André Malbergier

Comparative study of drug use among undergraduate students at the University of São Paulo--São Paulo campus in 1996 and 2001.

OBJECTIVE To compare the rate of drug use prevalence and to investigate opinions regarding such use among undergraduate students at the University of São Paulo--São Paulo campus in 1996 and again in 2001. METHODS Both studies followed the same procedures of sampling and data collection. A random sample of undergraduate students, divided into the areas Humanities, Exact Sciences and Biologic Sciences, responded to an anonymous and self-report survey regarding the use of licit and illicit drugs within the last 30 days, within the last 12 months and over the lifetime of the subject. The two surveys were compared through the construction of (95%) confidence intervals for the prevalence differences for each substance by area and by total number of students. The Wald test for homogeneity was applied in order to compare the prevalences. RESULTS High approval of regularly trying and using cocaine, crack, amphetamines and inhalants was observed. The drugs that showed statistic significant increasing were:lifetime use: alcohol, tobacco, marijuana, inhalants, hallucinogens, amphetamines, anti cholines, barbiturics and any illicit drug;last-12-month use: marijuana, inhalants, amphetamines, hallucinogens and any illicit drug;last-30-day use: marijuana, inhalants, amphetamines and any illicit drug. DISCUSSION The observed difference in the use of some drugs between the two surveys appears to be a consequence of the higher rates of favorable opinions regarding trying and regularly using some psychoactive substances, a finding that mirrors global trends in drug use.

Dependencia de tabaco e comorbidade psiquiatrica

A incidencia e a prevalencia de doencas mentais sao maiores nos fumantes do que no restante da populacao. O tratamento da dependencia da nicotina nestes pacientes e dificil. Este estudo tem por objetivo promover uma revisao da associacao entre o tabagismo e as doencas psiquiatricas. METODO: Foi realizada uma revisao seletiva da literatura sobre o tema. Os autores apresentam artigos sobre a associacao entre tabagismo e depressao, pânico, esquizofrenia, transtorno de deficit de atencao e hiperatividade (TDAH), doenca de Alzheimer e abuso de substâncias. RESULTADOS: O tabagismo tem intima relacao com outros transtornos psiquiatricas, especialmente com depressao, esquizofrenia, TDAH e abuso de drogas. Fumar e associado a um maior risco de crises de pânico e sao necessarios novos estudos de coorte para verificar a hipotese de uma relacao inversa entre o consumo de nicotina e desenvolvimento de doenca de Alzheimer. CONCLUSAO: Ha crescente evidencia da relacao entre o tabagismo e comorbidades psiquiatricas. Outros estudos da associacao entre comorbidades psiquiatricas e tabagismo sao necessarios para melhor compreensao desta relacao complexa.

Depression in women living with HIV: clinical and psychosocial correlates

The number of Brazilian women living with HIV has increased significantly in past years, rendering studies of their particular care demands including psychiatric issues. This study measures the prevalence of major depression, using the Structured Clinical Interview for DSM-IV Axis I Disorders, in a sample of 120 women living with HIV in treatment at a reference centre in São Paulo. Socio-demographic variables, HIV-related clinical and laboratory data, including CD4+ cell counts and HIV plasma viral loads, as well as psychosocial features (intimate relationships, disclosure of HIV serostatus, partner’s serostatus and patient’s emotional and financial support) were investigated as factors potentially associated with depression. The prevalence of major depression at the time of evaluation was 25.8% (95% CI 18.2–33.4%). Clinical status (p = 0.002), lack of emotional support (p = 0.02), use of antidepressants (p = 0.028) and length of time since HIV diagnosis (p = 0.05) were associated with major depression in univariate analysis. In multivariate multiple-regression model, HIV clinical status, lack of emotional support and higher plasma viral loads were associated with depression. Sixty per cent of the women have a major depression diagnosis during lifetime. We conclude that major depression is highly prevalent among women living with HIV, but it is still underdiagnosed and undertreated.

Depression in women infected with HIV

OBJECTIVE The number of women with HIV infection has been on the rise in recent years, making studies of the psychiatric aspects of this condition very important. The aim of this study was to evaluate the prevalence of major depression in women with HIV infection. METHOD A total of 120 women were studied, 60 symptomatic (with AIDS symptoms) and 60 asymptomatic (without AIDS symptoms). Sociodemographic data were collected, and depressive disorders were identified. The instruments used to evaluate the depressive disorders were the SCID, DSM-IV, 17-item Hamilton depression scale, Hamilton depression scale for nonsomatic symptoms and the Beck depression scale. RESULTS The prevalence of major depression was 25.8% and was higher in the symptomatic group than in the asymptomatic group (p = 0.002). CONCLUSIONS The prevalence of major depressive episodes in women with HIV infection is high, and women with AIDS-related symptoms are more often depressed than are those who have never presented such symptoms.

O consumo de álcool como fator de risco para a transmissão das DSTs/HIV/Aids

CONTEXTO: No Brasil 74,4% da populacao ja fez uso de alcool alguma vez na vida (Cebrid/Unifesp, 2005). O consumo dessa substância tem sido associado com a pratica de comportamento sexual de risco para as DSTs/HIV/Aids. OBJETIVOS: Revisar a literatura que investiga associacao entre comportamento sexual de risco para infeccao do HIV e o uso de alcool. METODOS: Realizou-se uma busca bibliografica nas bases de dados MEDLINE e LILACS nos periodos de 2000 a 2007. A busca foi realizada por meio do cruzamento dos unitermos comportamento sexual de risco, HIV e Aids com os unitermos alcool, uso, abuso e dependencia de alcool. RESULTADOS: Dados encontrados na literatura apontam que homens (heterossexuais e homossexuais), adolescentes, imigrantes e profissionais do sexo sao os que associam, mais frequentemente, alcool com pratica de sexo sem preservativo. As mulheres se expoem ao risco com menor frequencia. CONCLUSOES: O uso de alcool associado ao comportamento sexual mostrou ser um fator de risco para transmissao das DSTs/HIV/Aids, visto que, quando ingerido antes ou durante o ato sexual, favorece a pratica sem preservativo. O local em que se consome a bebida, antes ou durante o ato sexual, e a quantidade ingerida parecem ser fatores preponderantes na manutencao dessa associacao.

Depressive disorders and suicide attempts in injecting drug users with and without HIV infection

Injecting drug users (IDUs) seeking treatment for drug dependence were selected in two groups according to their HIV (human immunodeficiency virus) status. Thirty HIV-positive and 30 HIV-negative patients were submitted to a structured interview to assess psychiatric disorders. Initially, depressive disorders, suicide attempts and disorders related to substance use were analyzed. The results showed that the diagnosis of cocaine dependence was more frequent among HIV-infected patients than in the non-infected. Being HIV-positive was not associated with higher prevalence of depression. Suicide attempts were frequent in this sample, but the frequencies were equal in both groups. Concluding, the results did not show any association between the HIV-positive serology and depressive disorders and suicide attempts when IDUs are compared to the control group, also IDUs but HIV-negative.

Uso de substâncias na adolescência e problemas familiares

This study aimed to evaluate the association between substance use (alcohol, tobacco, and illicit drugs) and family problems among 965 adolescents from 50 public schools in two cities in Sao Paulo State, Brazil, in 2007. The Drug Use Screening Inventory (DUSI) was used for data collection. Use of alcohol, tobacco, and illicit drugs was associated with a negative assessment of the family relationship, lack of monitoring/support, and psychoactive substance use by family members (p < 0.05). Adolescents that reported having used alcohol, tobacco, and illicit drugs had more family problems than those who did not consume any substance (p < 0.001). Adolescents that used alcohol and tobacco (p = 0.028) and illicit drugs (p < 0.001) reported having more family problems than those who used only alcohol. The results highlight the importance of awareness of alcohol and tobacco use by adolescents, since such use was associated with significant family impairments, similar to illicit drug use.

Drug consumption among medical students in São Paulo, Brazil: influences of gender and academic year.

OBJECTIVE To analyze alcohol, tobacco and other drug use among medical students. METHOD Over a five-year period (1996-2001), we evaluated 457 students at the Universidade de São Paulo School of Medicine, located in São Paulo, Brazil. The students participated by filling out an anonymous questionnaire on drug use (lifetime, previous 12 months and previous 30 days). The influence that gender and academic year have on drug use was also analyzed. RESULTS During the study period, there was an increase in the use of illicit drugs, especially inhalants and amphetamines, among the medical students evaluated. Drug use (except that of marijuana and inhalants) was comparable between the genders, and academic year was an important influencing factor. DISCUSSION Increased inhalant use was observed among the medical students, especially among males and students in the early undergraduate years. This is suggestive of a specific behavioral pattern among medical students. Our findings corroborate those of previous studies. CONCLUSION Inhalant use is on the rise among medical students at the Universidade de São Paulo School of Medicine. Because of the negative health effects of illicit drug use, further studies are needed in order to deepen the understanding of this phenomenon and to facilitate the development of preventive measures.

Tratamento de depressão em indivíduos infectados pelo HIV

HIV/AIDS infection is frequently associated with psychiatric disorders, especially depression. The diagnosis and treatment of depression are essential to improve quality of life in these individuals. This review intends to summarize and discuss the most important results in the literature about the treatment of depression in HIV-infected individuals. The epidemiology, clinical presentation, contribution of depression on HIV infection, pharmacological treatment with antidepressants, testosterone, and psychostimulant drugs, and pharmacological interactions between antidepressants, benzodiazepines, and antiviral medications are discussed. The conclusion drawn from this study is that the treatment of depression in this population is effective, safe and does not promote immunosupression.

Gender parity and drug use: are girls catching up with boys?

OBJECTIVE To evaluate the association between gender and use of alcohol, tobacco, and other drugs in adolescents aged 10 to 18 years in the municipalities of Jacareí and Diadema, São Paulo, Brazil. METHODS A total of 971 adolescents completed the Drug Use Screening Inventory (DUSI). RESULTS In our sample, 55% of adolescents were male, 33.8% reported having made use in the previous month of alcohol, 13.5% of cigarettes, and 6.4% of illicit drugs. There was no significant difference between genders in the use of alcohol, tobacco, and illicit drugs in any of the analysis (p > 0.05). The use of alcohol, tobacco, and illicit drugs was associated with the city, age, educational level, school failure, and relationship with parents (p < 0.05). CONCLUSIONS Substance abuse among adolescents in our sample seems to follow the recent global trend towards the equalization of drug use between genders. This result should be taken into account by public health professionals in developing policies for this problem.