The cortical thickness of tricenarian cocaine users assembles features of an octogenarian brain.

It has been suggested that substance use disorders could lead to accelerated biological aging, but only a few neuroimaging studies have investigated this hypothesis so far. In this cross-sectional study, structural neuroimaging was performed to measure cortical thickness (CT) in tricenarian adults with cocaine use disorder (CUD, n1 = 30) and their age-paired controls (YC, n1 = 30), and compare it with octogenarian elder controls (EC, n1 = 20). We found that CT in the right fusiform gyrus was similar between CUD and EC, thinner than the expected values of YC. We also found that regarding CT of the right inferior temporal gyrus, right inferior parietal cortex, and left superior parietal cortex, the CUD group exhibited parameters that fell in between EC and YC groups. Finally, CT of the right pars triangularis bordering with orbitofrontal gyrus, right superior temporal gyrus, and right precentral gyrus were reduced in CUD when contrasted with YC, but those areas were unrelated to CT of EC. Despite the 50-year age gap between our age groups, CT of tricenarian cocaine users assembles features of an octogenarian brain, reinforcing the accelerated aging hypothesis in CUD.

Cingulate cortical thickness in cocaine use disorder: mediation effect between early life stress and cocaine consumption.

OBJECTIVE: The cingulate gyrus is implicated in the neurobiology of addiction, such as chronic cocaine consumption. Early life stress (ELS) is an important moderator of cocaine use disorder (CUD). Therefore, we investigated the effect of CUD on cingulate cortical thickness and tested whether a history of ELS could influence the effects of CUD. METHODS: Participants aged 18-50 years (78 with CUD due to crack cocaine consumption and 53 healthy controls) underwent magnetic resonance imaging and the cingulate thickness (rostral anterior, caudal anterior, posterior, and isthmus regions) was analysed. The clinical assessment comprised the Childhood Trauma Questionnaire (CTQ) and the Addiction Severity Index. Group comparisons adjusting by sex, age, and education were performed. Mediation models were generated where lifetime cocaine use, CTQ score, and cortical thickness corresponded to the independent variable, intermediary variable, and outcome, respectively. RESULTS: Group comparisons revealed significant differences in six out of eight cingulate cortices, showing lower thickness in the CUD group. Furthermore, years of regular cocaine use was the variable most associated with cingulate thickness. Negative correlations were found between CTQ scores and the isthmus cingulate (right hemisphere), as well as with the rostral anterior cingulate (left hemisphere). In the mediation analysis, we observed a significant negative direct effect of lifetime cocaine use on the isthmus cingulate and an indirect effect of cocaine use mediated by CTQ score. CONCLUSION: Our findings suggest that a history of ELS could aggravate the negative effects of chronic cocaine use on the cingulate gyrus, particularly in the right isthmus cingulate cortex.

Sex differences in brain regional homogeneity during acute abstinence in cocaine use disorder.

There are significant sex differences in the clinical characteristics of cocaine use disorder (CUD). As this is a brain disorder that involves changes in functional connectivity, we investigated the existence of sex differences among people with CUD and controls. We used a data-driven method comparing males (n = 20, CK-M) and females with CUD (n = 20, CK-F) and healthy controls (20 males, HC-M and 20 females, HC-F). The participants undertook a resting-state functional magnetic resonance imaging exam. Regional homogeneity (ReHo) was performed to identify group and sex differences. Persons with CUD of both sexes presented lower ReHo parameters than controls, especially within the parietal lobule. Males with CUD showed higher ReHo than females in three right-side brain areas: postcentral gyrus, putamen and fusiform gyrus. It was found that abstinence symptoms severity was associated with lower ReHo values in the right postcentral gyrus and the right fusiform gyrus. Participants with CUD exhibited altered ReHo parameters compared to controls, similar to what is found in ageing-related disorders. Our data also indicate that cocaine has sex-specific effects on brain functioning when analysing ReHo.

Cortical thickness and subcortical volume abnormalities in male crack-cocaine users.

Crack-cocaine offers a higher risk of abuse than intranasal and intravenous use of cocaine. Yet, current treatments remain disappointing and our understanding of the mechanism of crack-cocaine neurotoxicity is still incomplete. Magnetic resonance images studies on brain changes of crack-cocaine addicts show divergent data. The present study investigated gray matter (GM) abnormalities in crack-cocaine dependents (n = 18) compared to healthy controls (n = 17). MRI data was analysed using FreeSurfer and voxel-based morphometry (VBM). FreeSurfer analysis showed that CD had decreased cortical thickness (CT) in the left inferior temporal cortex (lTC), left orbitofrontal cortex (lOFC) and left rostro frontal cortex (lRFC), enlargement in left inferior lateral ventricle, and smaller GM volume in right hippocampus and right ventral diencephalon. VBM analysis showed that CD had significantly decreased GM volume in left Putamen and left nucleus accumbens. Furthermore, we found a negative correlation between duration of crack-cocaine use and lTC CT. These results provide compelling evidence for GM abnormalities in CD and also suggest that duration of crack-cocaine use may be associated with CT alterations.

Prevalence of burnout in pediatric intensivists: an observational comparison with general pediatricians.

OBJECTIVE: To study the prevalence of burnout in general pediatricians and pediatric intensivists and to evaluate factors that may be associated with this syndrome. DESIGN: Observational cohort study. SETTING: Pediatric departments of two hospitals in south Brazil. PATIENTS: Pediatric intensivists working in two regional PICUs and general pediatricians working in the outpatient departments in the same hospitals. INTERVENTION: Two researchers, blinded to the workplace of the physicians, undertook the assessment of burnout using the Maslach Burnout Inventory scale. Burnout was defined as high score in the domains for "emotional exhaustion" or "depersonalization" or a low score in the "professional accomplishment" domain. MEASUREMENTS AND MAIN RESULTS: The PICU and general pediatrician groups were similar demographically, and each had 35 recruits. Burnout was present in 50% of the study recruits and was more frequent among pediatric intensivists than general pediatricians (71% vs 29%, respectively, p < 0.01). In regard to the individual Maslach Burnout Inventory domains, the average score was higher for emotional exhaustion and depersonalization and lower for professional accomplishment in the PICU group (p < 0.01). A cluster analysis showed that pediatric intensivists were more likely to develop the burnout syndrome involving all Maslach Burnout Inventory domains. The multivariate analysis found that the odds ratio for burnout in pediatric intensivists was 5.7 (95% CI, 1.9-16.7; p < 0.01). CONCLUSIONS: Burnout is frequent among pediatric intensivists and characterized by cumulative involvement of emotional exhaustion, depersonalization, and professional accomplishment. Earlier recognition of emotional exhaustion may be important in preventing the development of a complete burnout syndrome. Improvement in workplace characteristics and measures to improve physician resilience are entirely warranted.

Patterns of non-medical use of methylphenidate among 5th and 6th year students in a medical school in southern Brazil / Padrões do uso não médico de metilfenidato em estudantes do 5º e do 6º ano de uma faculdade de medicina do Brasil

Objectives: To evaluate the prevalence of methylphenidate (MPH) use among 5th and 6th year medical students, to discriminate MPH use with and without medical indication, and to correlate MPH use with alcohol intake. Methods: This is a cross-sectional study in which medical students were invited to answer a questionnaire to evaluate academic and socioeconomic status, MPH use patterns, and attitudes towards neuroenhancing drugs. The Alcohol Use Disorders Identification Test (AUDIT) was used to assess alcohol intake; a score ≥ 8 suggests potentially hazardous alcohol use. Results: Fifty-two participants (34.2%) had already used MPH, of which 35 (23.02%) had used it without medical indication. The number of 6th year students who had used MPH was more than twice higher than that of their 5th year counterparts (32.89 vs. 13.15%, respectively; p = 0.004). Also, 43.6% (p = 0.031) of the users of MPH had an AUDIT score ≥ 8; 33.3% (p = 0.029) of non-medical users of MPH had an AUDIT score ≥ 8. Conclusions: In this study, the use of MPH without medical indication was prevalent. Our findings also confirmed the association between non-medical use of MPH and potentially hazardous alcohol use (AU)

Objetivos: Avaliar a prevalência do uso do metilfenidato entre estudantes do 5º e do 6º ano de uma faculdade de medicina, discriminar o uso com ou sem indicação médica e correlacionar o uso de metilfenidato com a ingestão de álcool. Métodos: Este é um estudo transversal, em que os alunos de medicina foram convidados a responder um questionário para avaliação do status socioeconômico e acadêmico, padrões do uso do metilfenidato e atitude em relação a drogas potencializadoras da cognição. Também foi aplicado o questionário The Alcohol Use Disorder Identification Test (AUDIT), que avalia o consumo de bebidas alcoólicas, onde um score ≥ 8 significa ingestão potencialmente perigosa de álcool. Resultados: Cinquenta e dois participantes (34,2%) já haviam usado metilfenidato, sendo que 35 destes (23,02%) haviam usado a substância sem indicação médica. O número de estudantes do 6º ano que fizeram uso não médico de metilfenidato foi mais de duas vezes maior do que o número de estudantes do 5º ano (32,89 versus 13,15%, respectivamente; p = 0,004). Em relação ao AUDIT, 43,6% (p = 0,031) dos usuários de metilfenidato tiveram escores ≥ 8; 33,3% (p = 0,029) dos usuários não médicos de metilfenidato tiveram escores ≥ 8 no AUDIT. Conclusões: Neste estudo, o uso de metilfenidato sem indicação médica foi prevalente. Os achados também evidenciaram a associação entre o uso não médico de metilfenidato e o uso potencialmente perigoso de álcool (AU)

Patterns of non-medical use of methylphenidate among 5th and 6th year students in a medical school in southern Brazil.

OBJECTIVES: To evaluate the prevalence of methylphenidate (MPH) use among 5th and 6th year medical students, to discriminate MPH use with and without medical indication, and to correlate MPH use with alcohol intake. METHODS: This is a cross-sectional study in which medical students were invited to answer a questionnaire to evaluate academic and socioeconomic status, MPH use patterns, and attitudes towards neuroenhancing drugs. The Alcohol Use Disorders Identification Test (AUDIT) was used to assess alcohol intake; a score ≥ 8 suggests potentially hazardous alcohol use. RESULTS: Fifty-two participants (34.2%) had already used MPH, of which 35 (23.02%) had used it without medical indication. The number of 6th year students who had used MPH was more than twice higher than that of their 5th year counterparts (32.89 vs. 13.15%, respectively; p = 0.004). Also, 43.6% (p = 0.031) of the users of MPH had an AUDIT score ≥ 8; 33.3% (p = 0.029) of non-medical users of MPH had an AUDIT score ≥ 8. CONCLUSIONS: In this study, the use of MPH without medical indication was prevalent. Our findings also confirmed the association between non-medical use of MPH and potentially hazardous alcohol use.

Tratamento farmacológico do paciente portador de síndrome de dependência alcoólica / Pharmacological treatment of patients with alcohol dependency syndrome

Os autores fazem uma revisão bibliográfica sobre o tratamento medicamentoso nos pacientes portadores da síndrome de dependência alcoólica.

Cocaína: lendas, história e abuso / Cocaine: myths, history and abuse

A civilizaçäo ocidental tem estado envolvida com múltiplos problemas sociais, sendo o abuso de drogas um deles. A cocaína e os transtornos decorrentes de seu abuso tornaram-se um problema de saúde pública. O presente trabalho tem como objetivo colaborar pelo aprofundamento da investigaçäo histórica desse tema. Há mais de 4500 anos, as folhas de coca säo usadas por índios da América do Sul. Com a industrializaçäo no século XIX, a cocaína chegou aos países desenvolvidos da época. Na medicina, essa substância também se mostrou presente, sendo usada, tanto por Freud quanto por outros médicos, na tentativa de curar inúmeras enfermidades. No entanto, a maior disponibilidade e a queda dos preços nos últimos 3 anos possibilitaram que essa droga fosse usada abusivamente por um número crescente de pessoas, trazendo consequências assustadoras para a saúde do indivíduo e para a sociedade como um todo

Aspectos psicológicos da AIDS / Psychologic aspects of AIDS

Os autores descrevem sus experiências com pacientes aidéticos num serviço de consultoria psiquiátrica de um hospital geral. Selecionam os achados mais relevantes pertencentes a dois grupos de risco para a doença: homossexuais e bissesuais. Säo descritas as sete maiores reaçöes psicoclógicas (sentimento de impacto, desastre, desconexäo com a realidade, ansiedade e depressäo, alternada com raiva e negaçäo). Os autores enfatizam a necessidade de um manejo adequado desses pacientes, no sentido de evitar conseqüências naturais de comportamentos acionados por sentimento de raiva e negaçäo, manifestados por hipersexualidade e descuido na exposiçäo sexual do parceiro

Aspectos psicologicos da AIDS

Os autores descrevem suas experiencias com pacientes aideticos num servico de consultoria psiquiatrica de um hospital geral. Selecionam os achados mais relevantes pertencentes a dois grupos de risco para a doenca: homossexuais e bissexuais. Sao descritas as sete maiores reacoes psicologicas (sentimento de impacto, desastre, desconexao com a realidade, ansiedade e depressao, alternada com raiva e negacao). Os autores enfatizam a necessidade de um manejo adequado desses pacientes, no sentido de evitar consequencias naturais de comportamentos acionados por sentimentos de raiva e negacao, manifestados por hipersexualidade e descuido na exposicao sexual do parceiro.