Investigação
Tópicos
Perinatal mental health (PMH), as an area of clinical and research interest, focuses on women's mental health throughout the perinatal period: from conception to the end of the first year after birth. For over than ten years PMH has been one of the privileged research areas in the SPM. First we designed a research project entitled "Postpartum depression and sleep", in which valid methods for screening of perinatal depression were developed. Additionally we explored the role of different variables (socio-demographic, obstetric, clinical, personality, the sleep, baby-related, among others) as correlates and risk factors for perinatal depression and anxiety.
Currently we are carrying out a new project, entitled "Screening, prevention and early intervention in perinatal depression in primary care". The funding we have obtained, from the EEA-Grants, allows us to perform the translation between the knowledge gained in the last decade and minimizing the high negative impact of perinatal depression. We are studying the predictive power of a new tool for screening and prevention that includes symptoms and risk factors that we have identified as the most valid and consistent in Portuguese women, including: previous depressive episodes, prenatal insomnia and negative affect.
In addition we are also testing the effectiveness of early intervention/prevention program for perinatal stress (randomized controlled trial), with sessions of psychoeducation and psychotherapy based on cognitive-behavioral therapy (CBT) and the Third Generation Therapies.
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Sleep is one of the main areas of interest in the Institute of Psychological Medicine (IPM) and the team developed several papers about the association between sleep and different cognitive and emotional processes. In the context of the project Perfectionism and Obsessive-Compulsive Spectrum Disorders it was largely shown the role of perfectionism as a sleep predictor (namely of insomnia symptoms) in samples of university students. During the years, following these results, the team has oriented several master theses, held by Medicine Faculty students, that continue to deepen the association between sleep (insomnia, pre-sleep arousal and other sleep variables) and cognitive processes as perfectionism and repetitive negative thinking. The project Postpartum Depression and Sleep that led to the publication of dozens of works in IPM allowed to explore, also, associations between sleep (namely through insomnia assessment and of other sleep variables, as chronotype) and different cognitive and emotional processes, in a sample at the perinatal period. It was particularly demonstrated the role of insomnia as a risk factor for postpartum depression, with negative affect mediating this association, a innovating result for this particular period (perinatal). In the project Infants temperament and psychological distress we explored the role of baby sleep, as well as temperament, for the emotional state of the mothers at the postpartum.
Suicide and other suicidal behaviours are major public health problems: suicide is among the top ten cause of death worldwide. Previous Suicidality, particularly suicidal attempts, and psychological/psychiatric problems are consistent predictors of suicide and other self-harm behaviours. However, these do not account for all the risk of suicide and other factors might be involved. Although there are several studies on the epidemiology and risk factors of the suicidality, there are still considerable gaps in our knowledge about the prevalence and incidence of suicidal ideation and of suicidal attempts in the Portuguese population, as well as on which correlates and risk factors of suicidality are important in specific population groups, such as perinatal women.
One purpose of this area of study is to characterize suicidal behaviours and analyse the rates of suicidal behaviours and ideation in particular groups of the Portuguese population, for example, students, women during the perinatal period, immigrants, and mental health patients. Another goal of this area of study is to explore the correlates and proximal and distal risk factors of suicidality, including demographic factors (e.g., gender, age), cultural and socio-economic risk factors (e.g., employment, immigration), psychological factors (e.g., personality traits, such as perfectionism), and psychiatric factors (e.g., previous suicidality, mental illness), in samples from the general population and in clinical samples. The findings of these studies might be helpful in the development of suicide prevention strategies.
Our team has acquired an extensive expertise in the development of instruments to be used in psychiatric research, with multiples purposes. Some of these are diagnostic tools used in epidemiological and biological psychiatric research, such as the Diagnostic Interview for Genetic Studies and the EP-GENE, while others, such as the Clinical Interview for Psychotic Disorders (CIPD) are used to assess the efficacy of therapeutic interventions (psychological or drugs). The CIPD is an entirely new interview developed considering the DSM-5 criteria for psychotic and affective disorders which has changed the focus from exclusively assessing symptom frequency/severity of symptoms to a comprehensive and functional assessment of interference, functioning, and the relationship people have with symptoms.
Also developed according to the diagnostic criteria of the DSM 5 and also with recent evidence of validity and usefulness for both clinical and research contexts, we have the DIPD - Diagnostic Interview for Psychological Distress. It was initially developed to serve the interests of our line of research on perinatal mental health, but now we also have a version that allows the assessment of symptoms and diagnostic criteria with any type of sample and at different periods of life. DIPD sections include: Major Depressive Disorder, suicidal behavior, Anxiety disorders, Trauma and Stress Disorders and Obsessive Compulsive Disorder.
Our team has also developed new diagnostic methodologies, such as a diagnostic consensus methodology OPCRIT
Within our research projects, there has been the need to develop (and / or translate and adapt), psychological assessment instruments, particularly elf-report questionnaires to evaluate traits, processes (cognitive and meta-cognitive), attitudes and symptoms. In order to do this, we have used the most rigorous and recomended qualitative and quantitative methodologies, to analyze the psychometric and operative properties, in clinical and community samples.
Our group has an extensive research experience in the field of personality and psychological distress (PD). These studies have focused in the characteristics and role of subclinical traits, namely studying perfectionism and the relationship between this trait and psychopathology. Our correlational studies have established an association between the maladaptive aspects of perfectionism and a broad range of psychopathological conditions and health problems. We have established that a transdiagnostic cognitive process - repetitive negative thinking) is a significant mediator of the relationship between perfectionism and psychological distress, as well as, with disordered eating behaviours and OC symptoms. We are now also interested in the role of parental perfectionism and RNT in the development of children perfectionism and psychopathology levels. For this purpose our aim is to analyse the role of parental perfectionism and RNT in the children emotion regulation and psychological distress/psychopathology symptoms (anxiety, depression, OC and eating disorders symptom.
Following the current trend for the combination of traits in analysing their pathways of influence in the (de) regulation trajectories, we have also analysed the interaction of perfectionism with other personality traits such as optimism, defensive pessimism, and more recently, features associated the so-called "dark personality" (narcissism, Machiavellianism and psychopathy).
Our expertise in this topic has led other departments (Civil Engineering and Computer Engineering) of University of Coimbra to seek our advice.
The IPM has a long research experience in the field of personality and psychological distress. Thus, in this context, another line of research undertaken has been to study the role of these processes in somatic diseases in which it has been shown that psychological disturbances have a major role, such as fibromyalgia (FM). FM is a chronic pain syndrome defined by widespread pain. Although the exact etiology and pathogenesis of FM are still unknown, there is increasing evidence supporting an integrative biopsychosocial model in which stress, psychological factors and personality traits (e.g. neuroticism; perfectionism) play a major role. Some studies suggest that psychological distress may play a causal role in the FM syndrome. However, the mechanisms that mediate this association are not fully understood. We hypothesize that in FM patients repetitive negative thoughts may be related with excessive monitorization of pain and other physical signs. As a consequence, this may result in higher pain intensity, and more pain-related fear – avoidance behaviour, which in turn determines more severe functional limitations. In this context, we have investigated the role of stress, some personality traits and specific cognitive processes, namely repetitive Negative Thinking (RNT) in the relationship between personality, psychological distress (PD) and pain perception in FM patients.
The Institute of Psychological Medicine has an extensive experience in psychiatric genetics studies, some of which were pioneering in establishing intra-European networks (e.g. ESF Programme on Molecular Neurobiology in Mental Illness) and USA-Portugal collaborations with projects funded by the NIMH focusing on the identification of susceptibility genes for these disorders through the use of linkage and the more recent state-of-the art association analysis with genome wide association studies (GWAS) and whole genome and exome sequencing.
For this purpose a collaborative network has been settled between Coimbra and other centers in North America, led by Carlos Pato, now working at the University of Southern California (USC Center for Genomic Psychiatry). This Genomic Psychiatry Cohort (GPC) has brought in close over 39,000 participants, including 10,000 patients suffering from schizophrenia, 5,000 patients suffering from bipolar disorder, and 15,000 control participants, and other disorders.
Our studies have utilized the more recent DNA and RNA microarray technology to identify chromosomal regions of linkage to each disorder, genetic association information, as well as areas of differential gene expression in the presence of illness. One of the areas of expertise of our team is phenotypic definition, and in this context, we have been contributing by developing phenotypic measures potentially more adequate to dissect the underlying pathologic mechanisms. In the context of the Center for Neuroscience and Cell Biology (CNC) of Coimbra we are now expanding our work in biomarkers in psychosis to the area of proteomics and metabolomics in order to deliver a predictive model based on a reduced panel of biomarkers that will provide enough information to be used as diagnosis or prognosis for schizophrenia, alone or in combination with the clinical interview.
Unlike the majority of other medical specialties, the challenge in psychiatry is to make evaluations based on observation of behaviours and experiences alone, given the absence of clinically relevant biological measures in psychiatry. With advances in structural and functional neuroimaging, remarkable power to visualize the living brain has been achieved. Importantly, different neuroimaging techniques - PET, MRS, fMRI, DTI - can all provide information about the functional and structural integrity of neural circuitry – ‘neural profiles’ – in healthy and psychiatrically unwell individuals.
Therefore, neuroimaging methodologies have the potential to be employed not only to identify biomarkers reflecting underlying illness mechanisms, but also to help identifying neuroimaging measures that can help in the future with diagnosis, prediction of future risk for development of psychiatric disorders, and prediction of treatment response.
At the Department of Psychological Medicine we are interested in using neuroimaging techniques to investigate the neurobiological underpinnings of mental disorders. With that purpose, we are developing research projects in partnership with the Institute for Nuclear Sciences Applied to Health (ICNAS), which has renowned expertise in neuroimaging research. Our overall goal is to identify potential biomarkers that can predict diagnostic and treatment outcomes during the early stages of Schizophrenia and Bipolar Disorder.
In the Institute of Psychological Medicine we prioritize the research in the topics that we also teach. One of which cuts across all our academic subjects in FMUC - the doctor-patient relationship, clinical communication, illness behavior and help-seeking behavior, in the patient-centered approach. In this context we have adapted several tools that allow us to deepen knowledge on these issues. This is the case of Patient Perception of Centeredness Scale-16, having studied their relationship with outcomes and key processes of the doctor-patient relationship as are adherence, satisfaction and perceived health. We have also developed the Illness and Help Seeking Behaviour Scale and have adapted other instruments that allowed us to investigate the relationship between some personality dimensions and help seeking behavior.
Projectos
(Ref. Outras Àreas - Clinico #217)
PI: Ana Telma Pereira
Financiamento: SANTANDER-FMUC
- (Ref.: Neurociências - Clinico #174)
PI: António Macedo
Financiamento: SANTANDER-FMUC
- Projecto EEA-Grants (MFEEE 2009-2014) Ref. 161SM3
Investigador responsável: Ana Telma Pereira
Finaciamento: Programa Iniciativas de Saúde Pública
Área: Melhoria dos serviços de saúde mental
Sub-área: Melhoria da capacidade dos cuidados de saúde primários para a prevenção do suicídio e para prevenir, diagnosticar e tratar a depressão.
- Projecto COMPETE 2020 Nº 016850, da Autoridade de Gestão do Programa Operacional Competitividade e Internacionalização, submetido no âmbito do Aviso de concurso nº 04/SAICT/2015
Investigador responsável: Ana Telma Pereira
Área: Ciências da Vida e da Saúde - Diagnóstico, Terapêutica e Saúde Pública - Investigação Clínica
Rating do painel de avaliação: 9
- Projecto COMPETE 2020 Nº xxxx, da Autoridade de Gestão do Programa Operacional Competitividade e Internacionalização, submetido no âmbito do Aviso de concurso nº 04/SAICT/2015.
Investigador responsável: António Macedo
Rating do painel de avaliação: 9
Área: Neurociências, Envelhecimento e Doenças Degenerativas - Neurociências - Sistemas, Clínica e Comportamento
Investigador responsável: Professor Doutor António Macedo
Unidade de Investigação: Instituto de Psicologia Médica - FMUC
APROVADO PELA COMISSÃO DE ÉTICA FMUC – Ref. 098-CE-2014
Investigador responsável: Professor Doutor António Macedo
Unidade de Investigação: Instituto de Psicologia Médica - FMUC
APROVADO PELA COMISSÃO DE ÉTICA FMUC – Ref. 41-CE-2012
Investigadores responsáveis: Prof Doutor António João Ferreira de Macedo e Santos
Prof Doutor José António Pereira da Silva
Unidades de Investigação: Instituto de Psicologia Médica – FMUC e Clínica Universitária de Reumatologia, Hospitais da Universidade, CHUC-EPE
APROVADO PELA COMISSÃO DE ÉTICA FMUC – Ref. 40-CE-2012