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António Egas Moniz, born in 1874, was a pioneer in neurology, neurosurgery and psychiatry who brought about important changes in the 1920s using groundbreaking brain imaging techniques, such as cerebral angiography. This innovative procedure allowed the visualization of brain structures, leading to many advances in neurology and neurosurgery. Moniz also made noteworthy contributions to psychosurgery, including the development of prefrontal lobotomy. Although initially praised for his inventive techniques, lobotomy sparked ethical debates and public controversies due to its adverse effects and questionable scientific foundation. Moniz's was awarded the Nobel Prize in Physiology or Medicine in 1949 and received various honors in Portugal for his scientific, literary, and artistic achievements. His work continues to influence the field of neuroscience, and angiography remains a crucial imaging method for diagnosing and treating brain disorders. Moniz's complex legacy highlights the intricate balance between medical advances, ethical considerations, and public perceptions in the history of medicine.

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BACKGROUND: Major Depressive Disorder (MDD) is a global health issue, and a significant portion of individuals with MDD experience Treatment-Resistant Depression (TRD), characterized by the lack of response to adequately trialed antidepressant medication and therapy. This systematic review aims to investigate the effectiveness of Mindfulness-Based Cognitive Therapy (MBCT) as an intervention for individuals with TRD. MATERIALS AND METHODS: We will conduct a thorough search for publications of randomized clinical trials and quasi-experimental studies in MEDLINE, Embase, PsycINFO, Web of Science databases, and ClinicalTrials.gov. Furthermore, reference lists of included studies will be manually screened for additional relevant articles, with no restrictions on language or publication date. The search will be conducted from the inception of the databases until June 2024. Our PICO-guided research questions are: (1) In adults with Treatment-Resistant Depression, is MBCT more effective than standard care or other active treatments in reducing depressive symptoms? (2) In adults with Treatment-Resistant Depression, does MBCT demonstrate a comparable safety profile to standard care or other active treatments? The quality of the included studies will be assessed independently using the Cochrane Risk of Bias Tool (RoB 2). This study seeks to evaluate the effectiveness and tolerability of Mindfulness-Based Cognitive Therapy as an intervention for Treatment-Resistant Depression, and will employ the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) methodology to appraise the confidence in the evidence. PROSPERO REGISTRATION: Prospero registration ID: CRD42023411978. Registered on April 07, 2023.

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BACKGROUND: Major Depressive Disorder is a long-term, recurring, and very common illness that is associated with a significant decline in functional ability. The gold-standard method of treating depression is pharmacotherapy, which involves the use of antidepressant medications either alone or in various combinations. However, approximately 30% of Major Depressive Disorder patients suffer from Treatment Resistant Depression, a more severe condition that has a profound impact on patients' lives. Our study aims to conduct the first comprehensive review and meta-analysis to assess the effectiveness and safety of adding Dialectical Behavior Therapy to antidepressant medications compared to groups using pharmacotherapy alone as an intervention for adults with Treatment Resistant Depression. MATERIALS AND METHODS: We will search for publications in the following databases: Cochrane Central Register of Controlled Trials, MEDLINE, Embase, Lilacs, Web of Science, and PsycINFO. We will manually review the reference lists of the included studies to identify potentially relevant studies. There will be no restrictions on the language or publication date. Quality assessment of the included studies will be performed independently according to the Cochrane Risk of Bias instrument. To assess the certainty of the findings' body of evidence, we will use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. This study aims to determine the effectiveness and safety of Dialectical Behavior Therapy as an intervention for Treatment Resistant Depression in adults. ETHICS AND DISSEMINATION: Ethical approval was not required as individual patient data was not obtained. Our intention is to publish the systematic review in a medical journal that offers open access upon completion of the process. TRIAL REGISTRATION: PROSPERO registration number CRD42023406301. Registered on March 24, 2023.

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Introduction: Major Depressive Disorder (MDD) is a chronic, recurrent, and highly prevalent disease that is associated with significant functional disability. During pregnancy, the prevalence of the disease is approximately 20%, with 12% of these, requiring treatment to avoid important negative consequences for the mother-baby binomial. Risk-benefit assessment of the use of antidepressants during pregnancy is mandatory, in addition to knowledge of the long-term effects of prenatal exposure to these drugs in the offspring. In this study, we will perform an updated systematic review and meta-analysis to explore the treatment of depression during pregnancy, along with its effectiveness, safety, and possible harm to women and children. Materials and methods: We will search for publications in the following databases: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, Embase, Web of Science, Scopus, Lilacs, and PsycINFO. The reference lists of the included studies will be manually reviewed to identify potentially relevant studies. There will be no restrictions on language or date of publication. Quality assessment of the included studies will be performed independently according to the Cochrane Risk of Bias (RoB2) instrument. To assess the certainty of the findings' body of evidence, we will use the Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. This study aimed to ascertain the efficacy and safety of antidepressants in pregnant women and children. Ethics and dissemination: Ethical approval was not required as individual patient data were not collected. Dissemination: Plan to publish a systematic review in an open-access medical journal at the end of the process. Systematic Review Registration: PROSPERO, CRD42023447694.

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To analyze the association between the coverage of psychosocial care centers (CAPS) and Primary Health Care (PHC) and the number of psychiatric hospitalizations in the metropolitan regions of the capitals of Rio de Janeiro (RJ) and São Paulo (SP) states. This is an ecological time-series study with population consisting of dwellers of metropolitan areas of the municipalities of RJ and SP hospitalized in the Unified Health System (SUS). Secondary data were collected from DATASUS and IBGE portal and indicators calculated (CAPS supply, PHC coverage, provision of psychiatric beds and psychiatric hospitalization rates). Indicators' time trends and the association between CAPS and PHC coverage and hospitalization rates were calculated. Reduced psychiatric hospitalizations rates and psychiatric beds and increased CAPS and PHC coverage were observed in the two location under study, with inverse and statistically significant association. Results confirmed the hypothesis of association between increasing CAPS and PHC supply with decreased psychiatric hospitalization rates, in the study's period and regions. This finding reinforces the importance of continuous and improved health and psychiatric reform-related policies.

CONCLUSÕES: O objetivo deste artigo é analisar a associação entre a cobertura de Centros de Atenção Psicossocial (CAPS) e a Atenção Básica (AB) e o número de internações psiquiátricas, nas regiões metropolitanas das capitais dos Estados de Rio de Janeiro (RJ) e São Paulo (SP). Estudo ecológico de séries temporais com população composta por residentes das regiões metropolitanas dos municípios do RJ e de SP internados no âmbito do SUS. Dados secundários foram coletados (portal do DATASUS e IBGE) e calculados indicadores (oferta de CAPS, cobertura da AB, oferta de leitos psiquiátricos e taxa de internações psiquiátricas). Foram calculadas as tendências temporais dos indicadores e a associação entre as coberturas de CAPS e AB e as taxas de internação. Observou-se redução das taxas de internações psiquiátricas e oferta de leitos e aumento da cobertura de CAPS e AB nas duas localidades estudadas, com associação inversa e estatisticamente significativa. : os resultados confirmaram a hipótese de associação entre as tendências crescentes de oferta de CAPS e AB e diminuição das taxas de internação psiquiátrica no período e regiões do estudo. Este achado reforça a importância da continuidade e aprimoramento das políticas relacionadas às reformas psiquiátrica e sanitária.

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Resumo Conclusões O objetivo deste artigo é analisar a associação entre a cobertura de Centros de Atenção Psicossocial (CAPS) e a Atenção Básica (AB) e o número de internações psiquiátricas, nas regiões metropolitanas das capitais dos Estados de Rio de Janeiro (RJ) e São Paulo (SP). Estudo ecológico de séries temporais com população composta por residentes das regiões metropolitanas dos municípios do RJ e de SP internados no âmbito do SUS. Dados secundários foram coletados (portal do DATASUS e IBGE) e calculados indicadores (oferta de CAPS, cobertura da AB, oferta de leitos psiquiátricos e taxa de internações psiquiátricas). Foram calculadas as tendências temporais dos indicadores e a associação entre as coberturas de CAPS e AB e as taxas de internação. Observou-se redução das taxas de internações psiquiátricas e oferta de leitos e aumento da cobertura de CAPS e AB nas duas localidades estudadas, com associação inversa e estatisticamente significativa. : os resultados confirmaram a hipótese de associação entre as tendências crescentes de oferta de CAPS e AB e diminuição das taxas de internação psiquiátrica no período e regiões do estudo. Este achado reforça a importância da continuidade e aprimoramento das políticas relacionadas às reformas psiquiátrica e sanitária.

Abstract To analyze the association between the coverage of psychosocial care centers (CAPS) and Primary Health Care (PHC) and the number of psychiatric hospitalizations in the metropolitan regions of the capitals of Rio de Janeiro (RJ) and São Paulo (SP) states. This is an ecological time-series study with population consisting of dwellers of metropolitan areas of the municipalities of RJ and SP hospitalized in the Unified Health System (SUS). Secondary data were collected from DATASUS and IBGE portal and indicators calculated (CAPS supply, PHC coverage, provision of psychiatric beds and psychiatric hospitalization rates). Indicators' time trends and the association between CAPS and PHC coverage and hospitalization rates were calculated. Reduced psychiatric hospitalizations rates and psychiatric beds and increased CAPS and PHC coverage were observed in the two location under study, with inverse and statistically significant association. Results confirmed the hypothesis of association between increasing CAPS and PHC supply with decreased psychiatric hospitalization rates, in the study's period and regions. This finding reinforces the importance of continuous and improved health and psychiatric reform-related policies.

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