Disturbo post-traumatico da stress e tossicodipendenza: revisione della letteratura e contributo sperimentale. Eventi traumatici, eventi stressanti e reazioni ad essi prima e durante la pratica tossicomanica.

Recenti dati epidemiologici, neurobiologici, genetici e di comorbidità clinica mostrano una correlazione evidente fra PTSD, e disturbi da abuso di sostanze. Dopo una revisione della letteratura, questa tesi analizza, con metodiche standardizzate, gli eventi potenzialmente stressanti e le loro conseguenze emotivo-affettive in 82 soggetti tossicodipendenti da eroina prima e dopo l’inizio della pratica tossicomanica per cercare di rispondere alle seguenti domande: esiste o meno un carico fortemente stressante prima dell’inizio della tossicodipendenza? Tale carico si modifica dopo l’inizio della tossicodipendenza? Vi è nel tempo una modifica del tipo degli eventi stressanti ed, infine, vi è una eventuale modificazione anche della reattività agli eventi stressanti prima e dopo l’inizio della pratica tossicomanica? I risultati confermano l’importanza degli eventi di vita nella storia tossicomanica dei nostri pazienti con la presenza di eventi di perdita e traumatici sia prima che dopo l’inizio della pratica tossicomanica, dove il loro numero tende ad aumentare. La perdita di persone care, il divorzio dei familiari ed il sentirsi trascurato-abbandonato sono gli eventi giudicati più importanti prima della tossicodipendenza. Tali eventi si ritrovano anche dopo, ma i tossicomani tendono a giudicare anche le conseguenze legali correlate alla pratica tossicomanica come eventi importanti. Minore frequenza ed importanza si rileva per gli abusi fisici e sessuali. Durante la pratica tossicomanica infine le reazioni tipiche del PTSD tendono ad essere applicate agli eventi stressanti con maggiore intensità. Le correlazioni fra PTSD e SUD sembrano quindi estendersi anche al piano clinico-sintomatologico di “spettro”

Can Ropinirole Modulate Reinforcing Subjective Effects of Cocaine in Humans?

In this study we evaluated, by means of the “cocaine rush visual analog scale,” the impact of ropinirole on the expected rush induced by cocaine in a group of heroin addicts abusing cocaine; the self-reported reaction to the rush blockade (if any) on cocaine consumption, and the correlations between this self-reported reaction and individual, clinical, and therapeutic parameters. Nineteen cocaine abuser heroin-dependent patients entered the study. Their experienced cocaine rush was 61.31 ± 32.1% of the maximum effect previously experienced. Compared with their previous rush intensity 16 patients experienced significantly lower intensity, 3 the same intensity, and none a higher intensity. In particular, two patients experienced a complete blockade of rush and reported a reduced use of cocaine. Fourteen patients experienced a partial blockade of cocaine rush; of these, nine reported they had reduced their use of cocaine. Ropinirole does diminish the subjective intensity of an expected cocaine rush, so interfering with the dynamics of reward, while supporting its possible use in the treatment of cocaine dependence

Do methadone and buprenorphine have the same impact on psychopathological symptoms of heroin addicts?

<p>Abstract</p> <p>Background</p> <p>The idea that the impact of opioid agonist treatment is influenced by the psychopathological profile of heroin addicts has not yet been investigated, and is based on the concept of a specific therapeutic action displayed by opioid agents on psychopathological symptoms. In the present report we compared the effects of buprenorphine and methadone on the psychopathological symptoms of 213 patients (106 on buprenorphine and 107 on methadone) in a follow-up study lasting 12 months.</p> <p>Methods</p> <p>Drug addiction history was collected by means of the Drug Addiction History Rating Scale (DAH-RS) and psychopathological features were collected by means of the Symptom Checklist-90 (SCL-90), using a special five-factor solution. Toxicological urinalyses were carried out for each patient during the treatment period.</p> <p>Results</p> <p>No statistically significant differences were detected in psychopathological symptoms, including 'worthlessness-being trapped', 'somatization', and 'panic-anxiety'. Methadone proved to be more effective on patients characterized by 'sensitivity-psychoticism', whereas buprenorphine was more effective on patients displaying a 'violence-suicide' symptomatology.</p> <p>Conclusions</p> <p>Heroin-dependent patients with psychiatric comorbidities may benefit from opioid agonist treatment not only because it targets their addictive problem, but also, precisely due to this, because it is effective against their mental disorder too.</p

Food consumption and eating behavior among Brazilian adolescents: National Adolescent School-based Health Survey (PeNSE), 2009

O objetivo deste artigo é descrever características de consumo e comportamento alimentar de adolescentes brasileiros e sua associação com fatores sociodemográficos. Estudou-se, em 2009, amostra representativa de alunos do 9º ano do ensino fundamental de escolas públicas e privadas das 26 capitais brasileiras e do Distrito Federal. Utilizou-se questionário autoaplicável sobre atributos sociodemográficos, consumo e comportamento alimentar, entre outros. Estimativas dos indicadores construídos foram apresentadas para o total da população e por sexo. A associação de cada um dos indicadores com variáveis sociodemográficas foi examinada por meio de regressão logística. A maioria dos adolescentes consumia regularmente feijão (62,6%), leite (53,6%) e guloseimas (50,9%), realizava pelo menos o almoço ou o jantar com a mãe ou responsável (62,6%) e comia assistindo televisão ou estudando (50,9%). Em geral, as meninas estavam mais expostas a práticas alimentares não desejáveis, e o melhor nível socioeconômico associou-se a maiores prevalências dos indicadores estudados. Os resultados revelaram consumo regular dos marcadores de alimentação não saudável e consumo inferior ao recomendado dos de alimentação saudável, apontando a necessidade de ações de promoção de saúde dirigidas a jovens.The objective of this article is to describe the characteristics of food consumption and eating behavior of adolescents and its association with socio-demographic factors. In 2009, a random sample of students in 9th grade of elementary education at public and private schools from 26 Brazilian state capitals and Federal District was studied. It was applied a self-administered questionnaire with socio-demographic attributes, food consumption and eating behavior, among others. Estimates of the constructed indicators were presented for the total population and by sex. The association of each indicator with socio-demographic variables was examined by logistic regression. The results showed that over half of adolescents presented frequent consumption of beans (62.6%), milk (53.6%) and sweets (50.9%), and held at least lunch or dinner with the mother or responsible (62.6%) and watching television or studying (50.9%). In general, girls were more exposed to undesirable eating habits and higher socioeconomic status was associated with a higher prevalence of the indicators studied. The results revealed regular consumption of unhealthy diet markers and consumption of less than the recommended for a healthy diet, pointing the need for strengthening health promotion activities targeting young people

Clonazepam as Agonist Substitution Treatment for Benzodiazepine Dependence: A Case Report

Nowadays, the misuse of benzodiazepines (BZDs) is a cause for a serious concern among pharmacologically inexperienced patients, whether treated or untreated, that could lead to significant complications, including tolerance, dependence, and addiction. We present a case report in which an Italian patient affected by anxiety disorder and treated with BZDs presented a severe case of dependence on BZDs. We treated him according to an agonist substitution approach, switching from the abused BZD to a slowonset, long-acting, high potency agonist (clonazepam), and looking at the methadone treatment model as paradigm. We decided to use clonazepam for its pharmacokinetic properties. The advantage of choosing a slow-onset, long-lasting BZD for the treatment of our patient was that it led us to a remarkable improvement in the clinical situation, including the cessation of craving, absence of withdrawal symptoms, reduced anxiety, improvements in social functioning, and a better cognition level

Can PCS help us save energy? Initial assessment using dynamic energy and CFD analyses

This study is the first step towards a broader research intent: developing and optimising a Personal Comfort System for tertiary sector working environments. The entire industrial sector, and in particular offices, have seen changes in working habits, with a large increase in smart working to prevent COVID infection. The chance to partialise the HVAC system and maintains the rooms in an under-conditioned state is the obligatory way towards reducing energy waste, providing each workstation with an independent system that guarantees the operator's comfort conditions. The first step of the analysis was conducted simulating a general scenario and adopting conservative assumptions in order to predict the potential energy savings and the required PCS power. BES and CFD were coupled, using the outputs of the dynamic energy simulations in its most energy demanding timestep as input for the fluid dynamics analysis. The results showed energy savings between 15 and 20%, which is likely an underestimation of the potential savings due to very conservative assumptions and looking at the data from the few field analyses available in literature. Moreover, the operators' localised thermal comfort conditions improved, moving from a slightly cold to a neutral situation. Despite the conservative hypothesis, the results are promising, showing several opportunities for further analysis and improvement, as well as possible ways for its optimisation

Do green roofs really provide significant energy saving in a Mediterranean climate? Critical evaluation based on different case studies

Green roofs represent a growing technology that is spreading increasingly and rapidly throughout the building sector. The latest national and international regulations are promoting their application for refurbishments and new buildings to increase the energy efficiency of the building stock. In recent years, vegetative coverings have been studied to demonstrate their multiple benefits, such as the reduction of the urban heat island phenomenon and the increase in the albedo of cities. On the contrary, this study aims to verify the actual benefit of applying a green roof on a sloped cover compared with installing a highly insulated tiled roof. The EnergyPlus tool has been used to perform dynamic analyses, which has allowed to understand the behavior of two different stratigraphies in accordance with weather conditions, rain, and irrigation profiles. Results have shown that the installation of a green roof cannot always be considered the best solution for reducing building energy consumption, especially if compared with a classic highly insulated clay tile roof. In terms of summer air conditioning, the maximum saving is 0.72 kWh/m2. The presence of water in the soil has also been proven a crucial factor