Hamer Nastasy Palhares Alves

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.

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.

Sociodemographic characteristics associated with binge drinking among Brazilians

BACKGROUND Binge drinking (BD) is a harmful pattern of alcohol use. This study describes this pattern of drinking and the sociodemographic variables associated with it in a representative sample of Brazilians. METHODS A cross-sectional survey of 3007 individuals using a multistage probabilistic sample was conducted in 143 Brazilian municipalities. The frequency of BD in the year preceding the study was assessed. BD was defined as the consumption of four drinks of alcohol within a two-hour period for women and five drinks in two hours for men. Weighted-ordered logit regression was used to assess the relationship between sociodemographic factors and BD. RESULTS Most respondents had not engaged in binge drinking (69.7%; 95% confidence interval (CI) 67.0-72.2%). Binge drinking was more common among participants who were male (odds ratio (OR) 2.9; 95% CI 2.3-3.6) or single (OR 1.5; 95% CI 1.1-2.1) or had higher family income (OR 2.3; 95% CI 1.3-3.8). Individuals between 18 and 44 years of age were four times more likely to engage in binge drinking than adolescents (OR 4.7; 95% CI 3.3-6.8). Evangelicals/Protestants were less likely to engage in binge drinking (OR 0.7; 95% CI 0.2-0.5). CONCLUSIONS Our study, which is the first representative survey of BD in Brazil, showed that the age range of adults who engaged in BD is wider than the age range observed in other countries. These individuals are at increased risk for the adverse consequences of binge drinking, including addiction, car accidents, involvement in crime, absenteeism, and family violence.

Perfil clínico e demográfico de médicos com dependência química

The misuse of alcohol and drugs among physicians is a common cause of malpractice, absenteeism and complaints to the Medical Councils. This problem demands more attention, because it entails risks to the population and to the physicians themselves. AIMS: To describe the clinical and demographic profile of a sample of physicians in treatment for alcohol and drug dependence also to evaluate psychiatric comorbidity and consumption-related consequences. METHODS: Data was collected from a sample of 198 physicians attending outpatient treatment by a questionnaire specifically designed for this study. RESULTS: Most of the subjects were men (87.8%), married (60.1%), with a mean age of 39.4 years (S.D. =10.7). Sixty-six per cent had already been in inpatient treatment for alcohol and drug misuse. Sixty-nine per cent were specialists practicing mainly: internal medicine, anaesthesiology and surgery. Psychiatric comorbidity was diagnosed in 27.7% for DSM-IV Axis I and in 6% for DSM-V Axis II. With regard to drugs the most frequent pattern was use of alcohol and drugs (36.8%), followed by exclusive use of alcohol (34.3%) and exclusive use of drugs (28.3%). It was observed that the mean interval between the identification of misuse of substances and the seeking of treatment was of 3.7 years. Thirty per cent tried to achieve treatment by themselves. The social and legal problems observed were: unemployment in the previous year (1/3 of the sample), marital problems and divorce (52%), car accidents (42%), legal problems (19%). 84.8% presented professional problems and 8.5% had problems within the Medical Councils. CONCLUSION: The researchers suggest supportive and preventive attitudes for this matter.

Clinical and Demographic Profile of Anesthesiologists Using Alcohol and Other Drugs under Treatment in a Pioneering Program in Brazil

BACKGROUND AND OBJECTIVES Anesthesiologists are the majority in impaired-physician programs that assist physicians who abuse psychoactive substances. The aim of this paper is to show a descriptive study about the clinical and sociodemographic profile of a sample of chemically dependent anesthesiologists treated in a reference program. In addition, the objective is to cite the psychiatric comorbities, the most frequently used drugs and the psychosocial and professional repercussions of substance abuse. METHOD A cross-sectional and prospective study was conducted, and a socio-occupational questionnaire and a structured interview were carried out to diagnose mental and psychoactive substance use disorders, according to the International Classification of Diseases (the ICD-10). The questionnaire and the structured interview were carried out by two skilled researchers. RESULTS Fifty-seven anesthesiologists were interviewed. Most of them were male (77.2%), and the mean age was 36.1 years (SD=8.5%). A high prevalence of abuse of opioid (59.6%), benzodiazepine (3.1%) and alcohol (35.1%) was observed. Opioid users sought treatment earlier than other substance users and usually they were under pressure from their colleagues and the Regional Council of Medicine. The incidence of drug abuse for self-medication was high in this subgroup. CONCLUSIONS Anesthesiologists may present a different profile concerning the risks of opioid use. Opioid abuse usually begins during medical residency or during the first years of clinical practice, which supports the hypothesis that addiction to opioids is an occupational issue among anesthesiologists.

Anesthetic drug abuse by anesthesiologists

BACKGROUND AND OBJECTIVES Physicians has a slightly higher rate of psychoactive substance use when compared to the population in general. Anesthesiology is one of the most affected medicine specialties, especially due to overwork and easier access to drugs. This paper aims to carry out a literature review on the topic. Therefore, research was conducted by searching topic-related keywords on papers from the last 30 years available on MEDLINE. CONTENT Despite the fact that alcohol abuse is the most common among anesthesiologists, the abuse of anesthetic agents causes more concern, due to its high dependence potential and consequences, which are often fatal. The most widely used drugs are opioids (fentanyl and sufentanil), propofol and inhalational anesthetics. Young professionals are the most affected. Among the consequences of drug abuse are workplace absence and even death. The return to operating rooms seems to increase the risk of relapse. In Europe and in the USA there are specialized treatment programs for the middle class, as well as preventive measures, such as strict control of drugs and identification of professionals at high risk of abuse. In Brazil, Anesthesiology is the second medicine specialty with most drug addicts, but the topic has not been much studied and there are few specialized programs in the field. CONCLUSIONS Substance abuse by anesthesiologists is an issue that needs to be discussed further, especially due to the possibility of severe consequences for professionals and patients.

Abuso de fármacos anestésicos pelos anestesiologistas

JUSTIFICATIVA Y OBJETIVOS: El uso de sustancias psicoactivas es un poco mas alto en la clase medica si lo comparamos con la poblacion en general. Entre las especialidades medicas, la Anestesiologia es una de las mas afectadas, principalmente por el exceso de trabajo y la mayor facilidad en el acceso a los farmacos. El objetivo de este articulo, es revisar la literatura sobre el asunto. Para eso, se realizo una investigacion con las palabras clave relacionadas con el asunto en el MEDLINE, con los articulos de los ultimos 30 anos. CONTENIDO: A pesar de que la droga de la que mas se abusa entre los anestesiologos sea el alcohol, el abuso de los agentes anestesicos es lo mas preocupante, debido al alto potencial de dependencia como tambien a sus consecuencias, muchas veces letales. Los mas usados son los opioides (fentanil y sulfentanil), el propofol y los anestesicos inhalatorios. Los profesionales mas jovenes son los mas afectados. Las consecuencias del uso van desde el alejamiento del local de trabajo hasta la muerte. El regreso al quirofano parece llevar a un alto riesgo de recaida. Programas de tratamiento especializado para la clase medica han sido propuestos en USA y en Europa, como tambien algunas medidas preventivas, como la rigidez en el control de los farmacos y la identificacion de los profesionales que tienen un mayor riesgo de abusar de las sustancias. En Brasil, los anestesiologos son la segunda especialidad que mas consume sustancias, sin embargo, el asunto es poco estudiado y hay una falta de programas especializados en esa area. CONCLUSIONES: El abuso de sustancias entre los anestesiologos es un asunto que necesita mas atencion, principalmente debido a las graves consecuencias que ese consumo puede acarrear, tanto para el profesional, como para los pacientes.

Guidelines of the Brazilian Association of Studies on Alcohol and Other Drugs (ABEAD) for diagnosis and treatment of psychiatric comorbidity with alcohol and other substance and dependence

Abstract In recent years, several studies have been focused on the comorbidity of psychiatric disorders with alcohol and other substance dependence. In this context, the Brazilian Association of Studies on Alcohol and Other Drugs initiated a project to establish Brazilian Guidelines. The aim of this study was to review diagnostic and therapeutic criteria for the most prevalent psychiatric comorbidities. Randomized clinical trials, epidemiological studies, animal testing and other forms of research are reviewed herein. The main psychiatric comorbidities are investigated and data published in the literature are reviewed, based on guidelines adopted by other countries. Epidemiological aspects, diagnostic criteria, integrated treatment and the organization of specialized service, as well as details regarding psychotherapy and pharmacological treatment are discussed. The guidelines of the Brazilian Association of Studies on Alcohol and Other Drugs reinforce the importance of adequate diagnosis and treatment regarding alcoholic and drug dependent patients suffering of comorbid psychiatric disorders.

Binge drinking among Brazilians: Higher drinking frequency increases related problems

Abstract Aims: To correlate binge drinking (BD) with alcohol-related problems (ARP) in the Brazilian population. Methods: A representative cross-sectional survey was conducted in 143 Brazilian cities. Associations between the frequencies of BD and ARP were gathered using an ordered logit regression model. Results: Higher BD frequencies significantly increased the chance of injury in accidents, job loss, and involvement in intense arguments and assaults over the year. High frequency in BD increases the odds of all ARP. Conclusion: There is a dose-response association between the frequency BD and ARP and is therefore a possible target for public prevention policies.

Perfil clínico e demográfico de anestesiologistas usuários de álcool e outras drogas atendidos em um serviço pioneiro no Brasil

BACKGROUND AND OBJECTIVES: Anesthesiologists are the majority in impaired-physician programs that assist physicians who abuse psychoactive substances. The aim of this paper is to show a descriptive study about the clinical and sociodemographic profile of a sample of chemically dependent anesthesiologists treated in a reference program. In addition, the objective is to cite the psychiatric comorbities, the most frequently used drugs and the psychosocial and professional repercussions of substance abuse. METHOD: A cross-sectional and prospective study was conducted, and a socio-occupational questionnaire and a structured interview were carried out to diagnose mental and psychoactive substance use disorders, according to the International Classification of Diseases (the ICD-10). The questionnaire and the structured interview were carried out by two skilled researchers. RESULTS: Fifty-seven anesthesiologists were interviewed. Most of them were male (77.2%), and the mean age was 36.1 years (SD = 8.5%). A high prevalence of abuse of opioid (59.6%), benzodiazepine (3.1%) and alcohol (35.1%) was observed. Opioid users sought treatment earlier than other substance users and usually they were under pressure from their colleagues and the Regional Council of Medicine. The incidence of drug abuse for self-medication was high in this subgroup. CONCLUSIONS: Anesthesiologists may present a different profile concerning the risks of opioid use. Opioid abuse usually begins during medical residency or during the first years of clinical practice, which supports the hypothesis that addiction to opioids is an occupational issue among anesthesiologists.