Monica L. Zilberman

Gender similarities and differences: The prevalence and course of alcohol- and other substance-related disorders

Abstract Changes in womens social role over the past years likely influenced the gender gap in substance use and substance—related disorders, with potentially significant prevention and treatment implications. The authors reviewed the literature about gender differences in prevalence estimates and course of substance—related disorders. Male—to—female ratios of prevalence estimates of substance use are narrowing in different countries. The initiation of substance use is progressively taking place at younger ages, the trend being more dramatic among women as compared to men. Womens accelerated progression to dependence (so—called “telescoping effect”) is a robust finding among alcohol—dependent individuals, although the effect seems to be weaker among younger individuals. As for other drugs, the literature is weaker and further research is needed. It is concluded that womens earlier age of initiation of substance use, faster progression to dependence and under—representation in addiction treatments should be addressed in future health care planning.

Brief Communications: Gender Differences in Gambling Progression

The authors compared 39 women and 38 men entering an outpatient treatment program for pathological gambling. They were diagnosed according to DSM-IV and selected by SOGS, followed by a semi-structured interview for demography and progression of the gambling behavior prior to treatment. Women were more often single (59% vs. 26%; p = .005) and started gambling significantly later than men (34.2 vs. 20.4 years; p < .001). The progression of the disorder was more than 2 times faster in women than in men. There was no difference in the age of seeking treatment (44.7 vs. 42.3 years). Findings from this study resemble gender differences in other addictions—in particular the faster progression among women—challenge pharmacodynamic hypotheses for this phenomenon, and suggest gender into account when devising treatment strategies for pathological gambling.

Alcohol and drug use among university students: gender differences

OBJECTIVE This study compared the pattern of alcohol, legal and illegal drugs use among students of the Universidade de São Paulo (Brazil) in 1996 and 2001. METHOD Samples of 2.564 (1996) and 2.837 (2001) students answered a questionnaire proposed by the World Health Organization, which characterizes the consumption of alcohol, legal and illegal drugs in lifetime, in the last 12 months and in the last 30 days. RESULTS Men showed a significant increase in lifetime use of tobacco (44.8% to 50.9%), marijuana (33.7% to 39.5%) and hallucinogens (6.6% to 14.1%) between 1996 and 2001. No significant change was observed among women between 1996 and 2001 in tranquilizer use. Concerning the consumption reported in the last 12 months, both genders displayed significant increases in the consumption of marijuana (22.3% to 27.1% for men and 12.9% to 16.9% for women), amphetamines (1.9% to 5.0% for men and 3.4% to 5.6% for women), and inhalants (9.8% to 15.7% for men and 5.4% to 10.6% for women). The greatest gender difference was observed in consumption reported in the last 30 days with significant increases in male use of tobacco (19.6% to 23.5%), marijuana (15.8% to 20.5%), amphetamines (1.1% to 3.2%), and inhalants (4.0% to 7.9%). Substance use reported in the last 30 days remained stable among women between the 2 surveys. CONCLUSION Rates of substance use among university students increased. These gender differences in substance consumption should be taken into account in the development of preventive and treatment strategies for undergraduate university students.

Gender differences in obsessive-compulsive disorder: a literature review

INTRODUCAO: O transtorno obsessivo-compulsivo (TOC) e um quadro heterogeneo, no qual subtipos tem sido propostos. Estudos anteriores sugerem que genero desempenha papel relevante na expressao fenotipica. O objetivo foi realizar uma revisao convencional da literatura sobre diferencas de genero em relacao a aspectos clinicos e geneticos ou familiares do TOC. METODO: Realizou-se uma revisao convencional da literatura incluindo todos os artigos que investigaram aspectos sociodemograficos, clinicos e geneticos do TOC, de acordo com o genero. A pesquisa foi baseada em publicacoes disponiveis nas bases de dados Medline e PsycInfo nos ultimos 20 anos, usando como palavras-chave: obsessive-compulsive disorder (OCD), e: gender, sex, male, female, demographic characteristics, clinical features, clinical characteristics, genetic, genes, genetics gender OCD, genes OCD, genes OCD males, genes OCD females. RESULTADO: Sessenta e tres artigos de fenotipo e genetica foram selecionados. Na maioria dos estudos, o sexo masculino associou-se mais que o feminino com: ser solteiro, apresentar inicio mais precoce dos sintomas, maior prejuizo social, mais sintomas sexuais, religiosos e de agressao, e mais comorbidade com transtorno de tiques e abuso de substâncias. Pacientes do sexo feminino apresentam mais sintomas de contaminacao/limpeza e mais comorbidade com transtornos alimentares e do controle de impulsos. Estudos geneticos e familiares sao controversos, mas indicam que o genero pode desempenhar um papel na expressao da doenca. CONCLUSAO: Genero e um fator relevante a ser considerado na avaliacao de pacientes com TOC. Sao necessarios mais estudos para determinar se este fator define de fato um grupo homogeneo e particular de TOC.INTRODUCTION Obsessive-compulsive disorder (OCD) is a heterogeneous condition, in which subtypes have been proposed. Previous studies suggested that gender plays a relevant role in OCD phenotypic expression. This study aimed to review the literature on gender differences in clinical, genetic or familial aspects of OCD. METHOD A conventional review was conducted, including all papers that investigated demographic, clinical, and genetic aspects of OCD according to gender. The search was based on data available in Medline and PsycINFO databases in the last 20 years, using as keywords: obsessive-compulsive disorder; and: gender, sex, male, female, demographic characteristics, clinical features, clinical characteristics, genetic, genes, genetics gender OCD, genes OCD, genes OCD males, genes OCD females. RESULTS Sixty three of 487 phenotypical and genetics studies were selected. Most studies indicate that male patients are more likely than females to be single, present early onset of symptoms and chronic course of the disorder, greater social impairment, more sexual-religious and aggressive symptoms, and greater comorbidity with tic and substance use disorders. Female patients present more contamination/cleaning symptoms and greater comorbidity with eating and impulse-control disorders. Genetic and family studies are inconclusive, but suggest that gender may play a role in the disease expression. CONCLUSIONS Gender is a relevant factor that should be taken into account when evaluating OCD patients. More studies are necessary to determine whether in fact it defines a homogeneous and particular group in OCD.

Felicidade: uma revisão

CONTEXTO: A felicidade e uma emocao basica caracterizada por um estado emocional positivo, com sentimentos de bem-estar e de prazer, associados a percepcao de sucesso e a compreensao coerente e lucida do mundo. Nos ultimos anos, diversos pesquisadores tem se preocupado em desvendar as relacoes entre felicidade e saude mental. OBJETIVO: Revisar criticamente a literatura cientifica que aborda o tema da felicidade, assim como as suas contribuicoes para a saude mental e a psiquiatria. METODOS: Revisao sistematica da literatura por meio do indexador MedLine, utilizando-se dos unitermos: happiness, mental health, well-being, positive psychology, resilience, optimism, gratitude, quality of life, positive emotions, personality. RESULTADOS: Variaveis como origem, saudes fisica e mental, religiosidade e determinadas caracteristicas psicologicas se associam positivamente a felicidade. Nao ha evidencias de que idade, genero, estado civil, poder aquisitivo nem ocorrencia de eventos externos (favoraveis ou nao) se associem significativamente a felicidade. CONCLUSAO: A felicidade e um fenomeno predominantemente subjetivo, estando subordinada mais a tracos psicologicos e socioculturais do que a fatores externamente determinados. A identificacao desses fatores e particularmente util na subpopulacao que e mais predisposta a doencas mentais, favorecendo o desenvolvimento de abordagens preventivas, com potencial repercussao nas areas social e ocupacional.

Are There Cognitive and Behavioural Approaches Specific to the Treatment of Pathological Gambling

Objective: Treatment approaches for pathological gambling have been modelled after preexisting substance addiction models. This paper reviews cognitive-behavioural models in a search for original insights that are specific to gambling treatment. Method: A computerized search of major health care databases (Medline and PsycINFO) was performed. Results: New cognitive-behavioural approaches to the treatment of pathological gambling provide 3 original additions to the traditional multimodal treatment of addictions: cognitive restructuring, in vivo exposure, and imaginal desensitization. Other cognitive-behavioural techniques, such as relapse prevention, problem solving, and social skill training, are shared by gambling treatment and addictions treatment. Conclusions: When treating pathological gamblers, clinicians must consider introducing techniques to address cognitive distortions related to gambling. Also, cue exposure—whether in vivo or imaginal—may help deal with urges prompted by such cues. The blending of these new techniques into a multimodal addiction treatment potentially balances the rational and external orientation of the cognitive-behavioural approach with interpersonal and introspective components of the traditional addiction treatment.

The impact of gender, depression, and personality on craving

Abstract Craving plays an important role in the addictive behavior process. The impact of gender, emotional state and personality on craving, however, has been understudied. Craving plays an important role in the addictive behavior process. The impact of gender, emotional state and personality on craving, however, has been understudied. Recency of substance use and impulsivity were significantly associated with craving intensity for both women and men. Regression analyses revealed that depression best predicted craving for women, but not for men. These results suggest that while recent substance use and impulsivity can be important predictors of craving across gender, depression plays a critical role in craving among women. This finding underscores the need for vigorous assessment and treatment of comorbid symptomatology in women entering addiction treatment.

Pathological Love: Impulsivity, Personality, and Romantic Relationship

INTRODUCTION Pathological love (PL)--behavior characterized by providing repetitive and uncontrolled care and attention to the partner in a romantic relationship--is a rarely studied condition, despite not being rare and causing suffering. This study aims at investigating impulsivity, personality, and characteristics related to the romantic relationship in this population. METHODS Eighty-nine individuals (50 with PL; 39 individuals with no psychiatric disorder) were compared regarding impulsivity, personality, type of attachment, satisfaction with romantic relationship, and love style. RESULTS Individuals with PL have higher levels of impulsivity (P<.001; Barratt Impulsiveness Scale), higher self-transcendence, that is, are more unconventional and hold sense of communion with a wider reality (P<.001; Temperament and Character Inventory) and keep dissatisfactory romantic relationships (P<.001; Adapted Relationship Assessment Scale). CONCLUSION Individuals with PL present personality traits and relationship aspects that must be taken into account in devising assessment and therapeutic strategies for this population.

Domestic violence, alcohol and substance abuse

Domestic violence and substance abuse are common in primary care patients. Although these problems are associated with severe physical and psychological sequelae, they are often undiagnosed. This article provides an overview of the prevalence of these problems, the health-related consequences for adults, children and elderly, as well as the challenges for clinicians in screening, assessment and referral.

Violência doméstica, abuso de álcool e substâncias psicoativas

Domestic violence and substance abuse are common in primary care patients. Although these problems are associated with severe physical and psychological sequelae, they are often undiagnosed. This article provides an overview of the prevalence of these problems, the health-related consequences for adults, children and elderly, as well as the challenges for clinicians in screening, assessment and referral.