Maria da Graça Tanori de Castro

Qualidade de vida e gravidade da dependência de tabaco

CONTEXTO: A qualidade de vida e um constructo que vem ganhando importância como uma forma de acessar o impacto tanto de uma patologia quanto de uma estrategia terapeutica na vida dos sujeitos. Este parâmetro tem sido pesquisado nas mais variadas areas, entre as quais o tabagismo. OBJETIVO: Avaliar a associacao entre a qualidade de vida e a gravidade da dependencia do tabaco. METODO: Foi realizado um estudo transversal, com uma amostra por conveniencia de 276 dependentes de tabaco da populacao geral, sem doencas tabaco-relacionadas. Os instrumentos utilizados foram: World Health Organization Quality of Life Instrument (WHOQOL-BREF), Beck Depression Inventory (BDI), Beck Anxiety Inventory (BAI), Fagerstrom Test for Nicotine Dependence e ficha com dados sociodemograficos. RESULTADOS: Foi verificada associacao entre a gravidade da dependencia de tabaco e piores escores em todos os dominios da qualidade de vida, avaliada por WHOQOL-BREF, tendo sido esse resultado influenciado por sintomas de ansiedade e depressao. CONCLUSAO: Os tabagistas mais graves tem mais prejuizos na qualidade de vida, no entanto esse grupo e o que apresenta os escores mais elevados de sintomas depressivos e de ansiedade, sendo importante realizar mais estudos a esse respeito.

Craving e dependência química: conceito, avaliação e tratamento

O craving ou fissura, cuja definicao mais comum e o desejo intenso por uma substância, e um conceito controverso entre os pesquisadores da area da dependencia quimica. OBJETIVO: Realizar revisao teorica a respeito do craving nos bancos de dados PsycInfo, Medline, ProQuest e Science Direct. METODO: As palavras-chave utilizadas foram craving, dependence e drug e o periodo pesquisado foi entre 1995 e 2007. RESULTADOS: Os resultados demonstraram que sao encontrados diversos significados para o craving, alguns se restringindo a desejo, e outros, considerando-o nao so como desejo, mas como antecipacao do resultado positivo do uso da substância, alivio dos sintomas de abstinencia ou afeto negativo e intencao de fumar, o que reflete uma visao multidimensional deste construto. A etiologia do craving pode ser explicada por intermedio dos modelos: comportamental, cognitivo ou psicossocial e neurobiologico, porquanto a opcao por um destes influencia a avaliacao e o manejo. CONCLUSAO: Conclui-se quanto a multidimensionalidade do craving e quanto a necessidade de que seja utilizado um modelo biopsicossocial que integre os diversos modelos no tratamento de dependentes quimicos. Destaca-se a importância da realizacao de mais estudos para a compreensao do craving em funcao deste ser um dos principais riscos de recaida.Craving is usually defined as an intense desire for a substance. This is a rather controversial concept among the researchers on the chemical dependence area. OBJECTIVE: The objective of this study was to carry out a theoretical review concerning craving at PsycInfo, Medline, ProQuest, Portal Capes and Science Direct Data Bases. METHODS: The keywords used were craving, dependence and drug, and the searching period was between 1995 and 2007. RESULTS: The results showed that many different meanings can be found for craving, some relate it only to desire, while others consider it not only as desire, but also as the anticipation of the positive result from the use of the substance, the relief of abstinence symptoms or negative affect and intention to smoke, which reflects a multidimensional view of this construct. The ethimology of craving can be explained by the following Models: Behavioral, Cognitive or Psychosocial and Neurobiological, being the option for one of them a factor that influences evaluation and usage. CONCLUSION: As a conclusion, we are in favor of craving multidimensionality, as well as the need to use a Biopsychsocial Model that integrates the various models for treating chemical dependent patients. It is also necessary to highlight the importance of carrying out more studies in oder to understand craving, for it is one of the principal risks of relapse.

Validação da versão brasileira do Questionnaire of Smoking Urges-Brief

CONTEXTO: A avaliacao do craving (ou fissura) e muito importante no tratamento do tabagismo. OBJETIVO: O objetivo desta pesquisa foi validar a versao brasileira do Questionnaire of Smoking Urges-Brief (QSU-B). METODOS: O delineamento foi experimental, e seus participantes foram divididos, aleatoriamente, em grupos de zero, 30 e 60 minutos de abstinencia do tabaco. A amostra foi de 201 sujeitos (134 mulheres e 67 homens), entre 18 e 65 anos (M = 38,15), e os instrumentos aplicados, alem do QSU-B, foram: Ficha com Dados Sociodemograficos, Escala Analogico-Visual do Craving, Fagerstrom Test for Nicotine Dependence e Inventarios Beck de Ansiedade e de Depressao. RESULTADOS: A analise fatorial com dois fatores teve variância total de 78,46% e a correlacao entre esses fatores foi significativa e de alta intensidade (r = 0,636; p < 0,001). Todos os valores de alfa de Cronbach do QSU-B estavam acima de 0,70. Observou-se correlacao do total do QSU-B com a Escala Analogico-Visual (r = 0,656; p < 0,001) e com a questao 1 (r = 0,201; p = 0,004) e a 2 (r = 0,257; p < 0,001) de Fagerstrom. CONCLUSAO: A versao brasileira do QSU-B demonstrou ser adequada, psicometricamente, para o uso tanto em pesquisas como nos atendimentos aos dependentes de tabaco.

Adaptação transcultural para o idioma português do Cocaine Craving Questionnaire - Brief

CONTEXTO: A avaliacao do craving (ou fissura) e muito importante no tratamento de dependentes de cocaina, sendo necessarias adaptacoes transculturais de escalas para aumentar a efetividade na avaliacao e no tratamento dessa clientela. OBJETIVO: O objetivo deste estudo foi traduzir, adaptar culturalmente e verificar a equivalencia semântica do Cocaine Craving Questionnaire - Brief (CCQ-Brief), o qual avalia o craving (fissura) por cocaina. METODO: O CCQ-Brief foi traduzido do ingles para o portugues, aplicado em 10 sujeitos e submetido ao brainstorming em um grupo de 4 sujeitos para reproducao individual e verbal, item a item. Realizou-se o backtranslation da primeira traducao e do brainstorming. Logo apos, traduziu-se novamente para o portugues. Todo o processo foi analisado por um comite de juizes especialistas, os quais emitiram pareceres com as observacoes pertinentes. RESULTADOS: Considerando-se os pareceres dos especialistas e um ultimo estudo piloto, construiu-se a versao final brasileira do CCQ-Brief e uma versao adaptada dessa escala para usuarios de crack. CONCLUSAO: Os resultados indicaram uma equivalencia semântica satisfatoria entre as versoes, podendo o CCQ-Brief ser util no tratamento de dependentes de cocaina.

WHOQOL-BREF psychometric properties in a sample of smokers

OBJECTIVE To study the World Health Organization Quality of Life Instrument Bref psychometric properties in a sample of smokers. It is a self-administered instrument to evaluate quality of life. It contains 26 questions allocated to 4 domains: Social, Psychological, Physical and Environmental, there are 2 questions related to the Global domain. METHOD The sample was formed by 276 tobacco users selected at random. The instruments applied were: World Health Organization Quality of Life Instrument Bref, Fagerström Test for Nicotine Dependence, and Medical Outcomes Study Short-Form 36-item. The statistical analysis was accomplished up by ANOVA, Cronbachs alpha, Pearsons Coefficient and Multiple Regression. RESULTS The World Health Organization Quality of Life Instrument Bref presented good reliability (Cronbachs alpha 0.9207), converging validation (0.382<r<0.753; p<0.001), discriminant validation and criterion validation (0.554<r<0.778; p<0.001). CONCLUSION The World Health Organization Quality of Life Instrument Bref proved to be an adequate instrument, with a good level of reliability, being easily and quickly administered.

Validação psicométrica do Cocaine Craving Questionnaire-Brief - Versão Brasileira Adaptada para o Crack para dependentes hospitalizados

Background: The craving is a very important factor in the treatment of drug addiction. Objective: Validate the Cocaine Craving Questionnaire-Brief - Brazilian Crack Adapted Version. Method: Subjects enrolled in this experimental study were randomized into groups: experimental for this group was shown an image of a subject using crack (G1) and control (G2) for this group no pictures were shown. The sample was composed of 109 subjects (G1 = 50 and G2 = 59), males, crack/cocaine dependent inpatients. The assessment instruments were: Clinical Interview with social and demographic data, CCQ-B - Crack Adapted Version; Visual Analogic Scale for Craving, Anxiety and Depression Beck and Inventories Visual Cue to elicit craving. Results: On the factorial analysis two factors were found: Factor 1, related to craving itself, and Factor 2, the perceived lack of control of crack use. The two-factor factorial analysis presented a total variation of 68.84%, and the correlation between these factors was significant and of low intensity (r = 0.204; p = 0.041). A Cronbach’s alpha value from total of points of scale was 0.85. We observed a correlation between the scale total score and the Visual Analogic Scale (r = 0.515; p < 0.01). Conclusion: The Cocaine Craving Questionnaire-Brief - Brazilian Crack Adapted Version proved to be an adequate psychometric instrument for use in research and in clinical settings.

Coping strategies for craving management in nicotine dependent patients

OBJECTIVE The aim of this study was to investigate the association between the intensity of craving and the types of coping skills used by nicotine-dependent patients. METHOD This was an experimental study. The sample comprised 201 subjects, mean age 38.15 years. The participants were randomly divided into groups of zero, 30 and 60 minutes of nicotine abstinence. The following instruments were administered: the Chart of Sociodemographic Data, the Fagerström Test for Nicotine Dependence, the Questionnaire of Smoking Urges, and the Coping Strategies Inventory. RESULTS The most frequently used coping strategies are presented in descending order: accepting responsibility, self-control and distancing. There was a positive correlation between the confrontive coping strategy and the total score on the Questionnaire of Smoking Urges (rs = 0.146; p = 0.045) and the score on Factor 1 (rs = 0.165; p = 0.023). CONCLUSION The most intense craving can lead nicotine-dependent individuals to use confrontive coping strategies that make them unable to control their emotions or to face the situations of high risk of relapse. This finding demonstrates that the treatment of smokers should include psychological education about the pitfalls of using these types of strategy and should teach them new types of coping strategies for craving management.

Relação entre gênero e sintomas depressivos e ansiosos em tabagistas

INTRODUCTION: Smoking often presents comorbid anxiety and depression, disorders that are more frequent in women. OBJECTIVE: The aim of this study was to evaluate the association between severity of nicotine dependence and anxiety and depression symptoms in both male and female smokers. METHOD: A cross-sectional study was performed using a convenience sample of 475 smokers from the general population. The instruments used were Fagerstrom Test for Nicotine Dependence, Beck Depression Inventory, Beck Anxiety Inventory, and a social and demographic record sheet. RESULTS: In women, anxiety symptoms (F = 9.691; p < 0.01) and depression (F = 16.23; p < 0.01) were associated with severity of nicotine dependence. In men, only anxiety symptoms (F = 7.219; p = 0.001) were associated with severity of nicotine dependence. CONCLUSION: Women with severe nicotine dependence have more anxiety and depression symptoms, while severe male smokers only showed more anxiety. The results demonstrated the importance of evaluating these symptoms in the treatment of smokers in Brazil.

Tratamento de exposição a estímulos e treinamento de habilidades como coadjuvantes no manejo do craving em um dependente de crack

OBJECTIVE An increased prevalence of crack cocaine users has been observed in clinical samples over the past years, underscoring the need for conducting research and developing treatment strategies aimed at this population. The objective of this study was to describe the case of a crack cocaine addict (inpatient) submitted to cue exposure treatment (CET) and coping skills training (CS) as adjuvant approaches to the conventional addiction treatment. CASE DESCRIPTION A male patient, 29 years old, single, with complete high school, was dependent on crack cocaine and marijuana and also had a diagnosis of harmful alcohol use. The patient had been hospitalized for 2 weeks and had undertaken a protocol comprising four motivational interview and relapse prevention sessions. Six sessions of CET and CS were carried out over 2 weeks, including both in vivo and imaginal exposure to stimuli evoking craving for crack cocaine, such as a crack pipe, a lighter, and simulated crack cocaine rocks (in vivo exposure), or remembering places and friends associated with drug use (imaginal exposure). The patient was also trained to use strategies for the management of craving. Three months after hospital discharge, toxicological screening was performed to assess abstinence. CET and CS were considered by the patient to be important techniques for the maintenance of abstinence and of a low level of craving 3 months after discharge. COMMENTS These findings suggest that the two techniques may be useful as adjuvant therapies in the treatment of crack cocaine dependents. CET and CS should be assessed in clinical trials in order to demonstrate their real benefits.

Marijuana Craving Questionnaire (MCQ-SF/Versão Brasil): validação semântica

OBJECTIVE: The aim of this study was to translate and adapt culturally the Marijuana Craving Questionnaire (MCQ-SF)10 which evaluates the craving for marijuana in a Brazilian sample. METHOD: The Marijuana Craving Questionnaire (MCQ-SF) was translated from English to Portuguese, administered to 10 subjects, submitted to a brainstorming in a group of three people for individual and verbal reproduction, item by item. Back-translation was executed, a translation for the original language, based on first translation and from brainstorming. Soon after, it was translated again into Portuguese. A committee of specialists analyzed all translations. RESULTS: After the committee considerations and a pilot study with 30 subjects, the final version of MCQ-SF/Versao Brasil was built. CONCLUSION: The results showed a satisfactory semantic equivalence between versions. The MCQ/Versao Brasil can be useful to evaluate the craving for marijuana on the dependents of this substance.