Felipe Ornell

Oxidative stress and BDNF as possible markers for the severity of crack cocaine use in early withdrawal

RationaleAn important goal of addiction research is to discover neurobiological markers that could predict the severity of addiction and help to determine appropriate treatment. Brain-derived neurotrophic factor (BDNF) and thiobarbituric acid reactive substances (TBARS) are being related to cerebral plasticity and impairment caused by substance abuse.ObjectivesThis study aims to evaluate alteration of TBARS and BDNF levels among crack cocaine users during early drug withdrawal and its relationship to severity of drug use.MethodsForty-nine adults crack cocaine users were recruited at a public psychiatric hospital with a specialized addiction treatment unit. Blood sample was collected at intake and discharge for the analysis of TBARS and BDNF measures. Information about drug use was assessed by the Addiction Severity Index 6th Version (ASI-6). Detailed information about crack cocaine use was obtained through the “Profile of the crack cocaine user.” Severity of crack use was estimated using information from age of first crack use, years of crack use, and crack rocks used in the previous 30xa0days.ResultsThere is a positive correlation between TBARS levels and severity of crack cocaine use (Ru2009=u20090.304, pu2009=u20090.04) and a negative correlation between BDNF and severity of crack cocaine use (Ru2009=u2009−0.359, pu2009=u20090.01) at discharge. Also, we found an inverse correlation between TBARS and BDNF levels (Ru2009=u2009−0.294, pu2009=u20090.004) at discharge.ConclusionsOur findings suggest that BDNF and TBARS could be possible markers for the severity of drug use. Further studies may show how those markers could be related to staging, prognosis, and treatment in crack cocaine dependence.

High levels of brain-derived neurotrophic factor are associated with treatment adherence among crack-cocaine users

Due to the complexity of crack -cocaine addiction treatment, the identification of biological markers that could help determining the impact or outcome of drug use has become a major subject of study. Therefore, we aim to evaluate the association of Brain-Derived Neurotrophic Factor (BDNF) and Thiobarbituric Acid Reactive Substances (TBARS) levels in crack -cocaine users with treatment adherence and with drug addiction severity. A sample of 47 male inpatient crack- cocaine users were recruited in a treatment unit, and blood samples were collected at admission and discharge in order to measure BDNF and TBARS serum levels. Subjects were split into 2 groups: treatment non-completers (n=23) and treatment completers (n=24). The completer group had a tendency of higher levels of BDNF than non-completers at admission (16.85±3.24 vs. 14.65±5.45, p=0.10), and significant higher levels at discharge (18.10±4.88 vs. 13.91±4.77, p=0.001). A negative correlation between BDNF levels at admission and years of crack use was observed. We did not find significant changes in TBARS levels during inpatient treatment, although the completer group tended to decrease these levels while non-completers tend to increase it. These findings suggest an association between higher levels of BDNF and better clinical outcomes in crack- cocaine users after detoxification. We believe that the variation in BDNF and TBARS found here add evidence to literature data that propose that such biomarkers could be used to better understand the physiopathology of crack- cocaine addiction.

Prevalence of driving under the influence of psychoactive substances and road traffic crashes among Brazilian crack-using drivers

BACKGROUNDnSubstance use disorders are associated with the increased risk of driving under the influence (DUI), but little is known about crack-cocaine and its relationship with road traffic crashes (RTC).nnnMETHODnA multicenter sample of 765 crack-cocaine users was recruited in six Brazilian capitals in order to estimate the prevalence of DUI and RTC involvement. Legal, psychiatric, and drug-use aspects related with traffic safety were evaluated using the Addiction Severity Index - 6th version (ASI-6) and the Mini International Neuropsychiatric Interview.nnnRESULTSnSeventy-six (28.3%) current drivers reported accident involvement following crack-cocaine use. Among drivers (n=269), 45.7% and 30.5% reported DUIs in the past 6 months and 30 days, respectively. Drivers reporting DUIs in the past month (n=82) had higher scores in the psychiatric, legal, and family problems subscales from the ASI-6, and lower scores in the family social support subscale in comparison to those without a history of DUIs (n=187). An overall high prevalence of psychiatric comorbidity and substance consumption was observed. Participants with 5+ years of crack-cocaine use were more likely to have been in a RTC (RR=1.52, 95%IC: 1.02-2.75), independently of marijuana use, binge drinking and psychiatric comorbidities.nnnCONCLUSIONnThe high prevalence of RTC and DUI involvement among crack-using drivers supports the idea that they are at a high risk group regarding traffic safety. Years of crack consumption seem to be associated with RTC involvement. Also, the presence of psychiatric comorbidities, poly-drug use, and cognitive impairment usually associated with crack addiction could yield additional risk of accidents.

Assessment of executive functions and inhibitory control in alcohol and crack use disorders

This study assessed executive functions and inhibitory control in alcohol and crack users, as previous research suggests an association between substance-related disorders and impaired self-regulation and impulse control. In this study, 67 men aged 18-65 years completed the following instruments: sociodemographic questionnaire, Vocabulary and Matrix Reasoning (Wechsler Abbreviated Scale of Intelligence), Five Digit Test, and Behavioral Assessment of the Dysexecutive Syndrome. Alcohol and crack users showed deficits involving processing speed, response inhibition, flexibility, abstraction, planning, and monitoring. Analysis per type of drug revealed poorer cognitive performance among alcohol users. Years of drug use were associated with planning deficits. These findings are consistent with the hypothesis of an association between drug abuse and cognitive changes. In conclusion, impairments in executive functioning and inhibitory control were found in the study samples.

Leptin levels and its correlation with crack-cocaine use severity: A preliminary study

BACKGROUNDnCrack-cocaine is an important public health problem in Brazil and worldwide. It is a potent form of cocaine which results in rapid and damaging stimulating effects on the central nervous system through inhibition of the dopamine transporter. Some studies have suggested that both food and drugs - including crack, can act on the same brain reward mechanisms, altering the dopamine pathways that modulate behavioral responses. Our hypothesis was that leptin, a well-known peptide that modulates energy metabolism and appetite, can be used as a biomarker for drug use.nnnMETHODSnAnthropometric data, drug use profiles, and leptin serum levels were evaluated in a cross-sectional study of 40 crack-cocaine users.nnnRESULTSnLeptin showed an inverse correlation with the severity of crack use, and this correlation remained when corrected by body mass index (BMI) and body composition by bioimpedance (BIA). The majority of subjects were eutrophic or overweight/obese considering BMI and BIA, and these variables were not significantly associated with the severity of crack use, but positively correlated with leptin levels.nnnCONCLUSIONSnOur preliminary findings suggest that leptin could be involved in drug use severity, perhaps through pathways similar to those whereby it modulates food intake. Considering the anthropometric parameters, these findings provide additional evidence that low weight is not predominant in crack users.

Brain-derived neurotrophic factor in substance use disorders: A systematic review and meta-analysis

BACKGROUNDnBrain-derived neurotrophic factor (BDNF) is associated with several neurodegenerative and psychiatric disorders. It is not clear, however, whether BDNF levels are modified in substance use disorders (SUDs).nnnMETHODSnWe conducted a systematic search of electronic databases to identify studies comparing peripheral plasma or serum BDNF levels in adults with SUDs vs. non-user controls. Forty studies were included in the meta-analysis involving a total of 2238 participants with SUDs and 2574 controls.nnnRESULTSnAfter trim and fill adjustment, current drug users presented lower serum BDNF levels (SMDu2009=u2009-0.99, 95%CI -1.40 to -0.58, I2u2009=u200995.9) than non-user controls. However, this difference disappears during withdrawal. Studies using serum or plasma BDNF samples have shown different results. Subgroup analysis revealed lower levels of serum BDNF in alcohol users (SMDu2009=u2009-0.70, 95%CI -1.15 to -0.25, I2u2009=u200989.81) and crack/cocaine users (SMDu2009=u2009-1.78, 95%CI -2.92 to -0.65, I2u2009=u200997.59) than controls. Meta-regression analysis revealed that gender, age, and age of first use moderate the effects of drug use in peripheral BDNF levels.nnnCONCLUSIONSnPeripheral BDNF levels are decreased in the serum, but not the plasma, of active drug users. Altogether, these findings suggest that BDNF levels may be related to acute use and addiction severity and also point to BDNFs potential utility as a biomarker in this population.

Comorbidities Associated With the Use and Misuse of Crack Cocaine

In this chapter, we will review essential aspects of the main comorbidities presented by crack cocaine users. We explore cooccurrence of crack cocaine use and other substance abuse, other mental disorders, and other relevant medical illnesses. When crack cocaine is accompanied by other psychiatric disorders, this condition often aggravates the pattern of consumption and drug effects, and is associated with worse outcomes, more complex clinical management, with reduced treatment adherence, increased healthcare costs, and worsening social indicators. The proper identification of comorbidities in crack cocaine users implies different treatment outcomes, since it allows the construction of more appropriate therapeutic strategies, increasing the chance of patient compliance and allowing for a better prognosis.

Brain-Derived Neurotrophic Factor in Cocaine Withdrawal

Brain-derived neurotrophic factor (BDNF) is a neurotrophin whose modulation may contribute to different types of brain plasticity, including drug addiction and dependence in both rodents and humans. Although modulation of BDNF has been demonstrated to contribute to different features of cocaine addiction, its modulation after short- and long-term withdrawal from drugs of abuse still remains elusive. Considering the cocaine-induced modulation of neurotrophin and its ability to modulate drug use and relapse in preclinical models, BDNF might be considered a promising biomarker to follow the use, withdrawal, and severity of relapse in humans, as well as a potential therapeutic target to modulate cocaine dependence. In this chapter, we report the relevant literature on the abstinence-induced modulation of BDNF in both preclinical and clinical studies.

Psychiatric disorders in aesthetic medicine: the importance of recognizing signs and symptoms

Psychiatric disorders are widely reported in patients seeking aesthetic treatments. Although they are not necessarily a contraindication for procedures, the recognition of these symptoms by the professional tends to strengthen the professional-patient relationship, thus leading to a better prognosis. This reduces the chances of dissatisfaction, complications, and aggravation of psychiatric symptoms, in addition to avoiding legal complications. In this article, the most common psychiatric disorders arising in cosmetic and aesthetic treatment are presented and discussed, as well as guidelines for recognizing the symptoms and managing these patients. ■ ABSTRACT

Erratum to “Prevalence of driving under the influence of psychoactive substances and road traffic crashes among Brazilian crack-using drivers” [Drug Alcohol Depend. 168 (2016) 255–262]

Please cite this article in press as: Scherer, J.N., et al., Erratum to “Prevalence of driving under the influence of psychoactive substances and road traffic crashes among Brazilian crack-using drivers” [Drug Alcohol Depend. (2016) 255–262]. Drug Alcohol Depend. (2016), http://dx.doi.org/10.1016/j.drugalcdep.2016.11.004 ere incorrectly shown as collaborators. The correct list of authors is shown below: Juliana Nichterwitz Scherer∗, Roberta Silvestrin, Felipe Ornell, Vinícius Roglio, Tanara Rosangela Vieira Sousa, Brazilian Crack Group1, isia Von Diemen, Felix Henrique Paim Kessler, Flavio Pechansky. The publisher would like to apologise for any inconvenience caused.