Brazilian Multicentre Study Of Common Mental Disorders In Primary Care: Rates And Related Social And Demographic Factors [estudo Multicêntrico Brasileiro Sobre Transtornos Mentais Comuns Na Atenção Primária: Prevalência E Fatores Sociodemográficos Relacionados]

Mental health problems are common in primary health care, particularly anxiety and depression. This study aims to estimate the prevalence of common mental disorders and their associations with socio-demographic characteristics in primary care in Brazil (Family Health Strategy). It involved a multicenter cross-sectional study with patients from Rio de Janeiro, São Paulo, Fortaleza (Ceará State) and Porto Alegre (Rio Grande do Sul State), assessed using the General Health Questionnaire (GHQ-12) and the Hospital Anxiety and Depression Scale (HAD). The rate of mental disorders in patients from Rio de Janeiro, São Paulo, Fortaleza and Porto Alegre were found to be, respectively, 51.9%, 53.3%, 64.3% and 57.7% with significant differences between Porto Alegre and Fortaleza compared to Rio de Janeiro after adjusting for confounders. Prevalence proportions of mental problems were especially common for females, the unemployed, those with less education and those with lower incomes. 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The Psychedelic State Induced By Ayahuasca Modulates The Activity And Connectivity Of The Default Mode Network

The experiences induced by psychedelics share a wide variety of subjective features, related to the complex changes in perception and cognition induced by this class of drugs. A remarkable increase in introspection is at the core of these altered states of consciousness. Self-oriented mental activity has been consistently linked to the Default Mode Network (DMN), a set of brain regionsmore active during rest than during the execution of a goal-directed task. Here we used fMRI technique to inspect the DMN during the psychedelic state induced by Ayahuasca in ten experienced subjects. Ayahuasca is a potion traditionally used by Amazonian Amerindians composed by a mixture of compounds that increase monoaminergic transmission. In particular, we examined whether Ayahuasca changes the activity and connectivity of the DMN and the connection between the DMN and the task-positive network (TPN). Ayahuasca caused a significant decrease in activity throughmost parts of the DMN, including its most consistent hubs: the Posterior Cingulate Cortex (PCC)/Precuneus and the medial Prefrontal Cortex (mPFC). Functional connectivity within the PCC/Precuneus decreased after Ayahuasca intake. No significant change was observed in the DMN-TPN orthogonality. Altogether, our results support the notion that the altered state of consciousness induced by Ayahuasca, like those induced by psilocybin (another serotonergic psychedelic), meditation and sleep, is linked to the modulation of the activity and the connectivity of the DMN.102Watts, A., Psychedelics and religious experience (1968) California Law Review, 56, pp. 74-85Shanon, B., (2002) The Antipodes of the Mind: Charting the Phenomenology of the Ayahuasca Experience, 6, p. 475. , OxfordNew York: Oxford University PressDos Santos, R.G., Grasa, E., Valle, M., Ballester, M.R., Bouso, J.C., Pharmacology of ayahuasca administered in two repeated doses (2012) Psychopharmacology, 219, pp. 1039-1053. , PMID: 21842159Callaway, J.C., McKenna, D.J., Grob, C.S., Brito, G.S., Raymon, L.P., Pharmacokinetics of Hoasca alkaloids in healthy humans (1999) Journal of Ethnopharmacology, 65, pp. 243-256. , PMID: 10404423Fontanilla, D., Johannessen, M., Hajipour, A.R., Cozzi, N.V., Jackson, M.B., The hallucinogen N, N-dimethyltryptamine (DMT) is an endogenous sigma-1 receptor regulator (2009) Science, 323, pp. 934-937. , PMID: 19213917Mckenna, D.J., Towers, G.H.N., Abbott, F., Monoamine-oxidase inhibitors in South-American hallucinogenic plants-tryptamine and beta-carboline constituents of ayahuasca (1984) Journal of Ethnopharmacology, 10, pp. 195-223. , PMID: 6587171De Araujo, D.B., Ribeiro, S., Cecchi, G.A., Carvalho, F.M., Sanchez, T.A., Seeing with the eyes shut: Neural basis of enhanced imagery following ayahuasca ingestion (2012) Human Brain MappingRiba, J., Valle, M., Urbano, G., Yritia, M., Morte, A., Human pharmacology of ayahuasca: Subjective and cardiovascular effects, monoamine metabolite excretion, and pharmacokinetics (2003) Journal of Pharmacology and Experimental Therapeutics, 306, pp. 73-83. , PMID: 12660312Riba, J., Rodriguez-Fornells, A., Urbano, G., Morte, A., Antonijoan, R., Subjective effects and tolerability of the South American psychoactive beverage Ayahuasca in healthy volunteers (2001) Psychopharmacology, 154, pp. 85-95. , PMID: 11292011Bouso, J.C., Fabregas, J.M., Antonijoan, R.M., Rodriguez-Fornells, A., Riba, J., Acute effects of ayahuasca on neuropsychological performance: Differences in executive function between experienced and occasional users (2013) Psychopharmacology, 230, pp. 415-424. , PMID: 23793226Riba, J., Romero, S., Grasa, E., Mena, E., Carrio, I., Increased frontal and paralimbic activation following ayahuasca, the pan-amazonian inebriant (2006) Psychopharmacology, 186, pp. 93-98. , PMID: 16575552Sheline, Y.I., Barch, D.M., Price, J.L., Rundle, M.M., Vaishnavi, S.N., The default mode network and self-referential processes in depression (2009) Proceedings of the National Academy of Sciences of the United States of America, 106, pp. 1942-1947. , PMID: 19171889Sood, A., Jones, D.T., On mind wandering, attention, brain networks, and meditation (2013) Explore: The Journal of Science and Healing, 9, pp. 136-141. , PMID: 23643368Buckner, R.L., Andrews-Hanna, J.R., Schacter, D.L., The brain's default network. 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Matrix Support In Mental Health In Primary Halth Care: A Review Of Scientific Papers And Official Documents [apoio Matricial Em Saúde Mental Na Atenção Primária à Saúde: Uma Análise Da Produção Científica E Documental]

The challenge of an effective comprehensive care in the Brazilian National Health System sustains a debate about the mMatrix support (MS) for the Family Health Strategy (FHS) while stressing the need for further studies on the subject. This paper aims to critically analyze the matrix support with the aid of scientific papers and documents from the Brazilian Ministry of Health, especially those directed to mental health (MH) matrix support in primary care. The results emphasize the importance of coordination between the MH and primary care, though they also indicate that MS in MH is encompassed within a health care model that is still under construction and that new theoretical-practical contributions and evaluative studies are needed for its improvement.1745287300Arona, E.C., Implantação do matriciamento nos serviços de saúde de Capivari (2009) Saude Soc, 18 (1), pp. 26-36Barban, E.G., Oliveira, A.A., O modelo de assistência da equipe matricial de saúde mental no programa saúde da família do município de São José do Rio Preto (Capacitação e educação permanente aos profissionais de saúde na atenção básica) (2007) Arq. Cienc. Saude, 14 (1), pp. 52-63Bezerra, E., Dimenstein, M., Os CAPS e o trabalho em rede: Tecendo o apoio matricial na atenção básica (2008) Psicol. Cienc. Prof, 28 (3), pp. 632-645Bezerra, R.S.S., Arranjo matricial e o desafio da interdisciplinaridade na atenção básica: A experiência do NASF em Camaragibe/PE (2010) Divulg. Saude Debate, 46, pp. 51-59Böing, E., Crepaldi, M.A., O psicólogo na atenção básica: Uma incursão pelas políticas públicas de saúde brasileiras (2010) Psicol. Cienc. Prof, 30 (3), pp. 634-649Bonfim, I.G., (2012) Apoio Matricial Em Saúde Mental Na Estratégia De Saúde Da Família Em Fortaleza: Ouro Que Não Boia. 2012, , Dissertação (Mestrado em Psicologia) - Centro de Humanidades, Universidade Federal do Ceará, FortalezaBonfim, I.G., (2009) Apoio Matricial Em Saúde Mental Na Atenção Básica: Uma Análise Da Produção Científica E Das Experiências. 2009, , Monografia (Especialização) - Centro de Ciências da Saúde, Universidade Estadual do Ceará, Fortaleza(2011) Secretaria De Atenção À Saúde. DAPES. Coordenação Geral De Saúde Mental, Álcool E Outras Drogas, , BRASIL. Ministério da Saúde, Saúde Mental no SUS: as novas fronteiras da Reforma Psiquiátrica. Brasília: MS(2009) Secretaria De Atenção À Saúde. Departamento De Atenção Básica E Departamento De Ações Programáticas Estratégicas, , BRASIL. Ministério da Saúde, Diretrizes NASF - Núcleo de Apoio à Saúde da Família. Brasília: MS(2012) Portaria 154, De 24 De Janeiro De 2008, , http://www.sbp.com.br/pdfs/portaria_154.pdf, BRASIL. Ministério da Saúde, Dispõe sobre a criação dos Núcleos de Apoio à Saúde da Família. Disponível em, Acesso em: 1 jul(2007) Secretaria De Atenção À Saúde, , BRASIL. Ministério da Saúde, Relatório de Gestão 2003-2006: saúde mental no SUS: acesso ao tratamento e mudança do modelo de atenção. Brasília: MS(2005) Secretaria De Atenção À Saúde. Departamento De Ações Programáticas Estratégicas, , BRASIL. Ministério da Saúde, Coordenação Geral de Saúde Mental. Reforma Psiquiátrica e a Política de Saúde Mental no Brasil. Brasília: MS(2004) Secretaria Executiva. 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The influence of ceremonial settings on mystical and challenging experiences occasioned by ayahuasca:A survey among ritualistic and religious ayahuasca users

Recent studies have recognized the importance of non-pharmacological factors such as setting to induce or promote mystical experiences or challenging experiences among ayahuasca users. This study aimed to evaluate the association between the setting in which ayahuasca is consumed and the intensity of mystical and challenging experiences considering three ayahuasca using traditions (Uniao do Vegetal, Santo Daime and neo-shamanic groups). A cross-sectional analysis was performed on survey data collected online from 2,751 participants. The Setting Questionnaire for the Ayahuasca Experience (SQAE) was used to evaluate six dimensions of the setting characteristics. The Mystical Experience Questionnaire (MEQ) and the Challenging Experience Questionnaire (CEQ) were used to quantify the psychedelic experience. Ratings on every SQAE setting dimension were negatively correlated with ratings of the CEQ (r values between 0.21 and 0.36) for all ayahuasca using traditions. Regression analysis revealed that ratings on four SQAE dimensions (Social, Comfort, Infrastructure and Decoration) explained 41% of the variance in CEQ ratings. Associations between SQAE and MEQ ratings were relatively weak and confined to the dimensions Leadership and Comfort, explaining 14% of the variance in MEQ ratings. Ratings of Social context were higher among members of Uniao do Vegetal compared to Santo Daime and neo-shamanic members. Ratings of Infrastructure, Comfort and Decoration were more consistently correlated with MEQ in the neoshamanic tradition compared to the other traditions. This study shows that the setting is an important moderator of a challenging experience under ayahuasca. Maximizing the quality of the setting in which ayahuasca is taken will reduce the chance of a challenging experience while contributing positively to a mystical experience. The present findings can be considered when designing rituals and the (social) environment of ayahuasca ceremonies, and indicate that the SQAE questionnaire can be employed to monitor the influence of ceremonial settings on the ayahuasca experience

Pharmacological And Psychosocial Management Of Mental, Neurological And Substance Use Disorders In Low- And Middle-income Countries: Issues And Current Strategies

Mental, neurological, and substance use disorders (MNS) are among the largest sources of medical disability in the world, surpassing both cardiovascular disease and cancer. The picture is not different in low- and middle-income countries (LAMIC) where the relative morbidity associated with MNS is increasing, as a consequence of improvement in general health indicators and longevity. However, 80 % of individuals with MNS live in LAMIC but only close to 20 % of cases receive some sort of treatment. The main aim of this article is to provide nonspecialist health workers in LAMIC with an accessible guide to the affordable essential psychotropics and psychosocial interventions which are proven to be cost effective for treating the main MNS. The MNS discussed in this article were selected on the basis of burden, following the key priority conditions selected by the Mental Health Action Programme (mhGAP) developed by the World Health Organization (WHO) (anxiety, stress-related and bodily distress disorders; depression and bipolar disorder; schizophrenia; alcohol and drug addiction; and epilepsy), with the addition of eating disorders, because of their emergent trend in middle-income countries.Wereview best evidence-based clinical practice in these areas, with a focus on drugs from the WHO Model List of Essential Medicines and the psychosocial interventions available in LAMIC for the management of these conditions in primary care. We do this by reviewing guidelines developed by prestigious professional associations and government agencies, clinical trials conducted in LAMIC and systematic reviews (including Cochrane reviews) identified from the main international literature databases (MEDLINE, EMBASE and PsycINFO). In summary, it can be concluded that the availability and use of the psychotropics on the WHO Model List of Essential Medicines in LAMIC, plus an array of psychosocial interventions, can represent a cost-effective way to expand treatment of most MNS. The translation of these findings into policies can be achieved by relatively low supplementary funding, and limited effort engendered by governments and policy makers in LAMIC.73141549156

LSD and creativity:Increased novelty and symbolic thinking, decreased utility and convergent thinking

Background: Controversy surrounds psychedelics and their potential to boost creativity. To date, psychedelic studies lack a uniform conceptualization of creativity and methodologically rigorous designs. Aims: This study aimed at addressing previous issues by examining the effects of lysergic acid diethylamide (LSD) on creativity using multimodal tasks and multidimensional approaches. Methods: In a randomized, double-blind, placebo-controlled, crossover study, 24 healthy volunteers received 50 mu g of LSD or inactive placebo. Near drug peak, a creativity task battery was applied, including pattern meaning task (PMT), alternate uses task (AUT), picture concept task (PCT), creative metaphors task (MET) and figural creativity task (FIG). Creativity was assessed by scoring creativity criteria (novelty, utility, surprise), calculating divergent thinking (fluency, originality, flexibility, elaboration) and convergent thinking, computing semantic distances (semantic spread, semantic steps) and searching for data-driven special features. Results: LSD, compared to placebo, changed several creativity measurements pointing to three overall LSD-induced phenomena: (1) 'pattern break', reflected by increased novelty, surprise, originality and semantic distances; (2) decreased 'organization', reflected by decreased utility, convergent thinking and, marginally, elaboration; and (3) 'meaning', reflected by increased symbolic thinking and ambiguity in the data-driven results. Conclusion: LSD changed creativity across modalities and measurement approaches. Three phenomena of pattern break, disorganization and meaning seemed to fundamentally influence creative cognition and behaviour pointing to a shift of cognitive resources 'away from normal' and 'towards the new'. LSD-induced symbolic thinking might provide a tool to support treatment efficiency in psychedelic-assisted therapy

Sufentanil-2-hydroxypropyl-β-cyclodextrin Inclusion Complex For Pain Treatment: Physicochemical, Cytotoxicity, And Pharmacological Evaluation

Sufentanil (SUF) is a synthetic analgesic opioid widely used for the management of acute and chronic pain. This drug was complexed with 2-hydroxypropyl-β-cyclodextrin (HP-β-CD) and the physicochemical characterization, in vitro/ex vivo toxicity assays, and pharmacological evaluation were performed. Differential scanning calorimetry, Fourier transform infrared spectroscopy (FTIR) analysis, and X-ray powder diffraction showed the formation and the morphology of the complex. Nuclear magnetic resonance afforded data regarding inclusion complex stoichiometry (1:1) with an association binding constant (Ka) value of 515.2 ± 1.2M-1 between SUF and HP-β-CD. Complexation with HP-β-CD protected SUF from light exposure and increased its photostability. Release kinetics revealed a decrease in SUF release rate (Krel = 7.05 ± 0.52 and 5.61 ± 0.39min-1/2 for SUF-HP-β-CD and SUF, respectively) and reduced hemolytic or myotoxic effects after complexation. Time course of tail-flick test showed that the duration of analgesia induced by SUF (150.0 ± 34.6min) was significantly increased (p < 0.001) after complexation with HP-β-CD (355.7 ± 47.2min) when injected at the same dose (1μg kg-1), prolonging the duration of analgesia after intramuscular administration and representing an alternative on the development of effective and safe drug-delivery system for opioid analgesics. © 2012 Wiley Periodicals, Inc.1011036983707Slingsby, L.S., Murison, P.J., Goossens, L., Engelen, M., Waterman-Pearson, A.E., A comparison between pre-operative carprofen and a long-acting sufentanil formulation for analgesia after ovariohysterectomy in dogs (2006) Vet Anaesth Analg, 33, pp. 313-327Meert, T.F., Pharmacotherapy of opioids: Present and future developments (1996) Pharm World Sci, 18, pp. 1-15Meert, T.F., Mesens, J., Verheyen, P., Noorduin, H., Hydroxypropyl-beta-cyclodextrin can modulate the activity of spinally administered sufentanil (1992) Eur J Anaesthesiol, 9, pp. 399-409Yaksh, T.L., Jang, J.D., Nishiuchi, Y., Braun, K.P., Goodman, M., The utility of 2-hydroxypropyl-beta-cyclodextrin as a vehicle for the intracerebral and intrathecal administration of drugs (1992) Life Sci, 48, pp. 623-633Jang, J., Yaksh, T.L., Hill, H.F., Use of 2-hydroxypropyl-β-cyclodextrin as an intrathecal drug vehicle with opioids (1992) J Pharm Exp Ther, 261, pp. 592-600Meert, T.F., Melis, W., Interactions between epiduraly and intrathecally administered sulfentanil and bupivacaine in hydroxypropyl-β-cyclodextrin in the rat (1992) Acta Anaesthesiol Scand, 43, pp. 79-89Holvoet, C., Plaizier-Vercammen, J., Vander Heyden, Y., Gabriels, M., Camu, F., Preparation and in vitro release rate of fentanyl-cyclodextrin complexes for prolonged action in epidural analgesia (2003) Int J Pharm, 265, pp. 13-26Ogawa, N.O., Higashi, K., Nagase, H., Endo, T., Moribe, K., Loftsson, T., Yamamoto, K., Ueda, H., Effects of cogrinding with β-cyclodextrin on the solid state fentanyl (2010) J Pharm Sci, 99, pp. 5019-5029Waldeck, A.R., Kuchel, P.W., Lennon, A.J., Chapman, B.E., NMR diffusion measurements to characterize membrane transport and solute binding (1997) Prog Nucl Magn Reson Spectrosc, 30, pp. 39-68Fraceto, L.F., Moraes, C.M., Abrami, P., Gonçalves, M.M., Andreo, F.N., Fernandes, S.A., de Paula, E., Preparação e caracterização Físico-química de complexos de inclusão entre anestésicos locais e hidroxipropilbeta-ciclodextrina (2007) Quim Nova, 30, pp. 777-784Wimmer, R., Aachamann, F.L., Larsen, K.L., Petersen, S.B., NMR diffusion as a novel tool for measuring the association constant between cyclodextrin and guest molecules (2002) Carbohydr Res, 337, pp. 841-849de Araujo, D.R., Tsuneda, S.S., Cereda, M.S., Carvallho, F.D.G.E., Preté, P.S.C., Fernandes, S.A., Yokaichiya, F., de Paula, E., Development and pharmacological evaluation of ropivacaine-2-hydroxypropyl-β-cyclodextrin inclusion complex (2008) Eur J Pharm Sci, 33, pp. 60-71Grillo, R., de Melo, N.F., Moraes, C.M., de Lima, R., Menezes, C.M., Ferreira, E.I., Rosa, A.H., Fraceto, L.F., Study of the interaction between hydroxymethylnitrofurazone and 2-hydroxypropyl-beta-cyclodextrin (2008) J Pharm Biomed Anal, 47, pp. 295-302Lambropoulos, J., Spanos, G.A., Lazaridis, N.V., Development and validation of an HPLC assay for fentanyl, alfentanil, and sufentanil in swab samples (2000) J Pharm Biomed Anal, 23, pp. 421-428Kranz, H., Brazeau, G.A., Napaporn, J., Martin, R.L., Millard, W., Bodmeier, R., (2001) Int J Pharm, 212, pp. 11-18. , Myotoxicity studies of injectable biodegradable in-situ forming drug delivery systemsMalheiros, S.V.P., Pinto, L.M.A., Gottardo, L., Yokaichiya, D.K., Fraceto, L.F., Meirelles, N.C., de Paula, E., A new look at the hemolytic effect of local anesthetics considering their real membrane/water partitioning at pH 7.4 (2004) Biophys Chem, 110, pp. 213-221Johnson Jr., C.S., Diffusion ordered nuclear magnetic resonance spectroscopy: Principles and applications progress in nuclear magnetic resonance (1999) Spectroscopy, 34, pp. 203-256Bakkour, Y., Vermeersch, G., Morcellet, M., Boschin, F., Martel, B., Azaroual, N., Formation of cyclodextrin inclusion complexes with doxycyclin-hyclate: NMR investigation of their characterization and stability (2006) J Incl Phenom Macrocycl Chem, 54, pp. 109-114Giordano, F., Novak, C., Moyano, J.R., Thermal analysis of cyclodextrins and their inclusion compounds (2001) Thermochim Acta, 380, pp. 123-151Yap, K.L., Liu, X., Thenmozhiyal, J.C., Ho, P.C., Characterization of the 13-cis-retinoic acid/cyclodextrin inclusion complexes by phase solubility, photostability, physicochemical and computational analysis (2005) Eur J Pharm Sci, 25, pp. 49-56Costa, P., Lobo, J.M.S., Modeling and comparison of dissolution profiles. (2001) Eur J Pharm Sci, 13, pp. 123-133Moraes, C.M., Abrami, P., de Paula, E., Braga, A.F., Fraceto, L.F., Study of the interaction between S(-) bupivacaine and 2-hydroxypropyl-beta-cyclodextrin (2007) Int J Pharm, 331, pp. 99-106Moraes, C.M., Abrami, P., de Araújo, D.R., Braga, A.F.A., Issa, M.G., Ferraz, H.G., de Paula, E., Fraceto, L.F., Characterization of lidocaine: Hydroxypropyl-β-cyclodextrin (2007) J Incl Phenom Macrocycl Chem, 57, pp. 313-316Bibby, D., Davies, N.M., Tueker, I.G., Mechanisms by which cyclodextrins modify drug release from polymeric drug delivery systems (2000) Int J Pharm, 197, pp. 1-11de Araújo, D.R., Fraceto, L.F., Braga, A.F.A., de Paula, E., Drug-delivery systems for racemic bupivacaine (S50-R50) and bupivacaine enantiomeric mixture (S75-R25): Cyclodextrins complexation effects on sciatic nerve blockade in mice (2005) Rev Bras Anestesiol, 55, pp. 316-328de Araújo, D.R., Moraes, C.M., Fraceto, L.F., Braga, A.F.A., de Paula, E., Cyclodextrin-bupivacaine enantiomeric mixture (S75-R25) inclusion complex and intrathecal anesthesia in rats (2006) Rev Bras Anestesiol, 56, pp. 495-506Irie, T., Uekama, K., Pharmaceutical applications of cyclodextrins. 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LSD and creativity: Increased novelty and symbolic thinking, decreased utility and convergent thinking

Background: Controversy surrounds psychedelics and their potential to boost creativity. To date, psychedelic studies lack a uniform conceptualization of creativity and methodologically rigorous designs. Aims: This study aimed at addressing previous issues by examining the effects of lysergic acid diethylamide (LSD) on creativity using multimodal tasks and multidimensional approaches. Methods: In a randomized, double-blind, placebo-controlled, crossover study, 24 healthy volunteers received 50 mu g of LSD or inactive placebo. Near drug peak, a creativity task battery was applied, including pattern meaning task (PMT), alternate uses task (AUT), picture concept task (PCT), creative metaphors task (MET) and figural creativity task (FIG). Creativity was assessed by scoring creativity criteria (novelty, utility, surprise), calculating divergent thinking (fluency, originality, flexibility, elaboration) and convergent thinking, computing semantic distances (semantic spread, semantic steps) and searching for data-driven special features. Results: LSD, compared to placebo, changed several creativity measurements pointing to three overall LSD-induced phenomena: (1) 'pattern break', reflected by increased novelty, surprise, originality and semantic distances; (2) decreased 'organization', reflected by decreased utility, convergent thinking and, marginally, elaboration; and (3) 'meaning', reflected by increased symbolic thinking and ambiguity in the data-driven results. Conclusion: LSD changed creativity across modalities and measurement approaches. Three phenomena of pattern break, disorganization and meaning seemed to fundamentally influence creative cognition and behaviour pointing to a shift of cognitive resources 'away from normal' and 'towards the new'. LSD-induced symbolic thinking might provide a tool to support treatment efficiency in psychedelic-assisted therapy