Nuno Félix da Costa

Combination of midazolam and flumazenil in upper gastrointestinal endoscopy, a double-blind randomized study

We evaluated the clinical usefulness of flumazenil (formerly Ro15-1788), a benzodiazepine antagonist, in combination with midazolam in upper gastrointestinal endoscopy. Thirty outpatients were randomized into two groups: those receiving flumazenil and those receiving placebo after endoscopy. For sedation, only midazolam was used. Performances pre-sedation and post-sedation (at 30 and 60 min) were analyzed using the Trieger test, Number Connection test, and Digit Symbol test. Patients receiving flumazenil were fully alert and able to ambulate 5 min after injection with this medication. Performances at 30 min in the Trieger, Number Connection, and Digit Symbol tests were significantly better in the group receiving flumazenil, p less than 0.005, p less than 0.025, and p less than 0.01, respectively. No phlebitis, nausea, vomiting, or anxiety were noted. No resedation events were documented. We conclude that flumazenil can dramatically shorten the recovery period following sedation with midazolam in upper gastrointestinal endoscopy, and its use is not associated with major side effects.

The burden of cyclothymia on alcohol dependence

BACKGROUND The relationship between cyclothymic temperament and alcoholism remains insufficiently explored. METHODS A sample of 125 alcohol-dependent patients diagnosed according to DSM-IV-TR criteria (APA, 2000) was recruited from a clinical setting. Cyclothymic temperament was diagnosed according to the Portuguese version of the Akiskal and Akiskal (2005) temperament scale. RESULTS Alcohol dependent patients who score positive (above mean) for CT present to some extent a more severe profile of alcohol-related problems. LIMITATIONS Correlational study CONCLUSIONS CT traits in alcohol dependents seems to influence whether subjects engage earlier in pathological alcohol use and present particular alcohol-related problems, in particular Cloninger type II alcoholism phenotype.

Alexithymia and alcohol dependence: Do different subtypes manifest different emotion regulations?

Abstract Objective: Alcohol abusers are vulnerable to emotional disabilities. Studies have shown that alexithymia is significantly associated with alcohol dependence and many other phenotypic descriptors. Given the high phenotypic heterogeneity that characterizes the alcohol dependence syndrome, the study aims to assess alexithymia features according to a multivariate classification scheme of alcoholism – the Lesch Alcoholism Typology (LAT). Methods: A total of 274 alcohol dependence outpatients (DSM diagnosis) were recruited from the Alcoholism Unit of the Psychiatric Service of Santa Maria University Hospital. After a detailed clinical observation, subjects were evaluated with the alcoholism classification system (LAT) and self-rated alexithymia with the Toronto Alexithymic Scale – 20 items (TAS-20). Results: Data showed that almost half of the alcohol-dependent individuals were defined as alexithymic cases (48.5%). “Organic” alcohol-dependent patients (type IV of Lesch classification) presented higher scores in TAS-20 when compared to other subtypes, even after controlling for potential confounding factors. Furthermore, the TAS-20 scores were related to educational level and family history of alcoholism. Conclusions: Results indicate that the alexithymia construct is an important psychological dimension in the characterization of alcohol dependence, especially the alcohol-dependent phenotypes that are more likely to present co-existing organic complications.

Are the binary typology models of alcoholism valid in polydrug abusers

OBJECTIVE To evaluate the dichotomy of type I/II and type A/B alcoholism typologies in opiate-dependent patients with a comorbid alcohol dependence problem (ODP-AP). METHODS The validity assessment process comprised the information regarding the history of alcohol use (internal validity), cognitive-behavioral variables regarding substance use (external validity), and indicators of treatment during 6-month follow-up (predictive validity). RESULTS ODP-AP subjects classified as type II/B presented an early and much more severe drinking problem and a worse clinical prognosis when considering opiate treatment variables as compared with ODP-AP subjects defined as type I/A. Furthermore, type II/B patients endorse more general positive beliefs and expectancies related to the effect of alcohol and tend to drink heavily across several intra- and interpersonal situations as compared with type I/A patients. CONCLUSIONS These findings confirm two different forms of alcohol dependence, recognized as a low-severity/vulnerability subgroup and a high-severity/vulnerability subgroup, in an opiate-dependent population with a lifetime diagnosis of alcohol dependence.

Multidimensional alcoholism typologies: could they guide clinical practice? Results from a 3-month prospective study

Abstract Objective. The current nosological classifications may describe a syndrome of “alcoholism” that is too heterogeneous to produce prognostic models for clinical management. Multidimensional alcoholism typologies (ATs) could represent a valuable paradigm in the search for targeted treatment. The main goal of this study was to evaluate the clinical implications of 3 empirically-validated ATs, focusing on various measures of clinical performance. Method. This was a 3-month naturalistic study in which drinking status, and participation in the clinical protocol and group psychotherapy were recorded and used as indicators of treatment performance. The clinical profiles of the subtypes were also compared and graphically presented. Alcohol-dependent outpatients were classified according to the Cloninger, Lesch, and NETER typologies. Results. The results showed that the type II (Cloninger), type IV (Lesch), and sociopathic and addictopathic (NETER) subgroups showed a worse outcome in terms of abstinence rates and clinical healthcare resource use. Conclusions. Our findings point to the need to differentiate multidimensional alcoholism subtypes before planning the clinical management of alcohol use disorders.

Modelling urban form: A multidimensional typology of urban occupation for spatial analysis:

The conceptual and methodological debate on urban form has grown in the last decades to recognize that social, economic, demographic and political processes can contribute to the development of new urban forms, especially those related to urban sprawl, as well as to find alternative methodologies for measuring them. Spatial metrics derived from landscape ecology arise as principal indicators to measure urban form. This paper proposes a typology of the urban occupation of Portuguese municipalities. It uses land use/cover data from 1990 and 2006 to extract built-up areas, and it presents five spatial metrics alongside seventeen statistical indicators from 1991 to 2011 most commonly used in the literature to characterize urban occupation. It uses a self-organising map as a visual tool to identify trends and relationships among variables and to cluster municipalities. Based on the self-organising map’s visual clustering, six types of urban occupation of Portuguese municipalities are proposed. In addition, the paper discusses the added value of using indicators that describe both the patterns and the characteristics of the municipalities for making spatial planning decisions in Portugal. The observed results show that spatial metrics are particularly adequate for measuring peri-urban municipalities (urban sprawl areas). These results represent the first multidimensional and systematic analysis of Portuguese urban occupation and they can be the first step in the integration of spatial metrics as indicators that are suitable for the analysis of spatial planning, and also for comparative purposes at a broader geographical scale.