Sandra Scivoletto

Alcohol use among adolescents: concepts, epidemiological characteristics and etiopatogenic factors

Alcohol is the most consumed substance among young people, and the onset of its use is starting at an earlier age, raising the risks of future dependence. The use of alcohol in adolescence is associated with a series of risk behaviors, besides raising the risk of involvement in accidents, sexual violence, and participating in gangs. Alcohol use by adolescents is strongly associated with violent death, poor academic performance, learning difficulties and damage in the development and structuring of cognitive-behavioral and emotional abilities. Alcohol consumption causes neurochemical modifications, with damage in memory, learning and impulse control. Professionals who deal with adolescents must be prepared for a thorough evaluation regarding the possible abusive use or dependence of alcohol in this age group. However, it is important to emphasize that the criteria utilized by some diagnostic tools for abuse and dependence were developed for adults, and must be applied with caution in adolescents. Thus, it is fundamental that these professionals be aware of the characteristics and peculiarities of adolescence and chemical dependence in this age-group.

Relação entre consumo de drogas e comportamento sexual de estudantes de 2o grau de São Paulo

OBJECTIVE: Investigate the relationship between drug consumption and sexual behavior in a population of high school students attending a public school in the city of Sao Paulo. METHOD: Questionnaires (a total of 689) were gathered from students with ages between 14 and 21 years old who responded to this study. The questionnaires contained questions about the consumption of psychoative substances and sexual behavior. Then, sexual behavior was compared for differences between drug users and non-users. RESULTS: Illicit drug users (n=366) demonstrated a higher prevalence of complete sexual intercourse: 80,8% of users versus 57,6% of non-users (n=305), p<0,0001); earlier initiation of sexual activity (on average 15,2 years in users versus 15,7 in non-users, p<0,005); more payments for sexual acts (31,1% of users versus 15% of non-users, p<0,001); and a trend toward lesser usage of condoms (56,8% of users versus 65,3% of non-users, p<0,10). The results also were similar when we studied each type of drug separately and the associaton of different types of drugs. CONCLUSIONS: Frequency of drug use was not related to sexual behavior. Alcohol and cannabis were the drugs most associated with sexual risk behavior. Crack use was associated with earlier initiation of sexual activity.

Differences in the pattern of drug use between male and female adolescents in treatment

INTRODUCTION/OBJECTIVES: The pattern of drug use among adolescents is not well known. Epidemiologic studies have reported no difference in the prevalence of drug use between genders. The present study wanted to assess the difference in drug use between genders in adolescents. The following variables were assessed: gender ratio of those looking for treatment; age they looked for treatment; age of the first drug use; substances used; with whom they first used drugs; pattern of drug use; possibly-related behavior (illegal acts, problems with the police and school delay). METHODS: Medical records of adolescents treated between 1993 and 2000 in a public medical center of the city Sao Paulo were analyzed. RESULTS: One-hundred and five medical records of adolescents aged 10 to 17 were reviewed. There were no differences between genders according to: age they looked for treatment; age of the first drug use; substances used; and illegal acts. There was a higher prevalence of male adolescents regarding to problems with the police and school delay. CONCLUSIONS: Data suggest that the behavioral consequences of drug use in female adolescents are less evident than in male adolescents, what could explain the lower frequency in which female adolescents had specialized treatment.

High rates of psychiatric disorders in a sample of Brazilian children and adolescents living under social vulnerability--urgent public policies implications.

References 1. Bressan RA, Pilowsky LS. Glutamatergic hypothesis of schizophrenia. Rev Bras Psiquiatr. 2003;25(3):177-83. 2. de Lucena D, Fernandes BS, Berk M, Dodd S, Medeiros DW, Pedrini M, Kunz M, Gomes FA, Giglio LF, Lobato MI, Belmonte-de-Abreu PS, GAMA CS. Improvement of negative and positive symptoms in treatmentrefractory schizophrenia: a double-blind, randomized, placebo-controlled trial with memantine as add-on therapy to clozapine. J Clin Psychiatry. 2009;70(10):1416-23. 3. Peeters M, Page G, Maloteaux JM, Hermans E. Hypersensitivity of dopamine

Estudos neuropsicológicos e de neuroimagem associados ao estresse emocional na infância e adolescência

CONTEXTO: A infância e a adolescencia sao periodos relevantes para a maturacao do cerebro. Experiencias no comeco da vida exercem influencia em padroes de comportamentos da vida adulta. OBJETIVO: Analisar estudos neuropsicologicos e de neuroimagem associados ao estresse emocional na infância e adolescencia que foram publicados na literatura nos ultimos 20 anos METODOS: Revisao da literatura na base de dados Medline/PubMed com os termos relacionados a neuropsicologia, neuroimagem e vivencia de abandono, violencia domestica, abuso fisico, abuso sexual e negligencia. RESULTADOS: Foram encontrados 607 artigos, dos quais 19 foram selecionados para analise por se adequarem ao tema proposto. Apesar das divergencias entre eles, ha evidencias de que grupos com experiencia de estresse emocional precoce (EEP) apresentam prejuizos em funcoes neurocognitivas como atencao, inteligencia, linguagem, funcoes executivas e tomada de decisoes, assim como alteracoes no hipocampo, corpo caloso, cortex pre-frontal e cortex cingulado anterior. A ocorrencia de transtornos psiquiatricos e de alteracoes comportamentais tambem e relevante nesses individuos. CONCLUSOES: Em virtude da diversidade de efeitos negativos do EEP no desenvolvimento neuropsicologico, considera-se fundamental a realizacao de pesquisas sistematizadas que possam nortear a elaboracao de estrategias de diagnostico e tratamento especificas, alem da implementacao de politicas publicas de prevencao a violencia na infância e adolescencia.

Use of psychoactive substances by adolescents: current panorama

Adolescence is a period of vulnerability to substance use disorders (SUDs). Epidemiological studies indicate that about 23% of Brazilian adolescents use drugs, with alcohol being the most widely consumed substance. The etiology of SUDs is complex, influenced by an interaction of genetic risk, individual development, environmental factors, context of use, and substance used. Clinicians should consider diagnostic criteria and be aware of behavioral changes that may indicate drug use and its consequences in various aspects of adolescent life. Identification and treatment of comorbid conditions is critical to the management of SUDs in this age group. Interventions should restrict access to drugs and facilitate prompt recognition of initial use, preventing progression to serious patterns of abuse or dependence. Intervention should be broad, including academic and occupational activities as well as social relationships and leisure, which are critical to the reestablishment of normal adolescent development.

The impact of psychiatric diagnosis on treatment adherence and duration among victimized children and adolescents in São Paulo, Brazil

OBJECTIVE: Despite the high prevalence of substance abuse and mood disorders among victimized children and adolescents, few studies have investigated the association of these disorders with treatment adherence, represented by numbers of visits per month and treatment duration. We aimed to investigate the effects of substance abuse and mood disorders on treatment adherence and duration in a special program for victimized children in São Paulo, Brazil. METHODS: A total of 351 participants were evaluated for psychiatric disorders and classified into one of five groups: mood disorders alone; substance abuse disorders alone; mood and substance abuse disorders; other psychiatric disorders; no psychiatric disorders. The associations between diagnostic classification and adherence to treatment and the duration of program participation were tested with logistic regression and survival analysis, respectively. RESULTS: Children with mood disorders alone had the highest rate of adherence (79.5%); those with substance abuse disorders alone had the lowest (40%); and those with both disorders had an intermediate rate of adherence (50%). Those with other psychiatric disorders and no psychiatric disorders also had high rates of adherence (75.6% and 72.9%, respectively). Living with family significantly increased adherence for children with substance abuse disorders but decreased adherence for those with no psychiatric disorders. The diagnostic correlates of duration of participation were similar to those for adherence. CONCLUSIONS: Mood and substance abuse disorders were strong predictive factors for treatment adherence and duration, albeit in opposite directions. Living with family seems to have a positive effect on treatment adherence for patients with substance abuse disorders. More effective treatment is needed for victimized substance-abusing youth.

Emergências psiquiátricas na infância e adolescência

OBJECTIVE The prevalence of psychiatric disorders in childhood/adolescence is of 10-15%.The most frequent causes of psychiatric emergence attendances in this age are: behavioral disturbances, suicidal behavior, and depression.The objective of this study is to present the most relevant clinical issues and to guide the initial procedures of psychiatric emergencies in childhood/adolescence. METHOD Non-systematic review. RESULTS Relevant clinical issues for psychiatric emergency evaluation of children/adolescents are presented. Clinical presentations are divided in relevant groups of symptoms, due to its frequency and to its impact to patients and their families. Therefore, the following syndromes are presented: aggressive behavior, intoxication, suicidal behavior, psychoses, anxiety disorders, eating disorders, maltreatment against children/adolescents. The initial procedures recommended for each of these conditions are described. CONCLUSION Psychiatric emergencies in childhood/adolescence can be the re-agudization or a first crisis of a psychiatric disorder. The emergency evaluations objectives are: to identify the diagnosis, the risks for the child/adolescent, the triggering and maintaining factors, and the presence of familiar and social support.

USE OF PSYCHOACTIVE SUBSTANCES AND SEXUAL RISK BEHAVIOR IN ADOLESCENTS

This study investigated the relationship between the use of illicit drugs and sexual-risk-behavior in a sample of students aged 14 to 21 years at a public high school in São Paulo in 1997. A total of 689 useable questionnaires documented the sample in consumption of psychoactive substances and sexual behavior. Sexual behavior of drug users and non-users was compared regarding history of complete sexual intercourse, age at first sexual intercourse, use of condoms, sexual intercourse with sex workers, and prostitution. Drug users (N = 366) presented a higher frequency of complete sexual intercourse (80.8% of users versus 53.5% of non-users), (N = 323, p<.001), a younger age at first sexual intercourse (on average 15.2 years in users versus 15.7 among non-users, p<.005), a trend toward lower use of condoms (56.7% among users versus 65.3% among non-users, p<.1), and more sexual intercourse with sex workers (31.1% among users versus 15% among non-users, p<.001). Sexual-risk-behavior increased with the number of drugs used. Alcohol and marijuana use were associated with the highest sexual-risk-behavior. These data are essential for the development of more specific preventive strategies, focusing on male alcohol and marijuana users.

Association of child maltreatment and psychiatric diagnosis in Brazilian children and adolescents

OBJECTIVES: The objective of this study was to evaluate the association between different types of child maltreatment and the presence of psychiatric disorders in highly vulnerable children and adolescents served by a multidisciplinary program. METHODS: In total, 351 patients with a mean age of 12.47, of whom 68.7% were male and 82.1% lived in shelters, underwent psychiatric evaluations based on the Kiddie-Sads-Present and Lifetime Version. Two different methods were used to evaluate maltreatment: medical records were reviewed to identify previous diagnoses related to socioeconomic and psychosocial circumstances, and the Childhood Trauma Questionnaire was used to obtain a structured history of trauma. Bivariate associations were evaluated between psychiatric disorders and evidence of each type and the frequency of abuse. RESULTS: The most frequent psychiatric diagnoses were substance use disorders, affective disorders and specific disorders of early childhood, whereas 13.67% of the sample had no psychiatric diagnosis. All patients suffered neglect, and 58.4% experienced physical or sexual abuse. The presence of a history of multiple traumas was only associated with a diagnosis of substance use disorder. Mental retardation showed a strong positive association with reported physical abuse and emotional neglect. However, a negative correlation was found when we analyzed the presence of a history of multiple traumas and mental retardation. CONCLUSION: All children living in adverse conditions deserve careful assistance, but we found that physical abuse and emotional neglect were most strongly associated with mental retardation and multiple traumas with substance abuse.