Common Mental Disorders And The Use Of Psychoactive Drugs: The Impact Of Socioeconomic Conditions

Objective: To evaluate the infl uence of socioeconomic conditions on the association between common mental disorders and the use of health services and psychoactive drugs. Methods: This was a population-based cross-sectional study conducted in the city of Botucatu, Southeastern Brazil. The sample was probabilistic, stratifi ed and cluster-based. Interviews with 1,023 subjects aged 15 years or over were held in their homes between 2001 and 2002. Common mental disorders were evaluated using the Self-Reporting Questionnaire (SRQ-20). The use of services was investigated in relation to the fortnight preceding the interview and the use of psychotropic drugs, over the preceding three days. Logistic regression was used for multivariable analysis, and the design effect was taken into consideration. Results: Out of the whole sample, 13.4% (95% CI: 10.7;16.0) had sought health services over the fortnight preceding the interview. Seeking health services was associated with female gender (OR=2.0) and the presence of common mental disorders (OR=2.2). 13.3% of the sample (95% CI: 9.2;17.5) said they had used at least one psychotropic drug, especially antidepressives (5.0%) and benzodiazepines (3.1%). In the multivariable analysis, female gender and the presence of common mental disorders remained associated with the use of benzodiazepines. Per capita income presented a direct and independent association with the use of psychoactive drugs: the greater the income, the greater the use of these drugs was. Conclusions: Lower income was associated with the presence of common mental disorders, but not with the use of psychotropic drugs. The association of common mental disorders and the use of psychotropic drugs in relation to higher income strengthens the hypothesis that inequality of access to medical services exists among this population.424717723Ballester, D.A., Filipon, A.P., Braga, C., Andreoli, S.B., The general practitioner and mental health problems: Challenges and strategies for medical education (2005) Sao Paulo Med J, 123 (2), pp. 72-76. , doi:10.1590/ S1516-31802005000200008Beck, C.A., Williams, J.V., Wang, J.L., Kassam, A., El-Guebaly, N., Currie, S.R., Psychotropic medication use in Canada (2005) Can J Psychiatry, 50 (10), pp. 605-613Galduroz, J.C., Noto, A.R., Nappo, S.A., Carlini, E.L., First household survey on drug abuse in São Paulo, Brazil, 1999: Principal findings (2003) Sao Paulo Med J, 121 (6), pp. 231-237. , doi:10.1590/S1516-31802003000600003Harding, T.W., Arango, M.V., Baltazar, J., Climent, C.E., Ibrahim, H.H., Ladrido-Ignacio, L., Mental disorders in primary health care: A study of their frequency and diagnosis in four developing countries (1980) Psychol Med, 10 (2), pp. 231-241Hart, J.T., The inverse care law (1971) Lancet, 1 (7696), pp. 405-412Hennekens, C.H., Buring, J.E., (1987) Epidemiology in Medicine, , Boston: Little, Brown and Company;Hosmer, D.W., Lemeshow, S., (1989) Applied Logistic Regression, , New York: John Wiley & Sons;Iacoponi, E., Detecção de distúrbios emocionais pelo médico: Impacto do tipo de trabalho médico e do conceito sobre doenças mentais. (1997) Rev Cienc Med PUCCAMP, 6, pp. 41-45Lima, M.S., Hotopf, M., Mari, J.J., Béria, J.U., De Bastos, A.B., Mann, A., Psychiatric disorder and the use of Benzodiazepines: An example of the inverse care law from Brazil (1999) Soc Psychiatry Psychiatr Epidemiol, 34 (6), pp. 316-322Maragno, L., Goldbaum, M., Gianini, R.J., Novaes, H.M.D., Cesar, C.L., Prevalência de Transtorno mental comum em populacões atendidas pelo Programa Saúda da família (QUALIS) no município de Sao Paulo, Brasil. (2006) Cad Saude Publica, 22 (8), pp. 1639-1648. , doi: 10.1590/S0102-311X2006000800012Mari, J.J., Williams, P., A validity study of a Psychiatric Screening Questionnaire (SRQ-20) in Primary care in the city of São Paulo (1986) Br J Psychiatry, 148, pp. 23-26Mari, J.J., Almeida-Filho, N., Coutinho, E., Andreoli, S.B., Miranda, C.T., Streiner, D., The epidemiology of psychotropic use in the city of São Paulo (1993) Psychol Med, 23 (2), pp. 467-474Marín-Lŕon, L., Oliveira, H.B., Barros, M.B., Dalgalarrondo, P., Botega, N.J., Social inequality and common mental disorders (2007) Rev Bras Psiquiatr, 29 (3), pp. 250-253Mendoza-Sassi, R., Béria, J.U., Barros, A.J., Outpatient health service utilization and associated factors: A population-based study (2003) Rev Saude Publica, 37 (3), pp. 372-378Moncrieff, J., Psychiatric drug promotion and the politics of neo-liberalism (2006) Br J Psychiatry, 188, pp. 301-302Patel, V., Araya, R., Lima, M., Ludermir, A., Todd, C., Women, poverty and common mental disorders in four restructuring societies (1999) Soc Sci Med, 49 (11), pp. 1461-1471Rodrigues, M.A., Facchini, L.A., Lima, M.S., Modificações nos padrões de consumo de psicofármacos em localidade do Sul do Brasil. (2006) Rev Saude Publica, 40 (1), pp. 107-114. , doi:10.1590/ S0034-89102006000100017(2000) Collaborating Centre for Drug Statistics Methodoly Guidelines for ATC classification and DDD assignment, , World Health Organization, 3. ed. Oslo;Zandstra, S.M., Furer, J.W., van de Lisdonk, E.H., van't Hof, M., Bor, J.H.J., van Well, C., Different study criteria affect the prevalence of benzodiapine use (2002) Soc Psychiatry Psychiatr Epidemiol, 37 (3), pp. 139-14

The influence of lifestyle and gender on sickness absence in Brazilian workers

Background: Despite an increasing body of knowledge concerning gender and lifestyle factors as determinants of sickness absence in well-developed countries, the relationship between these variables has not been elucidated in emerging econ

Longitudinal brain volumetric changes during one year in non-elderly healthy adults: a voxel-based morphometry study

Previous cross-sectional magnetic resonance imaging (MRI) studies of healthy aging in young adults have indicated the presence of significant inverse correlations between age and gray matter volumes, although not homogeneously across all brain regions. However, such cross-sectional studies have important limitations and there is a scarcity of detailed longitudinal MRI studies with repeated measures obtained in the same individuals in order to investigate regional gray matter changes during short periods of time in non-elderly healthy adults. In the present study, 52 healthy young adults aged 18 to 50 years (27 males and 25 females) were followed with repeated MRI acquisitions over approximately 15 months. Gray matter volumes were compared between the two times using voxel-based morphometry, with the prediction that volume changes would be detectable in the frontal lobe, temporal neocortex and hippocampus. Voxel-wise analyses showed significant (P < 0.05, family-wise error corrected) relative volume reductions of gray matter in two small foci located in the right orbitofrontal cortex and left hippocampus. Separate comparisons for males and females showed bilateral gray matter relative reductions in the orbitofrontal cortex over time only in males. We conclude that, in non-elderly healthy adults, subtle gray matter volume alterations are detectable after short periods of time. This underscores the dynamic nature of gray matter changes in the brain during adult life, with regional volume reductions being detectable in brain regions that are relevant to cognitive and emotional processes

Gene and environmental risk factors: interplay between CNR1 genetic variants cannabis use, childhood trauma and psychosis [abstract only]

Background: Cannabis use and childhood trauma have been proposed as environmental risk factors for psychosis and its known that gene-environment (G×E) interactions increase the risk of psychosis [1]. In particular, a recent finding suggests a link between genetic variants in the cannabinoid receptor type 1 (CNR1) gene, which encodes CB1 receptors and is expressed widely in the central and peripheral systems, and cannabis playing a role in the multifactorial pathogenesis of psychosis [2]. However, how the genetic variants interact with lifetime cannabis use and other environmental risk factors, such as childhood trauma, underlying psychosis remains challenging. Objective: To investigate whether there are associations of gene and environmental factors with psychosis, as well as G×E interactions in the relationship between lifetime cannabis use, childhood trauma, and single nucleotide variants (SNVs) of CNR1 and psychosis in a Brazilian sample. Methods: In a population-based case-control study nested in an incident study (STREAM, Brazil) [3], part of the WP2 EU-GEI consortium, 143 first-episode psychosis patients (FEPp) and 286 community-based controls of both sexes, aged between 16 and 64 years, were included over a period of three years. Thirteen SNVs of CNR1 gene (rs806380, rs806379, rs1049353, rs6454674, rs1535255, rs2023239, rs12720071, rs6928499, rs806374, rs7766029, rs806378, rs10485170, rs9450898), were genotyped from peripheral blood DNA using a custom Illumina HumanCoreExome-24 BeadChip genotyping arrays (GWAS Cardiff chip). Environmental adversities were evaluated using the Cannabis Experience and the Childhood Trauma Questionnaires. Data were analysed using a binary logistic regression model (Adj OR, 95% CI), including a binary outcome (community-based controls and FEPp), adjusted by sex, age, skin colour, years of education and tobacco smoking. Genotype frequencies were analysed under the dominant model (homozygous ancestral x heterozygous + homozygous variant). The significance level was set at α≤0.05. Results: Lifetime cannabis use and childhood trauma increased the risk for psychosis (OR=3.7; 2.6-6.195% CI, p<0.001; OR=3.0; 1.9-4.7 95% CI, p<0.001, respectively). We also showed that the presence of CNR1 rs12720071-T-allele moderated the association between lifetime cannabis use and psychosis (OR=6.0; 2.0-17.5 95% CI; p=0.001). Moreover, the combination of CNR1 rs12720071-T-allele carriers with childhood trauma also suggests a change in the risk of psychosis (OR=3.6; 1.4-9.0 95% CI; p=0.006). No significant associations between the environmental factors and other SNVs were found. Conclusions: We demonstrated a significant interaction between CNR1 rs12720071 SNV and two important environmental risk factors in their association with psychosis. T allele carriers of CNR1 rs12720071 had a higher risk of psychosis when lifetime cannabis use or childhood trauma were present. Our results suggest a G×E interaction involving the CNR1 gene, trauma and cannabis in psychosis. We will explore the associations between genetic and epigenetic markers of the CNR1 gene with environmental factors in larger and longer follow-up cohorts to better understand the mechanisms of endocannabinoid system dysfunction in the etiology of psychosis

Effect of D2R, NMDAR and CB1R genetic variants associated with cannabis use and childhood trauma in first-episode psychosis in a Brazilian population [abstract only]

Introduction Gene-environment interactions increase psychosis risk (Gayer-Anderson et al. Soc Psychiatry Psychiatr Epidemiol 2020; 55(5):645-657). However, identifying the genetic variants involved and how they interact with environmental risk factors underlying psychosis remains challenging. Objectives To investigate whether there are gene-environment interactions in the relationships of childhood trauma, lifetime cannabis use, and single nucleotide variants (SNVs) of dopamine D2 receptor (D2R: DRD2), N-methyl-d-aspartate receptor (NMDAR: GRIN1, GRIN2A and GRIN2B) and cannabinoid receptor type 1 (CB1R: CNR1) with psychosis. Methods In a population-based case-control study nested in an incident study (STREAM, Brazil) (Del-Ben et al. Br J of Psychiatry 2019; 215(6):726-729), part of the EU-GEI consortium (Gayer-Anderson et al. Soc Psychiatry Psychiatr Epidemiol 2020; 55(5):645-657), 143 first-episode psychosis patients and 286 community-based controls of both sexes aged between 16 and 64 years were included over a period of 3 years. Twenty-three SNVs of D2R (rs1799978, rs7131056, rs6275), NMDAR (GRIN1: rs4880213, rs11146020; GRIN2A: rs1420040, rs11866328; GRIN2B: rs890, rs2098469, rs7298664), and CB1R genes (CNR1: rs806380, rs806379, rs1049353, rs6454674, rs1535255, rs2023239, rs12720071, rs6928499, rs806374, rs7766029, rs806378, rs10485170, rs9450898), were genotyped from peripheral blood DNA using a custom Illumina HumanCoreExome-24 BeadChip. Environmental adversities were evaluated using the Cannabis Experience Questionnaire (Di Forti et al. The Lancet Psychiatry 2009; 6(5):427–436) and the Childhood Trauma Questionnaire (Grassi-Oliveira et al. Rev Saude Publica 2006; 40(2):249-55). Associations between SNVs and environmental risk factors were performed using the nonparametric multifactor dimensionality reduction software (version 3.0.2). Results Single locus analysis showed no association among the 23 SNVs with psychosis; however, gene-environment analysis was significant for the polymorphic loci rs12720071 and rs7766029 in CNR1. The best association models were the two-factor representing by the combination of CNR1 rs12720071 with lifetime cannabis use (p<0.001), and CNR1 rs12720071 with childhood trauma (p<0.05), both suggesting an increased risk of psychosis. Additionally, when considering the interaction of both environmental factors in the same model, we found CNR1 rs7766029 to be associated with psychosis (p<0.001). Conclusions Our study supports the hypothesis of gene-environment interactions for psychosis involving the T allele carriers of CNR1 SNVs (rs12720071 and rs7766029), childhood trauma and lifetime cannabis use in psychosis

Social disadvantage, linguistic distance, ethnic minority status and first-episode psychosis: Results from the EU-GEI case-control study

BackgroundEthnic minority groups in Western countries face an increased risk of psychotic disorders. Causes of this long-standing public health inequality remain poorly understood. We investigated whether social disadvantage, linguistic distance and discrimination contributed to these patterns.MethodsWe used case-control data from the EUropean network of national schizophrenia networks studying Gene-Environment Interactions (EU-GEI) study, carried out in 16 centres in six countries. We recruited 1130 cases and 1497 population-based controls. Our main outcome measure was first-episode ICD-10 psychotic disorder (F20-F33), and exposures were ethnicity (white majority, black, mixed, Asian, North-African, white minority and other), generational status, social disadvantage, linguistic distance and discrimination. Age, sex, paternal age, cannabis use, childhood trauma and parental history of psychosis were included as a priori confounders. Exposures and confounders were added sequentially to multivariable logistic models, following multiple imputation for missing data.ResultsParticipants from any ethnic minority background had crude excess odds of psychosis [odds ratio (OR) 2.03, 95% confidence interval (CI) 1.69-2.43], which remained after adjustment for confounders (OR 1.61, 95% CI 1.31-1.98). This was progressively attenuated following further adjustment for social disadvantage (OR 1.52, 95% CI 1.22-1.89) and linguistic distance (OR 1.22, 95% CI 0.95-1.57), a pattern mirrored in several specific ethnic groups. Linguistic distance and social disadvantage had stronger effects for first- A nd later-generation groups, respectively.ConclusionSocial disadvantage and linguistic distance, two potential markers of sociocultural exclusion, were associated with increased odds of psychotic disorder, and adjusting for these led to equivocal risk between several ethnic minority groups and the white majority

Jumping to conclusions, general intelligence, and psychosis liability: Findings from the multi-centre EU-GEI case-control study

BackgroundThe 'jumping to conclusions' (JTC) bias is associated with both psychosis and general cognition but their relationship is unclear. In this study, we set out to clarify the relationship between the JTC bias, IQ, psychosis and polygenic liability to schizophrenia and IQ.MethodsA total of 817 first episode psychosis patients and 1294 population-based controls completed assessments of general intelligence (IQ), and JTC, and provided blood or saliva samples from which we extracted DNA and computed polygenic risk scores for IQ and schizophrenia.ResultsThe estimated proportion of the total effect of case/control differences on JTC mediated by IQ was 79%. Schizophrenia polygenic risk score was non-significantly associated with a higher number of beads drawn (B = 0.47, 95% CI-0.21 to 1.16, p = 0.17); whereas IQ PRS (B = 0.51, 95% CI 0.25-0.76, p &lt; 0.001) significantly predicted the number of beads drawn, and was thus associated with reduced JTC bias. The JTC was more strongly associated with the higher level of psychotic-like experiences (PLEs) in controls, including after controlling for IQ (B =-1.7, 95% CI-2.8 to-0.5, p = 0.006), but did not relate to delusions in patients.ConclusionsOur findings suggest that the JTC reasoning bias in psychosis might not be a specific cognitive deficit but rather a manifestation or consequence, of general cognitive impairment. Whereas, in the general population, the JTC bias is related to PLEs, independent of IQ. The work has the potential to inform interventions targeting cognitive biases in early psychosis