Sergio Nicastri

Comparative study of drug use among undergraduate students at the University of São Paulo--São Paulo campus in 1996 and 2001.

OBJECTIVEnTo compare the rate of drug use prevalence and to investigate opinions regarding such use among undergraduate students at the University of São Paulo--São Paulo campus in 1996 and again in 2001.nnnMETHODSnBoth studies followed the same procedures of sampling and data collection. A random sample of undergraduate students, divided into the areas Humanities, Exact Sciences and Biologic Sciences, responded to an anonymous and self-report survey regarding the use of licit and illicit drugs within the last 30 days, within the last 12 months and over the lifetime of the subject. The two surveys were compared through the construction of (95%) confidence intervals for the prevalence differences for each substance by area and by total number of students. The Wald test for homogeneity was applied in order to compare the prevalences.nnnRESULTSnHigh approval of regularly trying and using cocaine, crack, amphetamines and inhalants was observed. The drugs that showed statistic significant increasing were:lifetime use: alcohol, tobacco, marijuana, inhalants, hallucinogens, amphetamines, anti cholines, barbiturics and any illicit drug;last-12-month use: marijuana, inhalants, amphetamines, hallucinogens and any illicit drug;last-30-day use: marijuana, inhalants, amphetamines and any illicit drug.nnnDISCUSSIONnThe observed difference in the use of some drugs between the two surveys appears to be a consequence of the higher rates of favorable opinions regarding trying and regularly using some psychoactive substances, a finding that mirrors global trends in drug use.

Alterações neuropsicológicas em dependentes de cocaína/crack internados: dados preliminares

OBJECTIVE: Although cocaine use is a significant public health problem, there is relative paucity of scientific data on long-term neurocognitive consequences of the exposure to the substance. METHODS: This study examined the association between crack cocaine dependence and neuropsychological performance. An extended battery of neuropsychological tests was administered to 15 abstinent cocaine abusers, inpatients in abstinence for two weeks, and 15 non-drug-using control subjects matched for age, gender, education, socio-economic status, handedness and IQ. RESULTS: The preliminary findings showed statistical significance (p<0,05) on differences of performance in attention, verbal fluency, verbal memory, visual memory, learning ability and executive functions. CONCLUSIONS: These results represent evidences that cocaine abuse is associated with decrements in cognitive functioning, similar to cognitive disorders associated to prefrontal and temporal brain impairments. Knowledge of specific cognitive deficits in cocaine abusers may be useful for designing more effective substance abuse prevention and treatment programs.

Decision‐Making Deficits Linked to Real‐life Social Dysfunction in Crack Cocaine‐Dependent Individuals

Crack cocaine-dependent individuals (CCDI) present abnormalities in both social adjustment and decision making, but few studies have examined this association. This study investigated cognitive and social performance of 30 subjects (CCDI × controls); CCDI were abstinent for 2 weeks. We used the Social Adjustment Scale (SAS), Wisconsin Card Sorting Test (WCST), and Iowa Gambling Task (IGT). Disadvantageous choices on the IGT were associated with higher levels of social dysfunction in CCDI, suggesting the ecological validity of the IGT. Social dysfunction and decision making may be linked to the same underlying prefrontal dysfunction, but the nature of this association should be further investigated.u2003

The frontal assessment battery (FAB) reveals neurocognitive dysfunction in substance-dependent individuals in distinct executive domains: Abstract reasoning, motor programming, and cognitive flexibility

Substance-dependence is highly associated with executive cognitive function (ECF) impairments. However, considering that it is difficult to assess ECF clinically, the aim of the present study was to examine the feasibility of a brief neuropsychological tool (the Frontal Assessment Battery - FAB) to detect specific ECF impairments in a sample of substance-dependent individuals (SDI). Sixty-two subjects participated in this study. Thirty DSM-IV-diagnosed SDI, after 2weeks of abstinence, and 32 healthy individuals (control group) were evaluated with FAB and other ECF-related tasks: digits forward (DF), digits backward (DB), Stroop Color Word Test (SCWT), and Wisconsin Card Sorting Test (WCST). SDI did not differ from the control group on sociodemographic variables or IQ. However, SDI performed below the controls in DF, DB, and FAB. The SDI were cognitively impaired in 3 of the 6 cognitive domains assessed by the FAB: abstract reasoning, motor programming, and cognitive flexibility. The FAB correlated with DF, SCWT, and WCST. In addition, some neuropsychological measures were correlated with the amount of alcohol, cannabis, and cocaine use. In conclusion, SDI performed more poorly than the comparison group on the FAB and the FABs results were associated with other ECF-related tasks. The results suggested a negative impact of alcohol, cannabis, and cocaine use on the ECF. The FAB may be useful in assisting professionals as an instrument to screen for ECF-related deficits in SDI.

Diretrizes da Associação Brasileira de Estudos do Álcool e outras Drogas (ABEAD) para o diagnóstico e tratamento de comorbidades psiquiátricas e dependência de álcool e outras substâncias

Recently, several studies have focused on comorbity psychiatric disorders with alcohol and other substance dependence. The Brazilian Association of Studies on Alcohol and Other Drugs proposed the Brazilian Guidelines project. This study review diagnostic and therapeutic criteria to the most prevalent psychiatric comorbidities. Randomized clinical trials, epidemiological, animal studies and other forms of research are reviewed. The main psychiatric comorbidities are studied based on guidelines adopted by other countries and the literature data resumed. Epidemiological aspects, diagnoses, integrated treatment and service organization, as well as specific psychotherapic and pharmacological treatment are discussed. The Brazilian Association of Studies on Alcohol and Other Drugs Guidelines reassures the importance of adequate diagnoses and treatment regarding alcoholic and drug dependent patients suffering of comorbid psychiatric disorders.

Consenso sobre a Síndrome de Abstinência do Álcool (SAA) e o seu tratamento

O corpo do conhecimento médico vem crescendo exponencialmente ao longo das últimas décadas, o que torna a boa prática da medicina um exercício cada vez mais difícil devido à constante necessidade de avaliar o que vale a pena continuar fazendo para o bem de nossos pacientes. Várias novas idéias surgiram com o objetivo de ajudar a organizar o conhecimento médico: “medicina baseada em evidências”, “revisão sistemática da literatura”, “educação médica continuada”. Além disso, os meios eletrônicos facilitaram muito o acesso à informação, criando a sensação de que existe um mundo de novas informações e que o médico não tem tempo para atualizar-se. No entanto, nenhum profissional isoladamente consegue fazer uma revisão consistente da literatura de todos os assuntos da sua prática clínica devido à dificuldade de tempo e muitas vezes de conhecimento. Nesse sentido, as associações médicas têm um papel fundamental em auxiliar seus afiliados com revisões sistemáticas da literatura que auxiliem o clínico a organizar-se frente a essa avalanche de informações. Nos últimos anos temos vistos vários consensos surgirem na literatura internacional. No nosso meio, recentemente a Associação Médica Brasileira (AMB) considerou a criação de consensos como uma das suas mais importantes metas para a nova gestão. O Departamento de Dependência Química da Associação Brasileira de Psiquiatria optou por começar pela Síndrome de Abstinência do Álcool, pois considerou-se que é um assunto no qual na prática clínica ainda não existe uma homogeneidade de procedimentos aqui no Brasil, muito embora a literatura internacional aponte para uma quase unanimidade sobre o que fazer e principalmente sobre o que não fazer. Devido à falta de experiência sobre esse tipo de atividades tentamos ser o mais cuidadosos possível e para tanto adotamos a seguinte estratégia: em primeiro lugar foram identificados os profissionais com maior experiência clínica e científica em dependência química. Tentou-se buscar a melhor distribuição possível entre as diferentes regiões do Brasil. Foi feita uma revisão da literatura por meio da Medline e pedido para que alguns dos participantes fizessem um resumo crítico de algumas partes do consenso. Durante um final de semana inteiro esses profissionais reuniram-se e discutiram a melhor forma de produzir o consenso. Após extensa discussão foi formada uma comissão encarregada de fazer o texto final. Esse texto foi enviado para cada um dos participantes para a aprovação final. O objetivo agora, após a publicação na Revista Brasileira de Psiquiatria, é divulgar esse consenso o máximo possível. Temos a intenção de que esse texto possa estar a disposição de todos os clínicos brasileiros que tenham a possibilidade de tratar alguém com a síndrome de abstinência do álcool.

Neural Bases of Pharmacological Treatment of Nicotine Dependence - Insights from Functional Brain Imaging: A Systematic Review

BackgroundNicotine dependence is difficult to treat, and the biological mechanisms that are involved are not entirely clear. There is an urgent need to develop better drugs and more effective treatments for clinical practice. A critical step towards accelerating progress in medication development is to understand the neurobehavioral effects of pharmacotherapies on clinical characteristics associated with nicotine dependence.ObjectivesThis review sought to summarize the functional magnetic resonance imaging (fMRI) literature on smoking cessation with the aim to better understand the neural processes underlying the effects of nicotinic and non-nicotinic pharmacological smoking cessation treatments on specific symptoms of nicotine dependence and withdrawal.Data SourcesWe conducted a search in Pubmed, Web of Science and PsycINFO databases with the keywords ‘fMRI’ or ‘functional magnetic resonance imaging’ and ‘tobacco’ or ‘nicotine’ or ‘smok*’. The date of the most recent search was May 2012.Study Eligibility Criteria, Participants and InterventionsThe original studies that were included were those of smokers or nicotine-dependent individuals, published in the English language, with pharmacological treatment for nicotine dependence and use of fMRI with blood oxygen level-dependent (BOLD) imaging or continuous arterial spin labelling (CASL). No date limit was applied.Study Appraisal and Synthesis MethodsTwo of the authors read the abstracts of all studies found in the search (nxa0=xa01,260). The inclusion and exclusion criteria were applied, and 1,224 articles were excluded. In a second step, the same authors read the remaining 36 studies. Nineteen of the 36 articles were excluded. The results were tabulated by the number of individuals and their mean age, the main sample characteristics, smoking status, study type and methodology, and the main fMRI findings.ResultsSeventeen original fMRI studies involving pharmacological treatment of smokers were selected. The anterior and posterior cingulate cortex, medial and lateral orbitofrontal cortex, ventral striatum, amygdala, thalamus and insula are heavily involved in the maintenance of smoking and nicotine withdrawal. The effects of varenicline and bupropion in alleviating withdrawal symptoms and decreasing smoking correlated with modulation of the activities of these areas. Nicotine replacement therapy seems to improve cognitive symptoms related to withdrawal especially by modulating activities of the default-network regions; however, nicotine replacement does not necessarily alter the activities of neural circuits, such as the cingulate cortices, that are associated with nicotine addiction.LimitationsThe risk of bias in individual studies, and across studies, was not assessed, and no method of handling data and combining results of studies was carried out. Most importantly, positron emission tomography (PET) studies were not included in this review.Conclusions and Implication of Key FindingsfMRI studies delineate brain systems that contribute to cognitive deficits and reactivity to stimuli that generate the desire to smoke. Nicotinic and non-nicotinic pharmacotherapy may reduce smoking via distinct neural mechanisms of action. These findings should contribute to the development of new medications and discovery of early markers of the therapeutic response of cigarette smokers.

Motivational Interviewing combined with chess accelerates improvement in executive functions in cocaine dependent patients: A one-month prospective study

BACKGROUNDnIn cocaine-dependent individuals, executive function (EF) deficits are associated with poor treatment outcomes. Psychological interventions and pharmacological approaches have produced only modest effect sizes. To date, studies of this topic have been few and limited. The aim of this study was to examine the effects of a new model of intervention, which integrates chess and Motivational Interviewing, Motivational Chess (MC) METHODS: We evaluated 46 cocaine-dependent inpatients (aged 18-45), in two groups-MC (n=26); and active comparison-AC (n=20). Using neuropsychological tests and an impulsivity scale, we assessed the subjects before and after the study period (one month of abstinence monitored by urine toxicology screening).nnnRESULTSnThe MC and AC groups did not differ at baseline. In the post-intervention assessment (after one month), both groups showed significant improvements in attention, mental flexibility, inhibitory control, abstraction abilities, and decision-making (p<0.01). In addition, the improvement in working memory was more significant in the MC group than in the AC group (group-by-time interaction, p=01).nnnCONCLUSIONSnOne month of abstinence was sufficient to improve various attentional and executive domains in cocaine-dependent subjects. The MC intervention was associated with greater improvements in EFs, especially working memory, suggesting that tailored interventions focusing on complex EFs accelerate the process of cognitive recovery during the initial period of abstinence.

Anormalidades de fluxo sangüíneo cerebral em indivíduos dependentes de cocaína

INTRODUCTION: In the last years, there have been reports of abnormalities in brain blood flow of cocaine abusers, detected by single photon computed emission tomography (SPECT). This abnormal pattern of brain perfusion has been associated with cognitive impairments but not with changes that could be seen by the use of structural neuroimaging techniques. One of the problems with most of the published papers on the subject is the inclusion of a large number of heroin users in the studied samples. Heroin also seems to affect the pattern of brain perfusion, particularly during withdrawal states. METHODS: Fourteen cocaine-dependent inpatients (none of them under the use of opiates) and 14 healthy volunteers (control group) were submitted to 99m-technetium ethyl-cysteinate dimer SPECT. The analysis of SPECT exams was made by visual qualitative analysis of the reconstructed images (standard method in clinical practice), performed by a radiologist unaware of the subjects diagnoses. RESULTS: Visual analysis showed a pattern suggestive of irregularities in the cerebral blood flow in nine patients, but in only two controls (p = 0.018; two tailed Fishers exact test). CONCLUSIONS: Abnormal brain circulation may be related to cognitive impairments reported in cocaine dependent subjects. Although brain perfusion deficits associated with cocaine use may be irreversible, there have been reports in the literature of treatments for these blood flow changes. There are abnormalities in the cerebral blood flow associated with cocaine dependence even in the absence of opiate abuse or dependence.

Outcome predictors of smoking cessation treatment provided by an addiction care unit between 2007 and 2010

OBJECTIVEnTo analyze the predictors of smoking cessation treatment outcomes in a sample with a high rate of medical and psychiatric disorders and addictions.nnnMETHODSnAnalysis of predictors of success of a 6-week treatment provided by an addiction care unit (CAPS-AD) to 367 smokers in Brazil from 2007 to 2010. Forty variables were collected at baseline. Success was defined as abstinence from smoking for a period of at least 14 consecutive days, including the last day of treatment. Twenty variables were selected for the logistic regression model.nnnRESULTSnThe only condition correlated with successful treatment after logistic regression was smoking ones first cigarette 5 minutes or more after waking (beta = 1.85, 95% confidence interval [95%CI] = 1.11-3.10, p = 0.018). Subjects with hypertension and alcohol use disorders and those who were undergoing psychiatric treatment showed success rates comparable to or greater than the average success rate of the sample (34.2-44.4%).nnnCONCLUSIONSnThese findings support the importance of the variable time to first cigarette in treatment outcomes for a sample with a high rate of clinical and psychiatric disorders. Good success rates were observed for pharmacological treatment, which was combined with group therapy based on cognitive-behavioral concepts and integrated into ongoing treatment of other addictions and psychiatric disorders.