Somatization in Latin America: a review of the classification of somatoform disorders, functional syndromes and medically unexplained symptoms

OBJETIVO: Os sintomas sem explicação médica são frequentes e estão associados a sofrimento mental em vários contextos. Estudos prévios apontam que as populações latino-americanas são propensas à somatização. Diante da reformulação da Classificação Internacional de Doenças para sua 11ª edição, as particularidades dos nativos desta região do mundo devem ser levadas em consideração. O objetivo deste estudo é prover informações sobre somatização na população latino-americana para a tomada de decisões quanto às categorias diagnósticas ligadas a sintomas sem explicação médica na Classificação Internacional de Doenças-11ª edição. MÉTODO: Revisão extensa da produção de 1995 a 2011 sobre somatização em populações de origem latino-americana. RESULTADOS: A análise dos 106 estudos incluídos nesta revisão foi dividida em 15 categorias: revisões sistemáticas, revisões conceituais, prevalências, atenção primária, depressão e ansiedade, fatores de risco, violência, quadros orgânicos, relacionamento com profissionais e o sistema de saúde, etnia, síndromes ligadas à cultura, síndrome da fadiga crônica, fibromialgia, transtorno dismórfico corporal, e conversão e dissociação. CONCLUSÃO: Os estudos latino-americanos confirmam a dificuldade na definição categorial de quadros com sintomas sem explicação médica. O suposto "traço somatizador" das culturas latinas pode estar associado mais à expressão cultural e linguística do que a um caráter de natureza étnica, e tais particularidades devem estar na agenda na nova classificação destes fenômenos na Classificação Internacional de Doenças-11ª edição.OBJECTIVE: medically unexplained symptoms are common and associated with mental illness in various contexts. Previous studies show that Latin American populations are prone to somatization. Given the reformulation of the International Classification of Diseases towards its 11th edition the peculiarities of the population from this region of the world shall be taken into consideration. The objective of this study is to provide information on somatization in Latin American populations to help the decision making about medically unexplained symptoms diagnostic categories in the 11th edition of the International Classification of Diseases. METHOD: Extensive review of the academic production from 1995 to 2011 on somatization in populations of Latin American origin. RESULTS: The analysis of 106 studies included in this review was divided into 15 categories: systematic reviews, conceptual reviews, prevalence, primary care, depression and anxiety, risk factors, violence, organic conditions, relationship with health care, ethnicity, culture-bound syndromes, chronic fatigue syndrome, fibromyalgia, body dysmorphic disorder, and conversion and dissociation. CONCLUSION: The Latin American studies confirm the difficulty in defining medically unexplained symptoms categories. The supposed "somatizing trace" of Latin cultures may be linked more to cultural and linguistic expression than to an ethnic nature, and these peculiarities must be on the agenda for the new classification of these phenomena in the Classification of Diseases-11th edition

A violência urbana é a maior causa de acidente de trabalho fatal no Brasil

OBJETIVO: Este estudo visou quantificar a ocorrência de mortes diretamente associadas à violência urbana dentre os acidentes de trabalho fatais. MÉTODOS: Foram realizadas autópsias verbais com familiares e colegas de trabalho de moradores de Campinas, SP, falecidos por causas externas no ano 2015. Também foram analisados boletins de ocorrência e laudos do Instituto Médio Legal relativos a essas mortes. RESULTADOS: Foram identificados 82 acidentes de trabalho fatais em Campinas em 2015, dos quais 25 foram assassinatos, 35 foram acidentes de trânsito não diretamente decorrentes de atividades laborais e três foram suicídios no trabalho. A mortalidade proporcional por homicídios, acidentes de trânsito e suicídios entre os acidentes de trabalho fatais foi estimada em 30,5%, 42,7% e 3,7%, respectivamente. CONCLUSÕES: A violência urbana foi responsável por 3/4 dos acidentes de trabalho fatais contabilizados no período estudado.OBJECTIVE: To quantify the occurrence of deaths directly associated with urban violence among fatal work-related accidents. METHODS: Verbal autopsies were performed with the relatives and coworkers of residents of Campinas, state of São Paulo, Brazil, who died from external causes in 2015. We have also analyzed police reports and reports of the Legal Medical Institute related to these deaths. RESULTS: We have identified 82 fatal work-related accidents in Campinas in 2015, of which 25 were murders, 35 were traffic accidents not directly related to work activities, and three were suicides at work. The proportional mortality rate for homicides, traffic accidents, and suicides among fatal work-related accidents was estimated at 30.5%, 42.7%, and 3.7%, respectively. CONCLUSIONS: Urban violence accounted for three-fourths of the fatal work-related accidents recorded in the period studied

Adverse effects of ayahuasca: Results from the Global Ayahuasca Survey

Introduction Ayahuasca is a plant-based decoction native to Amazonia, where it has a long history of use in traditional medicine. Contemporary ritual use of ayahuasca has been expanding throughout the world for mental health purposes, and for spiritual and personal growth. Although researchers have been conducting clinical trials and observational studies reporting medical and psychological benefits, most of these do not report ayahuasca’s immediate or medium-term adverse effects, so these are underrepresented in the literature. With the expansion of ayahuasca ceremonies from their traditional contexts to countries around the world, there is an important public health question regarding the risk/benefit balance of its use. Methods We used data from an online Global Ayahuasca Survey (n = 10,836) collected between 2017 and 2019 involving participants from more than 50 countries. Principal component analysis was performed to assess group effects. Logistic regression analysis was performed to test for adverse effects associated with history of ayahuasca use, clinical, context of use and spiritual effect variables. Results Acute physical health adverse effects (primarily vomiting) were reported by 69.9% of the sample, with 2.3% reporting the need for subsequent medical attention. Adverse mental health effects in the weeks or months following consumption were reported by 55.9% of the sample, however, around 88% considered such mental health effects as part of a positive process of growth or integration. Around 12% sought professional support for these effects. Physical adverse effects were related to older age at initial use of ayahuasca, having a physical health condition, higher lifetime and last year ayahuasca use, having a previous substance use disorder diagnosis, and taking ayahuasca in a non-supervised context. Mental health adverse effects were positively associated with anxiety disorders; physical health conditions; and the strength of the acute spiritual experience; and negatively associated with consumption in religious settings. Conclusions While there is a high rate of adverse physical effects and challenging psychological effects from using ayahuasca, they are not generally severe, and most ayahuasca ceremony attendees continue to attend ceremonies, suggesting they perceive the benefits as outweighing any adverse effects. Knowing what variables might predict eventual adverse effects may serve in screening of, or providing additional support for, vulnerable subjects. Improved understanding of the ayahuasca risk/benefit balance can also assist policy makers in decisions regarding potential regulation and public health responses

The Setting Questionnaire for the Ayahuasca Experience: Questionnaire Development and Internal Structure

The growing interest in research on psychedelic consumption in naturalistic contexts and their possible medical and therapeutic benefits requires assessment of the relationships between the substance and the individual who consumes it (set) and its context of use (setting). This study provides a novel measurement scale for the setting of Ayahuasca consumption, the Setting Questionnaire for the Ayahuasca Experience (SQAE), and examines its psychometric properties. Construction of the scale began with a literature review, followed by interviews on 19 Ayahuasca users from different backgrounds and different consumption experience, and an online survey for quantitative data collection (n = 2,994). Exploratory Graph Analysis (EGA) was used to investigate the questionnaire's dimensional structure with (n = 1,497, half of the sample), and multidimensional item response theory (MIRT) was used to compare the fit of the theoretical dimensions with the EGA proposed dimensions (n = 1,497, independent other half). EGA identified six dimensions, which corresponded partially to the theorized model (Leadership, Decoration, Infrastructure, Comfort, Instruction, and Social). The MIRT comparison found that the proposed theoretical model fit significantly better than the EGA model, providing support for the former (χ2/df = 1,967; CFI = 0,972; TLI = 0,969; RMSEA = 0,059; WRMR = 1,087). Our findings present evidence of validity of this instrument, justifying its use for future research on the influence of the setting during the ayahuasca experience. Its findings may provide a basis for expanding the settings investigated in the use of psychedelics in general

Ceremonial Ayahuasca in Amazonian Retreats—Mental Health and Epigenetic Outcomes From a Six-Month Naturalistic Study

Ayahuasca is a natural psychoactive brew, used in traditional ceremonies in the Amazon basin. Recent research has indicated that ayahuasca is pharmacologically safe and its use may be positively associated with improvements in psychiatric symptoms. The mechanistic effects of ayahuasca are yet to be fully established. In this prospective naturalistic study, 63 self-selected participants took part in ayahuasca ceremonies at a retreat centre in the Peruvian Amazon. Participants undertook the Beck Depression Inventory (BDI-II), State-Trait Anxiety Inventory (STAI), Self-compassion Scale (SCS), Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM), as well as secondary measures, pre- and post-retreat and at 6-months. Participants also provided saliva samples for pre/post epigenetic analysis. Overall, a statistically significant decrease in BDI-II (13.9 vs. 6.1, p < 0.001), STAI (44.4 vs. 34.3 p < 0.001) scores, and CORE-OM scores were observed (37.3 vs. 22.3 p < 0.001) at post-retreat, as well as a concurrent increase in SCS (3.1 vs. 3.6, p < 0.001). Psychometric improvements were sustained, and on some measures values further decreased at 6-month follow-up, suggesting a potential for lasting therapeutic effects. Changes in memory valence were linked to the observed psychometric improvements. Epigenetic findings were equivocal, but indicated that further research in candidate genes, such as sigma non-opioid intracellular receptor 1 (SIGMAR1), is warranted. This data adds to the literature supporting ayahuasca's possible positive impact on mental health when conducted in a ceremonial context. Further investigation into clinical samples, as well as greater analyses into the mechanistic action of ayahuasca is advised

Rapid antidepressant effects of the psychedelic ayahuasca in treatment-resistant depression: a randomized placebo-controlled trial

Background Recent open-label trials show that psychedelics, such as ayahuasca, hold promise as fast-onset antidepressants in treatment-resistant depression. Methods To test the antidepressant effects of ayahuasca, we conducted a parallel-arm, double-blind randomized placebo-controlled trial in 29 patients with treatment-resistant depression. Patients received a single dose of either ayahuasca or placebo. We assessed changes in depression severity with the Montgomery-Åsberg Depression Rating Scale (MADRS) and the Hamilton Depression Rating scale at baseline, and at 1 (D1), 2 (D2), and 7 (D7) days after dosing. Results We observed significant antidepressant effects of ayahuasca when compared with placebo at all-time points. MADRS scores were significantly lower in the ayahuasca group compared with placebo at D1 and D2 (p = 0.04), and at D7 (p < 0.0001). Between-group effect sizes increased from D1 to D7 (D1: Cohen's d = 0.84; D2: Cohen's d = 0.84; D7: Cohen's d = 1.49). Response rates were high for both groups at D1 and D2, and significantly higher in the ayahuasca group at D7 (64% v. 27%; p = 0.04). Remission rate showed a trend toward significance at D7 (36% v. 7%, p = 0.054). Conclusions To our knowledge, this is the first controlled trial to test a psychedelic substance in treatment-resistant depression. Overall, this study brings new evidence supporting the safety and therapeutic value of ayahuasca, dosed within an appropriate setting, to help treat depression. This study is registered at http://clinicaltrials.gov (NCT02914769)

Políticas de drogas e saúde pública: algumas incongruências entre políticas de drogas, saúde coletiva e direitos humanos no Brasil

Edição trilíngue: português, espanhol e inglêsTítulo em espanhol: Políticas de drogas y salud pública: algunas incongruencias entre las políticas de drogas, salud colectiva y derechos humanos en BrasilTítulo em inglês: Drugs policies and public health: some inconsistencies between drug policies, public health and human right