Cláudio Jerônimo da Silva

Leptin influence in craving and relapse of alcoholics and smokers.

Leptin inhibits signaling of dopamine in the nucleus accumbens, suggesting its role in regulating stress and its possible involvement in the neurobiology of reward system. The aim of this study was to review of the literature on the influence of leptin in the craving for alcohol and tobacco and whether there is already evidence that leptin may be a biomarker to indicate risk for craving and relapse. The review used as data bases Medline, LILACS and SciElo in the period between 2000 and 2012. Keywords were leptin, substance use disorders, craving and withdrawal, in Portuguese and English. Only 12 articles were met the inclusion criteria, relating leptin with craving in alcoholics (n = 10) and smokers (n = 2). No studies were found in the LILACS database. Leptin levels increase during abstinence and this may be related to a reduction of dopaminergic action in mesolimbic system, resulting in a greater intensity of craving and maintenance of addictive behavior. Although there are few studies, the most recent results indicate the usefulness of leptin as a marker of risk for relapse among smokers and alcoholics in abstinence.

Women who smoke and stop during pregnancy: who are they?

OBJETIVOS: identificar fatores envolvidos no comportamento de continuar fumando a despeito de estar gravida. METODO: entrevistas padronizadas foram aplicadas a 486 mulheres gravidas nas clinicas de pre-natal de quatro centros de saude na cidade do Rio de Janeiro, Brasil, no periodo de abril 2003 a fevereiro 2004. Todas as vezes que uma fumante era identificada, uma entrevista adicional foi aplicada, contendo a Escala de Edinburgh para Depressao, a escala de Fagerstron para dependencia de nicotina e o Questionario de Avaliacao de Doencas Mentais em adultos. RESULTADOS: a prevalencia de tabagismo nos estagios iniciais da gravidez foi de 21,1%. A maioria das tabagistas apresentou baixo nivel de dependencia de nicotina. Trinta e seis por cento das mulheres avaliadas pararam de fumar no primeiro trimestre da gestacao sem qualquer intervencao medica especifica. As mesmas beberam menos durante a gestacao e haviam tentado parar de fumar mais vezes anteriormente. CONCLUSOES: os resultados sugerem uma motivacao inespecifica para o bem estar do concepto que envolve as duas drogas licitas. Aquelas que pararam, tentaram mais vezes anteriormente e tambem diminuiram o consumo de alcool na gestacao atual.

Terapias Cognitiva e Cognitivo-Comportamental em dependência química

This article describes the current status of Cognitive and Behavioral Therapy as well Relapse Prevention and Coping Skill approaches applied in drug abuse treatments. The objective is show a review about theories and technique used by Cognitive Therapy and others approaches derived that, specifically Relapse Prevention and Coping Skill Treatments. Cognitive and Behavioral Therapy, Coping Skill, and Relapse Prevention are a short-time, goal-oriented and structured treatments. Thus, they assume a posture directive and active. We pointed out some difference between the theories about Cognitive Therapy, Relapse Prevention and Coping Skill. The Cognitive Therapy accentuated the focus in patients thought, feeling and circumstances that get in a dysfunctional behavioral. Relapse Prevention and Coping Skill are based in behavioral theories besides of the Cognitive. We, finally, look forward to introduce the lasted scientific finding to helpful the general psychiatric to improve the assistance in drug abuse treatment.

Contingency management targeting abstinence is effective in reducing depressive and anxiety symptoms among crack cocaine-dependent individuals.

Although contingency management (CM) is effective in promoting abstinence and treatment retention among crack cocaine users who meet the criteria for cocaine dependence, less is known about its off-target effects. In this secondary analysis, we evaluated the impact of CM on depressive and anxiety symptoms in a sample of cocaine-dependent individuals under treatment. Sixty-five crack cocaine users who met the criteria for cocaine dependence were randomly assigned to receive 12 weeks of standard treatment alone (STA; n = 32) or 12 weeks of standard treatment plus CM (STCM; n = 33). The outcome measures of the secondary analysis were depressive and anxiety symptoms assessed with the Beck Depression Inventory-II (BDI-II) and the Beck Anxiety Inventory (BAI). At baseline, 59 (90.8%) of the participants reported at least mild depressive symptoms and 47 (72.5%) reported at least mild anxiety symptoms. The mean BDI-II (24.5 ± 12.1) and BAI (20.7 ± 13.5) scores in the sample as a whole was moderate. After treatment, the reported levels of depressive symptoms (&bgr; = −9.6, p < .05) and anxiety symptoms (&bgr; = −9.9, p < .05) were lower among the individuals receiving STCM than among those receiving STA. This study provides evidence that an STCM intervention targeting crack cocaine abstinence also produces significant reductions in depressive and anxiety symptoms. This low cost intervention also demonstrated significant promise and optimization potential for crack cocaine users in a setting of scarce resources and high mental health comorbidity. Relevance Statement: We found that the prevalence of depressive and anxiety symptoms were extremely high among crack cocaine users, and that, among such individuals, contingency management (CM) reduced depressive and anxiety symptomatology to a greater degree than did standard treatment. Our results suggest that CM targeting crack cocaine abuse can have off-target effects on psychiatric symptomatology.

Erectile Dysfunction Symptoms in Polydrug Abusers Seeking Treatment

We appreciate the kind comment made by the colleagues (Ayubi and Safiri, 2017) in observing that there were both misunderstandings in the abstract and in the text regarding the odds ratio (OR) values of marital status, which require an erratum in order to correct them. It should be mentioned that the logistic regression analysis used in this study followed standard procedure, first identifying the

Sociodemographic Characteristics, Patterns of Crack Use, Concomitant Substance Use Disorders, and Psychiatric Symptomatology in Treatment-Seeking Crack-Dependent Individuals in Brazil

ABSTRACT Crack cocaine (crack) dependence is a severe disorder associated with considerable morbidity and mortality, constituting a major public health problem in Brazil. The aim of this study was to improve understanding of the profile of treatment-seeking crack-dependent individuals. We recruited 65 crack-dependent individuals from among those seeking treatment at an outpatient clinic for alcohol and drug treatment in the city of São Paulo, Brazil. Assessments, conducted between August 2012 and July 2014, focused on sociodemographic characteristics, the pattern/history of crack use, treatment history, concomitant substance use disorders, psychiatric symptomatology, and impulsivity. In the study sample, males predominated, as did unemployment, homelessness, and low levels of education. On average, the participants had smoked crack for 10 years. Most had previously been treated for crack dependence. Concomitant DSM-IV diagnoses of dependence on other substances were common, dependence on tobacco and alcohol being the most prevalent. Participants presented significant psychiatric symptomatology and impulsivity, with nearly half of the sample presenting psychotic symptoms, 90% presenting depressive symptoms, and 80% presenting anxiety symptoms. Most treatment-seeking crack-dependent individuals in Brazil are living in extremely poor social conditions and are struggling with the severe, chronic, and comorbid features of this disorder.

Erectile Dysfunction Symptoms in Polydrug Dependents Seeking Treatment

ABSTRACT Objective: To assess erectile dysfunction (ED) symptom prevalence, sexual behavior conditions, and risk factors associated to ED in a male polydrug dependent sample. Methods: A cross-sectional design study was conducted with 102 substance-dependent male polydrug users who sought outpatient treatment in São Paulo, Brazil. Sociodemographic data, drug of choice, chronic disease questions, sexually transmitted infections, International Index of Erectile Function (IIEF) scale, Sexual Addiction Screening Test (SAST), and WHOQOL-Bref instrument were used. Results: The erectile dysfunction prevalence was 32.3% and it was related to the marital status (single) (p < 0.001), occupational status (fully unemployed) (p < 0.001), presenting a chronic disease (p = 0.027), and with types of sexual partnerships (occasional partner) (p < 0.001). Alcohol (73.5%), tobacco (79.4%), cannabis (83.3%), and cocaine (snorted 78.4% and smoked 42.2%) were the drugs of choice. The ED risk decreased when marital status was married (odds ratio = 3.2 CI95% 1.411–7.518) and with chronic disease (odds ratio 0.06 CI95% 0.00–0.97), while having occasional sexual partners increased 14 times ED risk (OR 14.0 CI95%1.62–122.18). There were no significant associations between quality of life, DOC and ED. Conclusion: Approximately one third of the substance dependents in this sample presented ED. There is a need to integrate psychiatric and clinical care in substance treatment services, and to improve the provision of sexual health care and support available for this population.

Paraphilic Thoughts, Behaviors and Sex Addiction in a Sample of Persons Who Use Drugs: A Cross-Sectional Study

Objective: The aim of this study was to evaluate the prevalence of paraphilic thoughts/behaviors (including paraphilic disorders) with and without sexual addiction and sexual-related conditions in a sample of substance disorder patients. Methods: This was a cross-sectional study of substance-dependent individuals who sought outpatient treatment in São Paulo, Brazil. Data included sociodemographic information, drug of choice, responses to questions about sexual behavior, and to the following standardized questionnaires: (a) Sexual Addiction Screening Test, and (b) Childhood Trauma Questionnaire. Results: The sample comprised 134 persons who use drug, predominantly men (76.1%), 39.6% were aged between 18 and 29 years, and 54.9% were single. Most were persons who use polydrug, 73.9% were alcohol and cocaine users, 63.4% marijuana users, 81.1% tobacco users, and 5.2% steroid users. Prevalence of paraphilic thoughts/behaviors (including paraphilic disorders) with and without sexual addiction was 47%. The HPV/herpes and hepatitis B rates were 7.9% (P = 0.021) and 6.3% (P = 0.046) respectively. Paraphilic and nonparaphilic thoughts/behaviors were associated to the presence of childhood physical neglect (odds ratios [OR] = 4.7, 95% confidence interval [CI] 1.0 to 21.9), low educational level (OR = 7.2, 95% CI 1.4 to 36), heterosexuality (OR = 3.8, 95% CI 1.1 to 12.8) and youth (age 18 to 20 years) (OR = 5.6, 95% CI 1.4 to 11.8). Conclusions: The high prevalence of paraphilic thoughts/behaviors with or without sex addiction in persons who use drugs may be related to the experience of physical and emotional neglect during childhood and this possibility should routinely be investigated in clinical practice.

O adolescente e o jovem adulto no programa de álcool e drogas do Ambulatório Médico de Especialidade em Psiquiatria (Dra. Jandira Masur): características específicas e vulnerabilidades

Juliana de Almeida Castro Marinho Meirelles Universidade Federal de São Paulo Ana Carolina Schimdt de Oliveira Melina Machado Basílio Claudio Jeronimo da Silva Ronaldo Laranjeira Gerardo Maria de Araújo Filho _______________________________________________________________________________________ Como citar: MEIRELLES; Juliana de Almeida Castro Marinho et al. O adolescente e o jovem adulto no programa de álcool e drogas do Ambulatório Médico de Especialidade em Psiquiatria (Dra. Jandira Masur): características específicas e vulnerabilidades. In: II SIMPÓSIO NACIONAL SOBRE ADOLESCÊNCIA: VULNERABILIDADE, PROTAGONISMOS E DESAFIOS, 2. 2016, São Paulo. Anais...[S.I]: 2016. p. 31. DOI: http://dx.doi.org/10.22388/2525-5894.2016.008 _______________________________________________________________________________________