Rogério Lessa Horta

Perfil dos usuários de crack que buscam atendimento em Centros de Atenção Psicossocial

This paper describes the profile of 95 crack cocaine users attending three community mental health services (CAPS) in Greater Metropolitan Porto Alegre, Rio Grande do Sul State, Brazil, from August 2009 to March 2010. The instruments employed were questionnaires developed by the team, the Self-Reporting Questionnaire (SRQ-20), and inventories of criteria for dependence and abuse (SAMHSA). The data depict a group of users consisting predominantly of young males with elementary schooling, without regular employment but reporting individual income, none of whom living on the streets. They were currently addicted, with heavy daily use of crack for more than two years, and with high SRQ-20 score. This groups characteristics showed that the community mental health services are attended by crack users that suffer losses resulting from their addiction, but also some possible selection process in the supply of these health services (based mainly income, schooling, or primary support network).

Drogas: famílias que protegem e que expõem adolescentes ao risco

OBJECTIVE: This study was aimed to assess the relationship between substance use (alcoholic beverages, smoking and drug use) among teenagers and cohabitation with parents, as well as the relationship between substance use and parental smoking. METHODS: In 2002, a cross-sectional survey was carried out in the urban area of Pelotas, southern Brazil. Multi-stage sampling was used to obtain a sample of adolescents aged between 15 and 18 years. Adolescents were interviewed using a self-applied confidential questionnaire. RESULTS: The cohabitation of parents and adolescents significantly reduced the odds ratio of tobacco smoking, but had a lower effect on reducing drugs use and was not related to alcohol intake. CONCLUSION: Parental smoking seems to be related only to adolescent smoking. No interaction was found between the two variables in relation to the consumption of any of studied substances.

Prevalência de compulsão alimentar entre universitárias de diferentes áreas de estudo

INTRODUCCION: La compulsion alimentaria (CA) entre mujeres viene siendo considerada como factor de riesgo para el diagnostico de trastornos alimentares mas graves. El objetivo del presente estudio ha sido investigar la prevalencia de CA entre universitarias y su asociacion con el IMC (indice de masa corporea) y edad. MATERIAL Y METODO: Se evaluaron 491 estudiantes universitarias, con edad entre 17 y 55 anos, de tres areas de estudio (exactas, salud y humanidades) de la Universidade do Vale do Rio dos Sinos (UNISINOS), ubicada en el municipio de Sao Leopoldo (RS, Brasil). Para evaluar la frecuencia de CA, se utilizo el cuestionario autoaplicable Escala de Compulsion Alimentaria Periodica (ECAP). Las medidas de peso y estructura han sido autoinformadas. RESULTADOS: La prevalencia de CA entre las universitarias estudiadas ha sido de 18,1%. La frecuencia de IMC > 25 kg/m2 ha sido de 11,4% y 75,8% de ellas tenian mas de 20 anos de edad. Se observo una asociacion significativa entre IMC y CA en el grupo general, siendo que el 54,5% de las universitarias con exceso de peso u obesidad presentaron CA (p < 0,001), y la edad no ha sido asociada a la presencia de CA. Sin embargo, en el area de salud, las estudiantes con edad igual o menor a 20 anos presentaron mayor frecuencia de CA (p < 0,05) y, en el area de humanas, el resultado ha sido inverso (p < 0,05). CONCLUSION: El cuestionario autoaplicable ECAP revelo elevada prevalencia de CA entre mujeres universitarias, mostrando asociacion con exceso de peso. Investigaciones futuras son necesarias, con el objetivo de confirmar esos resultados y evaluar la presencia de otros trastornos alimentares.Introduction: Binge eating (BE) among women has been regarded as a risk factor for the diagnosis of more severe eating disorders. The present study aimed to investigate the prevalence of BE among female university students and its association with body mass index (BMI) and age. Material and methods: The study evaluated 491 female university students aged between 17 and 55 years in three fields of knowledge (exact sciences, health and humanities) at the Universidade do Vale do Rio dos Sinos (Unisinos), located in São Leopoldo (Brazil). A self-

Percepção de profissionais de saúde de CAPS I quanto a demandas relativas ao consumo de crack

Pesquisa qualitativa que analisa dois grupos focais realizados em 2009 com vinte trabalhadores de dois CAPS I da regiao de Porto Alegre, para verificar a sua percepcao diante do aumento de demandas que a expansao do crack tende a gerar sobre as redes locais de saude mental. Propos-se que debatessem o que lhes parecia fonte de sobrecarga e insatisfacao em geral e, especificamente, em funcao das demandas de usuarios de crack. Os resultados mostram forte preocupacao com a instabilidade dos contratos de trabalho, levando a falta de projecao no futuro. Alem disso, o acumulo de tarefas para suprir carencias das equipes, justificando-se o limitado interesse em planejar acoes de longo prazo e a opcao por tarefas menos complexas. Consideraram-se problemas na rotina de trabalho as ordens judiciais e a interferencia de agentes publicos, pedido expresso de hospitalizacao, familiares sem postura cooperativa, querelantes e usuarios desmotivados para o tratamento ou reingressando no servico. As equipes parecem estar no centro um conflito entre a impossibilidade de se evitar o surgimento de demandas da populacao usuaria das redes locais de saude, o que se evidencia no contexto do uso de crack, e os limites da gestao, ampliando o desgaste e a sobrecarga percebidos.This article analyzes different aspects of depression association with suicide among the elderly based on psychological autopsies. The retrospective method was used to study indeterminate deaths, based on interviews and reports, which analyze psychosocial circumstances related to suicide. The paper reveals the predominance of gender, social class and race - women, middle and upper class, white - and, in an unprecedented manner, contextualizes depression in a poorly studied population in Brazil and in the world with high risk of suicide. The physical and mental health, social circumstances and predominant biographical characteristics of the suicide victim were reconstructed in order to assess the impact of depression on suicide. Depression was presented in almost all cases, in primary or secondary diagnosis, as the symptom associated with other co-morbidities or as a reaction to social stressors, demanding different therapeutic approaches and procedures. The association between depression and multiple co-morbidity accentuates the case prognosis and cumulatively increases the risk of suicide. Depression followed by suicidal tendencies is a risk factor which justifies immediate preventive measures. Increasing assertive ways to diagnose and treat depression in old age is recommended.

Comportamentos violentos de adolescentes e coabitação parento-filial

OBJETIVO: Analizar la asociacion entre comportamientos violentos de adolescentes y la co-habitabilidad parental-filial. METODOS: Estudio transversal de base poblacional realizado en el area urbana de Pelotas, Sur de Brasil, en 2002, con muestreo en multiples fases. Fueron entrevistados 960 adolescentes con utilizacion de cuestionario auto-aplicado. Las variables dependientes (uso de armas y envolvimiento en peleas en el ultimo ano fueron referidos por los adolescentes) y la variable independiente co-habitabilidad parental-filial fueron sometidas a analisis por la prueba e chi-cuadrado y la tasa de prevalencias, ajustada para edad, sexo, nivel socioeconomico relato de uso en la vida y reciente de alcohol, tabaco o drogas ilicitas. RESULTADOS: El envolvimiento en peleas en el ultimo ano fue referido por 23% de los sujetos y el uso de armas por 9,6%. La tasa de prevalencia de ocurrencia de estos comportamientos fue de 1,38 (IC 95%: 0,71;2,68, p=0,34) para envolvimiento en peleas y de 1,68 (IC 95%: 1,06;2,67, p=0,03) para uso de armas, teniendo como referencia sujetos que co-habitaban con padre, con madre o con ambos. CONCLUSIONES: La co-habitabilidad parental-filial debe ser considerada en politicas de prevencion al uso de armas por ninos y adolescentes, pero se recomienda el cuidado de no estigmatizar ninos y adolescentes que no co-habitan con padres y madres.

Déficits cognitivos em pacientes usuários de crack

This paper has the objective of researching cognitive deficits in patients who are crack cocaine users. The use of smoked crack cocaine has been increasing in Brazil. Cognitive functions compromises come as a result. Attention, memory, executive function and problem solving deficits are frequently stressed problems. This was a transversal study of case-control type. The sample was constituted by the snowball effect strategy with crack cocaine users and alcohol and/or tobacco (non cocaine) users, all under hospital or ambulatory treatment. A neuropsychological battery, composed of: Raven General, Wais-R (Vocabulary, Comprehension, Cubes and Numerical Symbols) and Rey Complex Figure was applied to each subject and his or her performance was compared to that of the non user control group. The users were under abstinence for no less than seven days. The results evidence significant prejudice of the group of users in relation to the control group in terms of non-visual memory and visualconstructive functions.

Lifetime use of illicit drugs and associated factors among Brazilian schoolchildren, National Adolescent School-based Health Survey (PeNSE 2012)

OBJECTIVE This study aimed at describing the prevalence of illicit drug use among 9th grade students in the morning period of public and private schools in Brazil, and assessing associated factors. METHOD The Brazilian survey PeNSE (National Adolescent School-based Health Survey) 2012 evaluated a representative sample of 9th grade students in the morning period, in Brazil and its five regions. The use of illicit drugs at least once in life was assessed for the most commonly used drugs, such as marijuana, cocaine, crack, solvent-based glue, general ether-based inhalants, ecstasy and oxy. Data were subjected to descriptive analysis, and Pearsons χ² test and logistic regression was used in the multivariate analysis. RESULTS The use of illicit drugs at least once in life was reported by 7.3% (95%CI 5.3 - 9.4) of the respondents. Logistic regression was used for multivariate analysis and the evidences suggest that illicit drug use is associated to social conditions of greater consumption power, the use of alcohol and tobacco, behaviors related to socialization, such as having friends or sexual activity, and also the perception of loneliness, loose contact between school and parents and experiences of abuse in the family environment. The outcome was inversely associated with close contact with parents and parental supervision. CONCLUSION In addition to the association with the processes of socialization and consumption, the influence of family and school is expressed in a particularly protective manner in different records of direct supervision and care.

Revisão sistemática sobre tratamentos psicológicos para problemas relacionados ao crack

OBJETIVO: O objetivo deste artigo e apresentar uma revisao sistematica da literatura sobre tratamentos psicologicos oferecidos para usuarios de crack. METODOS: Foi realizada uma revisao sistematica por meio de uma busca na literatura internacional e nacional, indexada nas bases de dados Medline, SciELO, Lilacs e Web of Science. Os descritores utilizados foram: crack or crack cocaine or cocaine smokers (crack) and psychosocial treatment or psycotherapy or psychosocial treatment (tratamento psicologico) e a busca incluiu artigos publicados no periodo de 2001 a 2011. RESULTADOS: No total foram encontrados 155 artigos por meio dos descritores utilizados. Os artigos foram agrupados em tres dimensoes: tratamentos psicossociais na internacao e cuidados continuados, relaxamento respiratorio e outras tecnicas comportamentais e abordagens fundamentadas na Entrevista Motivacional, Cognitivo-Comportamental e Modelo Transteorico de Mudanca. CONCLUSAO: Com base nos estudos examinados, pode ser formulado um elenco de algumas intervencoes que estao sendo estudadas para o tratamento de usuarios de crack e algumas apresentam resultados satisfatorios. Os poucos esforcos de comparacao entre tecnicas resultaram em evidencias de pouca ou nenhuma diferenca, ainda que se registre o beneficio para os usuarios na aplicacao de qualquer delas. Nao existe consenso acerca da efetividade no tratamento de usuarios de crack. Parece oportuno e necessario o aprofundamento dos estudos nesse campo.

Influência da família no consumo de crack

Objective This paper aims to study the contributions of families of crack users on promoting both consumption and cessation of consumption of this substance. Methods A cross-sectional, mixed study with a quantitative design (descriptive and analytical statistics, by robust Poisson regression) and a qualitative design (thematic content analysis). Results Among 519 crack users interviewed 48.3% reported having shared crack cocaine with some family member. The more expressive occurrence of sharing was for marital relations indicated by 30.6% of respondents. The estimated prevalence rates of the outcome crack usage stopped for more than 12 weeks, by robust Poisson regression controlling for confounding factors, for crack users who reported shared with brothers use was 0.940 (95% CI: 0.885-0.999; p = 0.045). For qualitative dimension, 20 respondents freely exposed the involvement they realize that their families have with their drug use, some indicating opposition to consumption, other stimulus, or offering, besides the interplay between crack usage and family conflicts and a negative environment. In addition, respondents who reported having family members in mental health treatment were 9% more likely to be stopped for 12 weeks or more (PR = 1.09 95% CI: 1.03-1.15; p = 0.005). Conclusion Family groups appear not only as a protective factor, but also as an important risk factor for crack cocaine use and their inclusion treatments is justified on these evidences.

Perfil clínico e cognitivo de usuários de crack internados

The aim of this cross-sectional study was to assess the use of crack cocaine (semi-structured interview), adaptive functioning (concerning friends, work, and family), psychopathological functioning (Adult Self-Report) and cognitive functions (WAIS-III) among hospitalized crack cocaine users. From the 84 respondents (90.5% male), 53.6% used crack cocaine on a daily basis in the previous year, with an usual average consumption of 1.54 grams (SD=.53; Min.=.5; Max.=2.5). There was a large prevalence of internalizing (77.4%) and externalizing (77.4%) problems, adaptive functioning (84.6 to 97.6%) and wrongful behavior (70.3% of rule-breaking behavior and 59.6% of antisocial behavior). Cognitive functions were preserved (low average/average/high average) in most respondents (>75%), with worse performance on the Vocabulary subtest (22.6% in the low average range).