Mental health, behavior challenges and strategies for management Raffael Massuda MD, PhD rfmassuda@ufpr.br

MENTAL HEALTH Emotional Psychological Social

MENTAL HEALTH Emotional Feel Act Think Handle Stress Relate to others Make Choices Psychological Social

MENTAL HEALTH Emotional Feel Act Think Handle Stress Relate to others Make Choices Psychological Social Every stage of life

What Contributes to Mental Health? Biological Factors Mental Health Life Experiences Family History

Mental Health in Homocystinuria? Only 2.8% starts with psychiatry symptoms Most Common Psychiatry Diagnoses: Depression Psychosis - Schizophrenia Intelectual Disability Abbott, 1987 Demily, 2014

DEPRESSION Common condition in general population: 10% Abbott, 1987 Demily, 2014 woman in the black field - Glenn Brady

DEPRESSION Common condition in general population: 10% Same prevalence in homocystinuria Abbott, 1987 Demily, 2014 woman in the black field - Glenn Brady

DEPRESSION Common condition in general population: 10% Same prevalence in homocystinuria Main symptoms: Depressed mood Loss of interest or pleasure Change from previous functioning Weight change, insomnia, fatigue, worthlessness, memory, suicide thinking Abbott, 1987 Demily, 2014 woman in the black field - Glenn Brady

PSYCHOSIS Psychosis is a loss of contact with reality There are four symptoms associated with psychotic episode: Hallucinations Delusions Confused and disturbed thoughts Lack of insight and self-awareness Yayoi Kusama

PSYCHOSIS Hallucinations: are where someone sees, hears, smells, tastes or feels things that don't exist outside their mind Delusions: beliefs that are firmly maintained despite being contradicted by what is generally accepted as reality or rational argument Yayoi Kusama

Schizophrenia PSYCHOSIS Hallucinations: are where someone sees, hears, smells, tastes or feels things that don't exist outside their mind Delusions: beliefs that are firmly maintained despite being contradicted by what is generally accepted as reality or rational argument Schizophrenia Yayoi Kusama

SCHIZOPHRENIA Psychotic Disorder 1% of the population Chronic Disorder Positive Symptoms “psychosis” Psychotic Disorder 1% of the population Chronic Disorder Starts at: Men: 18-25 years old Women: 25-35 years old Negative Symptoms “blunt affect” Cognitive Impairment Thought Disorganization

PSYCHOSIS Psychosis in homocystinuria: could be late psychiatry symptom Prevalence: rare? Psychosis: related to vascular diseases and demyelination Increasing interest: Homocystine Hypothesis of Schizophrenia Colafrancesco, 2014 Eur Jour Pediatr Ryan 2002 J Child Neurol Yayoi Kusama

HOMOCYSTEINE LEVELS Adolescents with Schizophrenia Siblings of Patients with Schizophrenia Nevo, 2007 European Neuropsychoph Geller, 2013 Psychiatry Research Muntjewerff 2005 Molecular Psychiatry

HOMOCYSTEINE LEVELS 5 μ mols 70% risk Adolescents with Schizophrenia Siblings of Patients with Schizophrenia Nevo, 2007 European Neuropsychoph Geller, 2013 Psychiatry Research Muntjewerff 2005 Molecular Psychiatry 5 μ mols 70% risk

HOMOCYSTEINE LEVELS Petronijević 2008 Progress in Neuro-Psy Biological Psych

HOMOCYSTEINE LEVELS Petronijević 2008 Progress in Neuro-Psy Biological Psych

Are there any link between Schizophrenia and Homocystinuria? Moustafa, 2014 Front Behav Neurosc

Are there any link between Schizophrenia and Homocystinuria? PYRIDOXINE DOPAMINE GABA SEROTONINE NORADRENALINE Miyake, 2010 CNS Neuroscience & Therapeutics Kennedy, 2016 Nutrients

HOMOCYSTINE SCHZOPHRENIA HOMOCYSTINE

HOMOCYSTINE SCHZOPHRENIA HOMOCYSTINE DEPRESSION

HOMOCYSTINE SCHZOPHRENIA HOMOCYSTINE DEPRESSION BIPOLAR DISORDER

INTELECTUAL DISABILITY Intellectual disability: Deficits in general mental abilities: problems solving, planning, abstract thinking Impairment in everyday adaptive functioning: independence and social responsibility During the developmental period: delayed motor, language and social milestones Mazzocco, 2007 Neurogenetics Neurodevelopl Dis. DSM-5, 2013 Am Psy Assoc Yayoi Kusama

INTELECTUAL DISABILITY Intellectual disability: Prevalence: 50% pyrodoxine responders 80% non-responders Classical Homocystinuria: Good adherence: IQ Population average Poor adherence: Low IQ Mazzocco, 2007 Neurogenetics Neurodevelopl Dis. DSM-5, 2013 Am Psy Assoc Yayoi Kusama

MANAGEMENT STRATEGIES Multidisciplinary team! Diagnose better: Better treatment

MANAGEMENT STRATEGIES Multidisciplinary team! Diagnose better: Better treatment We need more studies!!

MANAGEMENT STRATEGIES Multidisciplinary team! Diagnose better: Better treatment We need more studies!! Early interventions: pharmacological, psychological and social

MANAGEMENT STRATEGIES Multidisciplinary team! Diagnose better: Better treatment We need more studies!! Early interventions: pharmacological, psychological and social End the stigma!

Thank You! rfmassuda@ufpr.br