Felix Henrique Paim Kessler

Adaptation and construct validation of the Barratt Impulsiveness Scale (BIS 11) to Brazilian Portuguese for use in adolescents

OBJECTIVE Impulsivity is associated with different psychiatric disorders. The Barratt Impulsiveness Scale version 11 is one of the scales mostly used to measure impulsivity and it does not have a validated version for Brazilian Portuguese. The objective of this study is to adapt and conduct the construct validation of the Barratt Impulsiveness Scale version 11 for adolescents. METHOD The scale was translated and adapted into Portuguese and then back-translated into English. The psychometric proprieties, factor analysis and construct validity were evaluated in two samples: 18 bilingual undergraduate medical students and 464 male adolescents between 15 and 20 years old from a well-delimited geographical area in the city of Canoas, southern Brazil. RESULTS The adolescent sample had a mean age of 17.3 +/- 1.7 years. Intra-class correlation coefficient achieved a value of 0.90, and internal consistency had a of 0.62. Factor analysis did not identify the 3 factors of the original scale. Impulsivity scores from the Barratt Impulsiveness Scale version 11 had a correlation with scores for attention deficit/hyperactive disorder and oppositional defiant disorder and with number of symptoms of conduct disorder, suggesting an appropriate construct validity of the scale. CONCLUSION Even considering some limitations in the Portuguese version, Barratt Impulsiveness Scale version 11 can be used in male adolescents and should be tested in other populations.

Uma visão psiquiátrica sobre o fenômeno do crack na atualidade

No inicio da decada de 80, socioetnografosamericanos descreveram na literatura cientifica uma novae potente forma de uso de cocaina – a inalacao do vaporexpelido da queima de pedras, manufaturadas a partir do“cozimento” da pasta basica combinada com bicarbonatode sodio. Quando queimada em um cachimbo de vidroou outro recipiente, produzia um ruido tipico de estalo,tendo sido, por isso, chamada de

Crack Users Show High Rates of Antisocial Personality Disorder, Engagement in Illegal Activities and Other Psychosocial Problems

The aim of this study was to compare three groups of Brazilian psychoactive substance (PAS) abuse patients (crack cocaine users, cocaine snorters, and non-cocaine PAS users) in terms of psychiatric comorbidities and severity of psychosocial problems. A cross-sectional, multi-center study was conducted at five Brazilian research centers. A total of 738 current PAS abusers seeking specialized treatment (outpatient and inpatient clinics) were assessed using the sixth version of the Addiction Severity Index (ASI-6): 293 patients using crack cocaine were compared with 126 using powder cocaine and 319 using non-cocaine PAS (mostly alcohol and marijuana). Psychiatric comorbidities were assessed in a smaller sample (290 cases), originating from three of the centers, using the Mini International Neuropsychiatric Interview Plus (MINI-Plus). Crack and powder cocaine users were significantly younger than non-cocaine PAS users (31.1 ± 8.1 and 32.9 ± 8.8 vs. 42.4 ± 12, respectively; p < .001). Crack users presented a higher rate of antisocial personality disorder (25%) than powder cocaine (9%) and non-cocaine PAS users (9%), even when adjusted for confounding factors (Pr = 2.6; 95% CI 1.10-6.40). According to ASI-6 summary scores, crack users presented a significantly higher rate of occupational, family, and legal problems and reported more illegal and violent activities such as burglary and theft (23%) and threatening or assaulting (32%) than non-cocaine PAS users. Our findings, combined with the recent increase observed in the prevalence of crack use in Brazil, highlight the severity of psychiatric symptoms and psychosocial problems related to this powerful drug and corroborate the already suggested association between crack/cocaine, violence, and legal problems. Treatment programs for crack users should routinely consider the possibility of associated psychiatric comorbidities, such as antisocial personality disorder, which may affect treatment outcomes.

Psychometric properties of the sixth version of the Addiction Severity Index (ASI-6) in Brazil

BACKGROUND There are few research tools in Brazil to assess more broadly the alcohol and other drug related problems. OBJECTIVE To test the psychometric properties of ASI in its sixth version (ASI-6). METHODS A multicenter cross-sectional study was conducted in four Brazilian state capitals. Four research centers interviewed 150 adult inpatients or outpatients, and one research center interviewed 140 patients. A total of 740 substance abusers were selected. Training and supervision of interviewers were performed to assure the quality of dada collected. RESULTS Most areas of the ASI showed good reliability between the instrument and the interviewers, with no statistically significant differences between the ASI-6 Summary Scores for Recent Functioning (SS-Rs) of both interviews. Cronbachs alpha for ASI-6 subscales ranged from 0.64 to 0.95. Correlations between the ASI-6 Alcohol and Drug scores and the concurrent instrument (ASSIST) were high (0.72 and 0.89, respectively). There was a significant negative correlation between the scores in psychiatric, medical and drug areas and the scores of WHOQOL. CONCLUSION Analysis of the psychometric properties of ASI-6 both in outpatients and inpatients in Brazil indicate a good reliability and validity of this instrument for the Brazilian culture. The development of this instrument in Brazil is an important advancement, which will certainly have implications for the prevention, clinical research, and social rehabilitation fields.INTRODUCAO: Existem poucos instrumentos de pesquisa no Brasil que avaliam de forma mais ampla os problemas relacionados ao alcool e a outras drogas. OBJETIVO: Testar as propriedades psicometricas da ASI, em sua sexta versao (ASI-6). METODOS: Um estudo transversal e multicentrico foi conduzido em quatro capitais de estados brasileiros. Quatro centros de pesquisa entrevistaram 150 pacientes adultos internados ou em tratamento ambulatorial. Foram selecionados um total de 740 abusadores de substâncias. A qualidade dos dados coletados foi assegurada pelo treinamento e supervisao aos entrevistadores. RESULTADOS: A maioria das areas da ASI mostraram boa confiabilidade entre o instrumento e os entrevistadores, sem diferencas estatisticamente significativas entre os Escores Sumarios de Funcionamento Recente da ASI-6. O alfa de Cronbach para as subescalas da ASI-6 variou de 0,64 a 0,95. Correlacoes entre os escores da area Alcool e Drogas da ASI-6 e o instrumento concorrente (ASSIST) foram altas (0,72 e 0,89, respectivamente). Existiu uma correlacao negativa estatisticamente significativa entre os escores nas areas psiquiatrica, medica e drogas, e os escores da WHOQOL. CONCLUSAO: A analise das propriedades psicometricas da ASI-6 tanto em sujeitos internados quanto em tratamento ambulatorial no Brasil apontam para uma boa confiabilidade e validade deste instrumento para a cultura brasileira.

Changing patterns of cocaine use and hiv risks in the south of Brazil.

Abstract For well over a decade, researchers in Porto Alegre, Brazil, have been documenting the extent of the AIDS epidemic in the region, with a specific focus on the linkages between drug use and HJV seropositivity. Virtually all of the studies conducted during those years found injection drug use (IDU) to be the major vector for HIV seropositivity in this population. However, recent research found that the number of IDUs had declined significantly. Qualitative interviews and focus groups suggested many reasons for this decline: (1) many had died, because they had never heard of AIDS or HIV, and were unaware of how HIV is transmitted. As a result, they had become infected through the sharing of injection paraphernalia. (2) The quality of street cocaine had declined, making injection difficult. (3) Because of a fear of AIDS, some shifted to the smoking of crack, which had become a newly availability commodity in the street culture. Within this context, this article describes the qualitative data describing the decline of cocaine injecting and the corresponding emergence of crack use in Porto Alegre, Brazil, and related HIV risks.

Diretrizes da Associação Brasileira de Estudos do Álcool e outras Drogas (ABEAD) para o diagnóstico e tratamento de comorbidades psiquiátricas e dependência de álcool e outras substâncias

Recently, several studies have focused on comorbity psychiatric disorders with alcohol and other substance dependence. The Brazilian Association of Studies on Alcohol and Other Drugs proposed the Brazilian Guidelines project. This study review diagnostic and therapeutic criteria to the most prevalent psychiatric comorbidities. Randomized clinical trials, epidemiological, animal studies and other forms of research are reviewed. The main psychiatric comorbidities are studied based on guidelines adopted by other countries and the literature data resumed. Epidemiological aspects, diagnoses, integrated treatment and service organization, as well as specific psychotherapic and pharmacological treatment are discussed. The Brazilian Association of Studies on Alcohol and Other Drugs Guidelines reassures the importance of adequate diagnoses and treatment regarding alcoholic and drug dependent patients suffering of comorbid psychiatric disorders.

HIV seroprevalence among drug users: an analysis of selected variables based on 10 years of data collection in Porto Alegre, Brazil.

Data from five studies were pooled to describe associations between drug use and HIV. The Risk Assessment. Battery in Porto Alegre, Brazil, was used to collect data from 1449 subjects in 5 separate studies conducted between 1995 and 2004. The subjects were divided into categories based on their pattern of drug use: (1) injection drug users (IDUs), (2) crack smokers, (3) frequent drug users, and (4) infrequent cocaine/alcohol/marijuana users. The sample consisted primarily of young males with low education and income levels. Half of the subjects reported frequent condom use, and exchanges involving drugs, sex, and money were infrequent (although more common in groups 1 and 2). The overall seroprevalence was 20.6%, and the prevalence was different across the four groups, showing a linear decrease from group 1 (57.1%) to group 4 (11.7%). The IDU and crack-smoking groups showed similarities in their risk levels when compared with the other two groups, and individuals in group 1, 2, and 3 were more likely to report having had four or more sex partners. After controlling for all other risk factors, IDU, males having sex with males, and crack use were highly associated with HIV (OR 7.30, 95% CI: 5.10.10.40; OR 3.04, 95%CI: 1.89,4.80; OR 2.03, 95%CI: 1.40, 2.92, respectively). The findings confirm that poverty, low education, and IDU remain risk factors for HIV in Porto Alegre, Brazil, and the study identities crack smoking as a new risk factor.

Preliminary Estimates of Human Immunodeficiency Virus Prevalence and Incidence Among Cocaine Abusers of Porto Alegre, Brazil

A sample of 193 southern Brazilian inner-city cocaine abusers was studied to assess the prevalence of human immunodeficiency virus (HIV) infection. Following the exclusion of those who were seropositive from the intake sample, a cohort of 138 HIV-negative cocaine abusers was followed for 18 months to assess seroincidence rates and the associated characteristics. HIV status, drug use, sexual risk behaviors, and presence and severity of medical and psychiatric symptoms were collected at intake using a Brazilian version of the Risk Assessment Battery, the Addiction Severity Index (ASI), Symptom Check List-90 (SCL-90), and Beck Depression Inventory (BDI): this was repeated at 6-, 12-, and 18-month intervals. The overall seroprevalence was 28,5%, and the variables associated with HIV seropositivity were age older than 25 years, being single, having less than 8 years of education, and having injected cocaine at least once. Although follow-up procedures were difficult to implement due to sample characteristics, we obtained data from 82,6% of the participants for at least one follow-up and for 57% at all follow-up windows. Most participants showed high scores on the Beck Depression Inventory (mean of 20.6±13.9) and Symptom Check List-90 (mean of 106.4±91.9). There were 8 seroconversions in the 18-month period, yielding an incidence rate of 5.03/100 (confidence interval [CI] 2.2–9.7) person-years at risk. None of the seroconverters reported recent cocaine injection, and only 14.5% of the overall sample reported ever injecting cocaine, which suggests that another significant mode of transmission via sexual behavior should be considered as well. Each of these findings has important implications for the design of preventive interventions.

Comorbidade: uso de álcool e outros transtornos psiquiátricos

Alcohol related disorders often coexist with other psychiatric disorders and its incidence is increasing in last decades. Studies show that patients with comorbidity, specially those with severe psychiatric disorders, have higher rates of suicide, relapse, money spent in treatment, homeless and they use more medical service. Their evaluation must be meticulous because the differencial diagnosis become complicated without a long period of alcohol withdrawal. These patients have a worse prognostic and their treatment is more difficult. Most of studies in this area have indicated that the integration of psychosocial and pharmacological techniques is more effective. The long term treatment must focus in the reduction of symptoms, improvement of social and familiar funcioning, coping skills and relapse prevention.

Psicodinâmica do adolescente envolvido com drogas

Drug abuse amongst adolescents is becoming increasingly prevalent placing serious consequences in their development and their relationship with family and society. The present paper discloses some epidemiological data on protectors and risk factors for drug abuse in this population demonstrating that personal and family stressors during early life are associated with drug abuse. On the other hand, engaged parents, personal motivation and constant monitoring are associated with avoidance of drugs. Major prospective studies in this field are also reviewed. Psychodynamic theories related to addiction and their evolution through the thoughts of authors such as H. Kohut, J. McDougall, H. Rosenfeld, C. Olievenstein, Khantzian, are analyzed. The application of the thecnics based on psychoanalytic psychotherapy in chemical dependents is also discussed.