Tabagismo: abordagem, prevenção e tratamento

Este livro é um guia prático para lidar com abordagem, prevenção e tratamento do tabagismo. Está dividido em dez capítulos e pretende instrumentalizar os profissionais da saúde a adquirir ferramentas teórico-práticas, que visam o aprimoramento das intervenções para cessação do tabagismo. A metodologia utilizada buscou recomendações do Ministério da Saúde, bem como consensos e diretrizes sobre o assunto

SLC6A4 STin2 VNTR genetic polymorphism is associated with tobacco use disorder, but not with successful smoking cessation or smoking characteristics: a case control study.

The aim of this study was to determine if variable number of tandem repeats (VNTR) in the second intron (STin2) of the serotonin transporter (SLC6A4) gene was associated with tobacco use disorder, successful smoking cessation, or smoking characteristics. In this case-control study, patients with current tobacco use disorder, diagnosed according to DSM IV criteria (n = 185), and never-smokers, diagnosed according to CDC criteria (n = 175), were recruited and received 52 weeks of combined pharmacotherapy and cognitive therapy. Successful smoking cessation was defined as exhaled carbon monoxide < 6 ppm. SLC6A4 gene STin2 VNTR polymorphism was assessed using a Multiplex-PCR-based method. At baseline, participants were evaluated using the Fagerström Test for Nicotine Dependence (FTND) and the ASSIST scale

O ensino de psiquiatria, habilidades de comunicação e atitudes no currículo integrado do curso de Medicina da Universidade Estadual de Londrina

Este artigo relata uma experiência de ensino de psiquiatria, habilidades de comunicação e atitudes no currículo integrado do curso de Medicina da Universidade Estadual de Londrina. O mapa conceitual do módulo temático de problemas mentais e do comportamento foi proposto para facilitar uma aprendizagem interdisciplinar significativa de psiquiatria. O conhecimento de psiquiatria é adquirido utilizando-se a metodologia de Aprendizagem Baseada em Problemas. O treinamento de habilidades de comunicação e atitudes é realizado de diferentes formas, com pacientes verdadeiros, pacientes simulados, vídeos, relatos de casos, dramatizações e trabalhos em pequenos grupos. Os métodos de avaliação do conhecimento de psiquiatria, habilidades de comunicação e atitudes incluem avaliação somativa eformativa, que fornecem feedback ao estudante acerca de seu progresso, o exame clínico estruturado por objetivo (Osce), portfolios e relatórios de casos. As competências de conhecimento de psiquiatria, habilidades em comunicação e atitudes são internalizadas dependendo do método de treinamento de uma aprendizagem significativa e de como os estudantes são avaliados em sua prática da medicina

Características clínicas e qualidade de vida de fumantes em um centro de referência de abordagem e tratamento do tabagismo Clinical characteristics and quality of life of smokers at a referral center for smoking cessation

OBJETIVO: Comparar, entre fumantes e nunca fumantes, os seguintes aspectos: qualidade de vida, IMC, hospitalizações, incapacidades, história familiar de transtorno mental, doenças relacionadas ao uso de tabaco, depressão e uso de substâncias psicoativas. MÉTODOS: Um total de 167 fumantes inscritos em um programa de cessação do tabagismo no Centro de Referência de Abordagem e Tratamento do Tabagismo da Universidade Estadual de Londrina e 272 nunca fumantes doadores de sangue foram incluídos no estudo. Foram utilizados um questionário estruturado para a coleta de dados sociodemográficos, Alcohol, Smoking and Substance Involvement Screening Test, World Health Organization Quality of Life Instrument, brief version (WHOQoL-BREF) e Fagerström Test for Nicotine Dependence, todos validados para uso no Brasil, assim como critérios diagnósticos para a pesquisa de transtornos depressivos. RESULTADOS: A média de idade para fumantes e nunca fumantes foi, respectivamente, de 45 e 44 anos. As mulheres predominaram nos dois grupos. Fumantes mais frequentemente apresentaram incapacidades laborais e domésticas, presença de fumantes em casa, hospitalizações, transtorno depressivo, uso de sedativos, história de transtorno mental na família e piores escores em todos os domínios do WHOQoL-BREF. A média de idade do início do tabagismo em fumantes com depressão ou em uso de substâncias psicoativas foi mais baixa do que os sem essas comorbidades. Fumantes apresentaram mais frequentemente diabetes, hipertensão arterial, doenças cardíacas, doenças respiratórias e úlcera péptica do que os que nunca fumaram. O IMC médio foi menor entre fumantes do que nos que nunca fumaram. CONCLUSÕES: Este estudo sugere que, no tratamento do tabagismo, deveriam ser identificados subgrupos de fumantes com características específicas: início precoce do tabagismo, doenças que sofrem agravos pelo tabaco, depressão e uso de substâncias psicoativas.<br>OBJECTIVE: To compare smokers and never smokers in terms of the following: quality of life; BMI; hospitalizations; functionality; family history of mental disorder; tobacco-related diseases; depression; and psychoactive substance use. METHODS: We evaluated 167 smokers enrolled in a smoking cessation program at the Londrina State University Referral Center for Understanding and Treating Smoking, together with 272 never-smoking blood donors. We employed the following instruments, all validated for use in Brazil: a structured questionnaire for the collection of sociodemographic data; the Alcohol, Smoking and Substance Involvement Screening Test; the World Health Organization Quality of Life Instrument, brief version (WHOQoL-BREF); and the Fagerström Test for Nicotine Dependence. We also applied diagnostic criteria for the investigation of depressive disorders. RESULTS: The mean age of the smokers and never smokers was, respectively, 45 and 44 years. Females predominated in both groups. Smokers more often presented with impaired work/domestic functionality, hospitalizations, depressive disorders, smoking in the household, sedative use and a family history of mental disorders, as well as scoring lower in all domains of the WHOQoL-BREF. The mean age at smoking onset was lower for smokers with depression or using psychoactive substances than for smokers without such comorbidities. Diabetes, arterial hypertension, heart disease, respiratory disease and peptic ulcer were more common in smokers than in never smokers. The mean BMI was lower in the smokers than in the never smokers. CONCLUSIONS: This study suggests that, for smoking cessation programs, subgroups of smokers with specific characteristics (early age at smoking onset, tobacco-related diseases, depressive disorders and use of psychoactive substances) should be identified

Adjunctive Treatment with Lodenafil Carbonate for Erectile Dysfunction in Outpatients with Schizophrenia and Spectrum: A Randomized, Double-Blind, Crossover, Placebo-Controlled Trial

Introduction. Evidence is accumulating to support the presence of erectile dysfunction in patients with schizophrenia. This dysregulation may be amenable to therapeutic intervention to improve adherence and quality of life of patients who suffer from schizophrenia and schizoaffective disorders. Aim. We aimed to evaluate the use of adjunctive medication lodenafil for the treatment of erectile dysfunction in outpatients with schizophrenia and spectrum. Methods. the design was a randomized, double-blind, crossover, placebo-controlled trial with lodenafil and it was carried at the Schizophrenia Outpatients Program. Main Outcome Measures. the measures used to assess sexual dysfunction were Arizona Sexual Experiences Scale (ASEX) and International Index of Erectile Function (IIEF). the Positive and Negative Syndrome Scale (PANSS) and the Quality of Life Scale (QLS) were also used. the measures included the levels of prolactin, estradiol, luteinizing hormone, sex hormone-binding globulin, free testosterone, and total testosterone at baseline and end point. Lodenafil and placebo pills were used by the patients for 16 weeks. Results. Fifty male outpatients fulfilled the criteria and 94% of the participants completed the study. Lodenafil and placebo produced improvement in ASEX, IIEF scale, PANSS, and QLS, and there was no statistical difference between lodenafil and placebo groups in all sexual domains in the results of PANSS and QLS and in the results of hormone levels. Conclusion. These results indicate that both lodenafil and placebo were effective in the treatment of erectile dysfunction for schizophrenia. Placebo effect is very important in patients with schizophrenia and this study showed the importance of discussing sexuality and trying to treat these patients. Further studies designed to test treatments of erectile dysfunction in patients who suffer from schizophrenia are necessary. Nunes LVA, Lacaz FS, Bressan RA, Nunes SOVA, and Mari JJ. Adjunctive treatment with lodenafil carbonate for erectile dysfunction in outpatients with schizophrenia and spectrum: A randomized, double-blind, crossover, placebo-controlled trial. J Sex Med 2013; 10: 1136-1145.Univ Estadual Londrina, Dept Clin Med, BR-86050190 Londrina, Parana, BrazilUniversidade Federal de São Paulo, Dept Psiquiatria, São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psiquiatria, São Paulo, BrazilWeb of Scienc

Depressed female smokers have higher levels of soluble tumor necrosis factor receptor 1

Aim: To examine clinical and biomarkers in depressed female smokers, in order to better clarify the process that link mood disorders, childhood trauma and smoking in women. Methods: The clinical sample comprised women with unipolar or bipolar depression, divided into subgroups of smokers and never-smoker. The control groups comprised two subgroups non-depressed women, separated into smokers and never-smokers. A structured questionnaire was used to assess socio-demographic and clinical data. The following scales were used: 17-item version Hamilton Depression Rating Scale, Hamilton Anxiety Rating scale (HAM-A), Sheehan disability scale, the Child Trauma Questionnaire. The following biomarkers were investigated: lipid profile, including total cholesterol, high-density lipoprotein cholesterol (HDLc), low-density lipoprotein cholesterol, triglycerides the Castelli's Risk indexes I and II; and cytokines, including interleukins (IL)-1β, IL-6, IL-10, IL-12, soluble tumor necrosis factor receptor 1 (sTNF-R1). Results: Depressed female smokers showed a number of significant positive correlations: emotional neglect and sTNF-R1 (p = 0.02); waist circumference and sTNF-R1 (p = 0.001); body mass index and sTNF-R1 (p < 0.01); HAM-A and sTNF-R1 (p = 0.03); IL-1β and sTNF-R1 (p < 0.01); IL-10 and sTNF-R1 (p = 0.001); IL-12 and sTNF-R1 (p < 0.01);Castelli index I and sTNF-R1 (p < 0.01); Castelli index II and sTNF-R1 (p < 0.01); and a significantly negative correlation between HDLc and sTNF-R1(p = 0.014). Conclusion: This study suggests that depressed female smokers who experienced more childhood trauma and had more anxiety symptoms are associated with the activation of inflammatory processes and alterations in components of lipid profile. Keywords: Tobacco use disorder, Depression, Inflammation, Metabolism, Child abus