrant men living in most deprived areas. Only one-third of serious cases had received treatment in the previous year.DiscussionAdults living in São Paulo megacity had prevalence of mental disorders at greater levels than similar surveys conducted in other areas of the world. Integration of mental health promotion and care into the rapidly expanding Brazilian primary health system should be strengthened. This strategy might become a model for poorly resourced and highly populated developing countries.

ResumoA conscientização de que os transtornos mentais representam um sério problema de saúde pública é relativamente recente, ocorrendo a partir da publicação do estudo The Global Burden of Disease pela Organização Mundial da Saúde. Diferenças de gênero na incidência, prevalência e curso de transtornos mentais, assim como na apresentação clínica e na resposta terapêutica, têm sido extensivamente demonstradas por estudos epidemiológicos.Palavras-chave: Saúde mental da mulher, epidemiologia psiquiátrica, prevalência de transtornos mentais, diferenças de gênero, ciclo reprodutivo. AbstractThe awareness that mental disorders present a serious public health problem is relatively new, occurring after the publication of The Global Burden of Disease by the World Health Organization. Gender differences in the incidence, prevalence, and course of mental disorders, as well as in their clinical features and response to treatment; have been extensively demonstrated in epidemiological studies.

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ResumoContexto: O beber pesado episódico (BPE) tem sido fortemente associado a danos e a uma carga social consideráveis. Objetivos: Este estudo tem como finalidade avaliar o panorama brasileiro a partir de aspectos sociodemográficos, fatores individuais e sociais relacionados ao beber pesado. Métodos: A busca de artigos científicos foi realizada com base em um programa de computador nos principais bancos de dados científicos. Resultados: Os homens beberam pesado mais freqüentemente que as mulheres. O beber pesado episódico foi mais prevalente em adolescentes e adultos jovens, e a prevalência tende a diminuir com o aumento da idade. As condições socioeconômicas parecem ter um efeito sobre o beber pesado. O início precoce do beber pesado esteve associado com história de dependência do álcool na vida adulta. O beber pesado episódico esteve associado ao uso concomitante de outras substâncias psicoativas. Os fatores de risco para BPE incluíram atividades sociais e disponibilidade de dinheiro. A pressão dos pares mostrou influenciar mais do que o suporte parental especialmente no final de adolescência. O BP também variou de acordo com a cultura, com mais episódios de BP no Sul em comparação com o Norte do País. Conclusões: Uma variedade de aspectos sociodemográficos e individuais associados ao beber pesado foi identificada. Porém, o conhecimento nessa área ainda é muito limitado. Mais pesquisas no Brasil são urgentemente necessárias visto que os resultados provenientes de outras culturas não podem ser generalizados. Silveira, C.M. et al. / Rev. Psiq. Clín 35, supl 1; 31-38, 2008 Palavras-chave: Álcool, beber pesado episódico, beber pesado, população geral, Brasil. AbstractBackground: Heavy episodic drinking has been shown to be closely associated with considerable damage to and burden on society. Objectives: This review aims to give an overview of the Brazilian reality based on socio-demographic aspects, considering individual and social factors related to heavy drinking. Methods: A computer-assisted search of relevant articles was conducted in the foremost scientific databases. Results: Males tended to heavy drinking more

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The present study demonstrates that specific correlates differently contribute throughout alcohol use trajectory in a Brazilian population. It also reinforces the need of preventive programs focused on early initiation of alcohol use and high-risk individuals, in order to minimize the progression to dependence and improve remission from AUD.

The aim of the study was to examine the psychosis continuum in a Latin-American community setting. Data were from the Brazilian São Paulo Epidemiologic Catchment Area Study, a cross-sectional survey conducted in two boroughs of the city of São Paulo. The Composite International Diagnosis Interview (version 1.1) was applied to a probabilistic sample of 1,464 adults, who were interviewed in their household, in order to identify the presence of psychotic symptoms. A subsample was assessed with Schedules for Clinical Assessment in Neuropsychiatry interview. We described the occurrence of psychotic symptoms, categorized into subgroups according to their clinical impact, disability, and help-seeking behavior. The correlation of socio-demographic variables, depressive symptoms, and alcohol and substance use disorders with those psychotic subgroups was analyzed. Polychotomic logistic regression tested the associations between subgroups of psychosis (clinical and subclinical) and the correlates. Of the total sample, 38.0% presented at least one lifetime psychotic symptom, 1.9% met the criteria for an ICD-10 diagnosis of non-affective psychosis, 5.4% presented clinically relevant psychotic symptoms, and 30.7% endorsed clinically non-relevant symptoms. The most common psychotic symptom was delusion with a plausible explanation (in 18.6%). The presence of any psychiatric diagnosis was associated with the presence of psychotic symptoms (OR range, 1.9-8.9). Subclinical psychosis subgroups were found to be associated with the 18-24 year age bracket, chronic depressive mood, and alcohol use disorder. Our results support the concept of a psychosis continuum in Latin-American populations, suggesting that different risk factors influence their manifestation across the continuum.

Background-Decreased signal intensity in the corpus callosum, reported in adult bipolar disorder patients, has been regarded as an indicator of abnormalities in myelination. Here we compared the callosal signal intensity of children and adolescents with bipolar disorder to that of matched healthy subjects, to investigate the hypothesis that callosal myelination is abnormal in pediatric bipolar patients.