Autobiographical and semantic memory of adolescent drug users

BACKGROUND: Psychiatric disorders in infancy and adolescence may impair the access to the memory of facts and events occurred during these periods. OBJECTIVE: The main purpose of this study was to investigate the autobiographical and semantic memory of a group of adolescent drug users and a control group of adolescent non-users. METHODS: Twenty-five males participated in each group between 13 and 17 years old. Two questionnaires were applied: Kihlstrom e Schacter (1995) for semantic memory and Borrini et al. (1989) for autobiographical memory. RESULTS: The group of drug users had more difficulties in accessing autobiographical memory (p = 0.0205) and semantic memory (p = 0.0057). CONCLUSIONS: Some hypotheses might be raised: users presented cognitive complications that make difficult the access to long-term memories, as well as others related to the dynamics of drug use.CONTEXTO: Transtornos psiquiátricos na infância e adolescência podem prejudicar o acesso às memórias de fatos e eventos ocorridos durante esse período. OBJETIVO: O objetivo deste estudo foi investigar as memórias autobiográfica e semântica de adolescentes usuários e não usuários de drogas. MÉTODOS: Participaram de cada grupo 25 adolescentes do gênero masculino, com idades entre 13 e 17 anos. Dois questionários foram aplicados: Kihlstrom e Schacter (1995), que avalia a memória semântica e Borrini et al. (1989), que avalia a memória autobiográfica. RESULTADOS: O grupo de usuários de drogas apresentou maior dificuldade para acessar as memórias autobiográfica (p = 0,0205) e semântica (p = 0,0057). CONCLUSÕES: Algumas hipóteses podem ser levantadas: usuários apresentam complicações cognitivas que dificultam o acesso às memórias de longo prazo, e também outras causas relacionadas à dinâmica do uso de drogas

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.Department of Psychiatry and Institute of Psychiatry, Universidade de São Paulo (USP)Universidade Federal de São Paulo (UNIFESP) Lato Sensu Graduate Program in Child and Adolescent Mental HealthUNIFESP, Lato Sensu Graduate Program in Child and Adolescent Mental HealthSciEL

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

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 yout

Association between polymorphism SLC6A3 3 UTR VNTR and response to treatment of nicotine dependence

Objective: To evaluate the association between response to treatment of nicotine dependence with bupropion and the presence of the polymorphism SLC6A3 3 UTR VNTR, in the gene that codifies the dopaminergic transporter. Method: A hundred patients were treated in the Nicotine Dependence Outpatient Clinic of the Institute of Psychiatry, University of São Paulo Medical School. All patients were male, diagnosed as nicotine dependents and had no other diseases. All received bupropion until 300 mg a day for 12 weeks, combined with cognitive-behavioral group therapy. The Fagerström Scale was applied at the beginning and at the end of treatment. Cigarette cessation was evaluated in the last week of treatment and one month later. Patients had 10 ml blood extracted and genotiped for SLC6A3 3 UTR VNTR polymorphism. Results: There was no association between cigarettes cessation and the presence of polymorphism. Conclusion: More studies are needed to assess whether the presence of polymorphism SLC6A3 3 UTR VNTR could be associated with a better response to treatment of nicotine dependence.Objetivo: Avaliar a associação entre a resposta ao tratamento da dependência de nicotina com bupropiona e a presença do polimorfismo SLC6A3 3 UTR VNTR, localizado no gene que codifica o transportador dopaminérgico. Método: Foram acompanhados no Ambulatório de Tabagismo do Instituto de Psiquiatria da Faculdade de Medicina da USP 100 pacientes do sexo masculino com diagnóstico de dependência de nicotina, sem outras patologias. Todos receberam bupropiona até 300 mg ao dia por 12 semanas, associada à terapia cognitivo-comportamental em grupo. A Escala de Fagerström foi aplicada no início e no final do tratamento, e avaliou-se a parada do uso de cigarros na última semana de tratamento e um mês após. Os pacientes tiveram 10 ml de sangue colhidos e genotipados para a existência do polimorfismo SLC6A3 3 UTR VNTR. Resultados: Não foi encontrada associação entre cessação do uso de cigarro e presença do polimorfismo. Conclusão: São necessários mais estudos para avaliar se a presença do polimorfismo SLC6A3 3 UTR VNTR estaria relacionada à melhor resposta ao tratamento da dependência de nicotina.Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP)Universidade de São Paulo Faculdade de Medicina Instituto de PsiquiatriaUniversidade Federal de São Paulo (UNIFESP) Faculdade de Medicina Departamento de GinecologiaUSP Faculdade de Medicina Departamento de PsiquiatriaUNIFESP, Faculdade de Medicina Depto. de GinecologiaSciEL

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

BACKGROUND: Childhood and adolescence are relevant periods for the brain maturation process. Experiences in early life have an important influence on adults patterns of behavior. OBJECTIVE: To analyze what have been published in the last 20 years about neuropsychological and neuroimaging, associated with occurrence of various forms of emotional stress in childhood and adolescence. METHODS: Literature review of the Medline/PubMed database with the terms related to neuropsychology, neuroimaging, abandonment experience, domestic violence, physical and sexual abuse and neglect. RESULTS: 607 articles were found but only 19 fit with the proposed subject and were selected. Despite the differences between the studies, there is evidence that groups with experience of early emotional stress show losses in neurocognitive functions such as attention, intelligence, language, executive functions, and decision-making, as well as changes in hippocampus, corpus callosum prefrontal cortex, and anterior cingulate cortex. The occurrence of psychiatric disorders and behavioral disorders were also relevant in these individuals. DISCUSSION: Considering many negative consequences that early stress can cause in neuropsychological and mental development, there is a need for more research on the topic in order to develop specific strategies for diagnosis and treatment, besides the implementation of public policies for violence prevention in childhood and adolescence, especially in developing countries.CONTEXTO: A infância e a adolescência são períodos relevantes para a maturação do cérebro. Experiências no começo da vida exercem influência em padrões de comportamentos da vida adulta. OBJETIVO: Analisar estudos neuropsicológicos e de neuroimagem associados ao estresse emocional na infância e adolescência que foram publicados na literatura nos últimos 20 anos MÉTODOS: Revisão da literatura na base de dados Medline/PubMed com os termos relacionados à neuropsicologia, neuroimagem e vivência de abandono, violência doméstica, abuso físico, abuso sexual e negligência. RESULTADOS: Foram encontrados 607 artigos, dos quais 19 foram selecionados para análise por se adequarem ao tema proposto. Apesar das divergências entre eles, há evidências de que grupos com experiência de estresse emocional precoce (EEP) apresentam prejuízos em funções neurocognitivas como atenção, inteligência, linguagem, funções executivas e tomada de decisões, assim como alterações no hipocampo, corpo caloso, córtex pré-frontal e córtex cingulado anterior. A ocorrência de transtornos psiquiátricos e de alterações comportamentais também é relevante nesses indivíduos. CONCLUSÕES: Em virtude da diversidade de efeitos negativos do EEP no desenvolvimento neuropsicológico, considera-se fundamental a realização de pesquisas sistematizadas que possam nortear a elaboração de estratégias de diagnóstico e tratamento específicas, além da implementação de políticas públicas de prevenção à violência na infância e adolescência

Intellectual Disability and Psychiatric Diagnoses of Children and Adolescents with a History of Stressful Events and Social Deprivation in Brazil: Preliminary Results. IQ, Depression and Stress

Abstract: Background: Studies have shown that stressful events in childhood are associated with impairments in cognitive functions and intellectual disability.Objective: Compare the intellectual functioning in groups of Brazilian children and adolescents with a history of stressful events with lifetime history of depression and without lifetime history of depression.Method: 30 children and adolescents underwent psychiatric evaluation and neuropsychological assessment of estimated intellectual quotient (EIQ), verbal knowledge, and visuospatial skills.Results: 15 patients (50%) had EIQ within the average and 6 had EIQ in the lower average (20%) for Brazilian standardized norms. The other part had at least some degree of intellectual disability and they were classified as: 2 mild mental retardation (6.7%) and 7 borderline (23.3%). Also, half of the sample had at least one lifetime depressive episode, and the performance in EIQ and visuospatial skills was worse in this group.Conclusion: 50% of the children and adolescents with a history of early stressful events and social deprivation had at least some degree of intellectual disability. In addition, a subgroup with history of depressive episodes had worse EIQ performance when compared to those without depression, possibly due to a greater impairment in visuospatial skills. The specific role of impaired right cerebral hemisphere, corpus callosum, and prefrontal cortex associated with depressive disorders and maltreatment should be investigated in further studies

Brazilian guideline for the treatment of patients with opioids dependence syndrome

There is a relatively low prevalence of opioid use in Brazil, particularly involving the non-medical use of codeine and opiate-containing syrups. However, opioid dependence syndrome shows a significant total impact on mortality and morbidity. Over the past 20 years, scientific progress has changed our understanding of the nature of opioid addiction and its various possible treatments. Addiction is a chronic illness treatable if the treatment is well-delivered and tailored to the needs of the particular patient. There is indeed an array of treatments that can effectively reduce drug use, help manage drug cravings, prevent relapses and restore people to productive social functioning. The treatment of drug addiction will be part of long-term, medical, psychological, and social perspectives. This guideline aims at providing guidance to psychiatrists and other mental health professionals who care for patients with Opioid Dependence Syndrome. It comments on the somatic and psychosocial treatment that is used for such patients, and reviews scientific evidences and their strength. Also, the essential historical, epidemiological and neurobiological aspects of Opioid Dependence are reviewed.Existe uma prevalência relativamente baixa do uso de ópioides no Brasil, em particular envolvendo o uso não médico da codeína e de xaropes que contêm opióides. No entanto, a síndrome de dependência apresenta um significativo impacto total na mortalidade e morbidade. Nos últimos 20 anos, o avanço científico tem modificado nosso entendimento sobre a natureza da adição aos opióides e os variados tratamentos possíveis. A adição é uma doença crônica tratável se o tratamento for realizado e adaptado tendo em vista as necessidades do paciente específico. Há, de um fato, um conjunto de tratamentos que podem efetivamente reduzir o uso da droga, ajudar a gerenciar a fissura pela droga, prevenir recaídas e recuperar as pessoas para o funcionamento social produtivo. O tratamento da dependência de drogas será parte de perspectivas de longo prazo do ponto de vista médico, psicológico e social. Esta diretriz almeja fornecer um guia para os psiquiatras e outros profissionais de saúde que tratam de pacientes com Síndrome de Dependência de Opióides. Ela tece comentários sobre o tratamento somático e psicossocial que é utilizado nesses pacientes e revisa as evidências científicas e seu poder. Da mesma forma, os aspectos históricos, epidemiológicos e neurobiológicos da dependência de opióides são revisados.Universidade de São Paulo Hospital de Clínicas Instituto de PsiquiatriaFaculdade de Medicina do ABCJohns Hopkins University School of MedicineAssociação Brasileira de Psiquiatria Departamento de Dependência QuímicaHospital Albert EinsteinUniversidade Federal de São Paulo (UNIFESP)UNIADUNIFESPSciEL