Examining predictors of cocaine withdrawal syndrome at the end of detoxification treatment in women with cocaine use disorder.

BACKGROUND: Detoxification is frequently recommended as a treatment for moderate to severe Cocaine Use Disorder (CUD). However, the response to detoxification varies among patients, and previous studies have focused mostly on patterns of drug use behavior to test associations with treatment outcomes, overlooking the potential impact of psychosocial factors, other clinical variables, and individual life experiences. In this study we comprehensively examined several variables aiming to find the most relevant predictors to classify patients with severe versus non-severe cocaine withdrawal symptoms at the end of detoxification. METHODS: Data from 284 women with CUD who enrolled in a 3-week detoxification program was used in this longitudinal study. Psychosocial, clinical, and drug use behavior characteristics were evaluated, generating a dataset with 256 potential predictors. We tested six different machine learning classification algorithms. RESULTS: The best classification algorithm achieved an average accuracy and ROC-AUC of approximately 70%. The 16 features selected as best predictors were the severity of psychiatric, family, and social problems and the level of exposure to childhood maltreatment. Features associated with drug-use behavior included days consuming drugs and having craving symptoms in the last month before treatment, number of previous drug/alcohol-related treatments, and a composite score of addiction severity. The level of cocaine withdrawal syndrome at the beginning of detoxification was also a key feature for classification. A network analysis revealed the pattern of association between predictors. CONCLUSION: These variables can be assessed in real-world clinical settings, potentially helping clinicians to identify individuals with severe cocaine withdrawal that is likely to be sustained over the course of detoxification.

A systematic mini-review of epigenetic mechanisms associated with electroconvulsive therapy in humans.

Introduction: Electroconvulsive therapy (ECT) is one of the most effective strategies for treating resistant major depression. Although the mechanism of action is not fully understood and studies are limited, epigenetics is a promising area for the development of biomarkers associated with ECT treatment response. Aim: We reviewed studies available in the literature that explored the epigenetics of ECT in peripheral samples from patients with major depressive disorder (MDD). Methods: A systematic review was performed following The PRISMA guidelines. The search was performed in seven electronic databases: Scopus, Web of Science, Medline, PsycINFO, Embase, Cochrane, and Cinahl. Results: Nine studies were included. Seven assessed DNA methylation and three investigated microRNAs (miR). Overall, most studies were exploratory, with small sample sizes, and we found high heterogeneity between the study's design, ECT protocols, molecular biology methods, and epigenetic findings. Investigated candidates with some evidence of association with ECT treatment response were BDNF, S100A10, RNF213M, TNKS, FKBP5, miR-126, miR-106a, and miR-24. Conclusion: The present findings seem to support previous preclinical research, suggesting that epigenetic mechanisms play an important role in the molecular mechanism underlying ECT effects.

Brazilian Psychiatric Association Consensus for the Management of Acute Intoxication. General management and specific interventions for drugs of abuse.

OBJECTIVE: To present the Brazilian Psychiatric Association's Consensus for the Management of Acute Intoxication. METHODS: A group of experts selected by the Brazilian Psychiatric Association searched for articles in the MEDLINE (by PubMed) and Cochrane Database, limited to human studies and acute intoxication. Groups reviewed these materials for appropriateness to the topic and the quality of the work. To perform a table of agreed recommendations at the end of the systematic review, a survey using the Delphi method was conducted. Three survey rounds were conducted to develop a consensus. RESULTS: Support for intoxication may start with Initial Management: Resuscitation/Life Support/Differential Diagnosis. For that, the group proposed these orders of assessment: A (airway), B (breathing), C (circulation), D.1. (disability), D.2. (differential diagnosis), D.3. (decontamination), D.4. (drug antidotes), E (enhanced elimination). Then, the group of experts presented specific interventions for the main drugs of abuse. CONCLUSIONS: The approach to intoxication with drugs of abuse is complex and requires systematic protocols. The group of experts suggested the adoption of the classic use in welcoming the patient of the A-B-C-D-E technique with constant investigation of this patient until reaching a specific conduct and with the support to remit the picture. The group of experts believes that this document, at this time, can help psychiatric, general, and emergency doctors deal with psychiatric emergency episodes due to acute intoxication.

The Perceptions of Women About Their High Experience of Using Crack Cocaine.

Introduction: The aim of this study was to explore the perceptions of women about their experience in using crack cocaine, discussing their motivations for using it and the repercussions in their lives. Objective: To investigate these experiences, a qualitative exploratory study was conducted, using the inductive thematic analyses of the content. Methods: Eight female crack cocaine users took part in this study. They were assessed by a semi-structured interview, addressing the crack cocaine use experience. Four main themes emerged in the interviews: (1) crack cocaine "high" experience; (2) symptoms related to crack cocaine use; (3) circumstances of crack cocaine use; and (4) crack cocaine use consequences. Results: The main perceptions reported by the users were related to a feeling of being disconnected to the world preceded by a pleasant experience, especially during the first moments of use. They revealed that the drug fulfills a key role of coping strategy to handle with negative thoughts, emotions or life experiences. An important influence of social issues was reported in relation to the onset of crack cocaine use. Negative consequences and significant impact on their lives appeared in their reports, regarding the loss of family ties, involvement with prostitution, traumatic experiences and violence. Conclusion: Taking together all women's perceptions suggests that beyond the positive immediate rewarding effect, the maintenance of use might be related to the dissociative experience and self-medication role, acting as negative reward by relieving of negative life experiences that, in turn, are both cause and consequence of the drug use.

Association Between Recent Cannabis Consumption and Withdrawal-Related Symptoms During Early Abstinence Among Females With Smoked Cocaine Use Disorder.

BACKGROUND: The effects of cannabis on clinical outcomes of treatment services for other drug use disorders remains unclear. The primary aim of the current study was to investigate the effects of recent cannabis consumption on the severity of cocaine withdrawal and depressive symptoms during a 3-week inpatient treatment program for women with cocaine use disorder. The second goal of this study was to test the effect of recent alcohol or tobacco use on the aforementioned outcomes. METHODS: This was a longitudinal study with 2 assessment time points: at enrollment and upon discharge from a medically managed intensive inpatient unit. The sample was composed of 214 early abstinence females with cocaine use disorder. Cocaine withdrawal and depressive symptoms were measured using the Cocaine Selective Severity Assessment (CSSA) and the Beck Depressive Inventory (BDI-II). Recent substance use was evaluated using the Addiction Severity Index (ASI-6). RESULTS: Patients with cocaine use disorder and with frequent recent cannabis use reported higher severity of cocaine withdrawal and depressive symptoms after 3 weeks of inpatient treatment. Neither recent alcohol nor tobacco use was associated with increased CSSA or BDI outcomes, suggesting these substances play a minor role compared to recent cannabis use in affecting withdrawal-related symptoms. CONCLUSIONS: The assessment of recent cannabis use may help identify patients in need of additional treatment to manage severe cocaine withdrawal symptoms and depressive symptoms during early abstinence.

Primeiros socorros psicológicos: relato de intervenção em crise em Santa Maria / Psychological first aid: report of crisis intervention in Santa Maria

No Brasil, a psicologia das emergências e desastres é concebida como uma área de estudo e intervenção em fenômenos que envolvem situações de catástrofe. Nesse contexto, as intervenções em crise objetivam aumentar o percentual de sujeitos que se recuperam da tragédia e acelerar esse processo de reconstrução. Os Primeiros Socorros Psicológicos (PSP) são protocolos de intervenção que visam padronizar o atendimento às vítimas com base em evidências sobre reações agudas ao estresse. No presente artigo, é relatada a experiência de aplicação do referido protocolo em vítimas do incêndio da boate Kiss em Santa Maria. Ressalta-se que a intervenção possibilitou o acolhimento emocional dos sujeitos de forma empática e não invasiva, o desenvolvimento de estratégias de enfrentamento (coping) adaptativas de forma conjunta e a busca de apoio social. Aponta-se para a necessidade de aprimoramento técnico e profissional para futuras intervenções em crise no contexto brasileiro.(AU)

In Brazil, the Psychology of Emergencies and Disasters is conceived as a field of study and performance in phenomena involving disaster. In this context, crisis interventions aimed at increasing the percentage of subjects who recover from this tragedy and accelerate the reconstruction process. Psychological First Aid (PFA) intervention protocols are aiming to standardize the care victims based on evidence of acute reactions to stress. This article aims to report the experience of implementing this protocol in victims of the Kiss nightclub fire in Santa Maria. It is noteworthy that the intervention enabled the host of emotional subjects empathetically and noninvasive, developing coping strategies (coping) adaptive jointly and search for social support. It points to the need for technical improvement and professional crisis for future interventions in the Brazilian context.(AU)

Desafios e tecnologia na psicoterapia cognitiva do TDAH na infância: seguimento de um ano de caso de gêmeos monozigóticos / Challenges and technology in the cognitive psychotherapy of childhood ADHD: one-year follow-up of monozygotic twins

A escolha do caso deve-se a quatro principais motivos: (1) a alta complexidade do caso dificulta o diagnóstico, a abordagem psicofarmacológica e psicoterempica; (2) as dificuldades logísticas comuns aos profissionais e pacientes do Sistema Unico de Saúde (SUS), como dificuldades econômicas e assistenciais, que dificultam o tratamento; (3) a importância da combinação tecnológica de diferentes modelos de terapias cognitivas na abordagem do TDAH, fundamental para alguns casos; (4) e a importância da viabilização proporcionada pelo Programa de Residência quando permite a busca por auxílio externo, em termos de supervisão, o que potencializa a capacitação do residente.

Estudo piloto sobre o uso de preservativo feminino em mulheres que buscam atendimento em um centro de triagem para HIV/Aids em Porto Alegre / Pilot study on the use of the female condom by women who seek help at a public center for HIV/Aids in Porto Alegre, Brazil

Introdução: Foi realizado um experimento não-comparado consecutivo com 50 mulheres que buscavam atendimento para realizar testagem sorológica para o HIV em um centro de referência de Porto Alegre, visando a conhecer as impressões iniciais sobre o uso do preservativo feminino como método de prevenção para a Aids. Métodos: Em uma reunião inicial, em grupos de cinco a oito mulheres, voluntárias assistiam a um vídeo sobre o preservativo feminino, que descreveu sua colocação, suas funções e o aproveitamento de sua sensibilidade, associado à manipulação ao vivo do preservativo utilizando uma prótese pélvica. Posteriormente, as voluntárias preenchiam um questionário padronizado sobre situações de risco e recebiam seis preservativos para utilizarem no período de quinze dias, quando deveriam retornar para responder a outro questionário sobre a experiência. Resultados: O questionário do retorno foi preenchido por 39 mulheres (78 por cento), sendo que 92,4 por cento usaram o preservativo; destas, 92,3 por cento consideraram a experiência satisfatória, tendo salientado a segurança, o conforto, a maior sensibilidade e a opção de o uso do preservativo ser da mulher. Os companheiros ficaram satisfeitos com o uso em 51,3 por cento das ocasiões. As maiores dificuldades referiram-se à colocação, pouco à vontade com o uso. Conclusão: Os achados preliminares sugerem que este método é útil para as mulheres estudadas, necessitando, entretanto, de uma adaptação cultural para sua utilização com benefício máximo, bem como a inclusão de elementos qualitativos na coleta de dados sobre práticas sexuais específicas

Limites e alternativas para a implementaçäo de um programa para dependentes químicos em risco para infecçäo pelo HIV utilizando o conceito de Rede Social / Limits and alternatives to the implementation of a program for intravenous drug users at risk of HIV infection using the social Network Approach

Descrevem as etapas de execuçäo de um programa de açöes preventivas para usuários de drogas sob o risco de infecçäo pelo vírus da imunodeficiência humana (HIV), utilizando como paradigma de intervençäo um modelo de abordagem de redes sociais. Säo descritos os passos de instalaçäo do projeto dentro de um grande hospital universitário do sul do Brasil, com ênfase nos métodos e técnicas originais desenvolvidos pela equipe de atendimento. As dificuldades de implementaçäo do projeto säo discutidas ao longo das seçöes, buscando identificar os motivos pelos quais o programa obteve êxito apenas parcial. Destacam-se alguns pontos críticos, tais como a utilizaçäo de uma técnica ainda näo difundida em nosso meio, a dificuldade de reter em tratamento usuários de drogas injetáveis, a falta de estrutura para atendimentos imediatos, e as dificuldades em motivar equipes e pacientes para o tratamento. Ao final do texto, säo feitas sugestöes com o objetivo de facilitar o desenvolvimento de novos projetos que busquem utilizar o mesmo modelo conceitual.

Terapia cognitiva no tratamento da fobia social / Cognitive therapy in the treatment of social phobia

A terapia cognitiva de Beck é utilizada para o tratamento de diversos transtornos psiquiátricos. Neste caso os autores utilizaram esta técnica focada na fobia social em uma paciente atendida no Ambulatório do Hospital Materno-Infantil Presidente Vargas, onde a clientela é oriunda da comunidade. A técnica mostrou-se viável, com bom resultado, sendo importante por ser de baixo custo, breve, possibilitando atendimento a maior número de pacientes, além de ser um treinamento em um serviço de Residência em Psiquiatria (AU)

Terapia cognitiva no tratamento da fobia social / Cognitive therapy in the treatment of social phobia

A terapia cognitiva de Beck é utilizada para o tratamento de diversos transtornos psiquiátricos. Neste caso os autores utilizaram esta técnica focada na fobia social em uma paciente atendida no Ambulatório do Hospital Materno-Infantil Presidente Vargas, onde a clientela é oriunda da comunidade. A técnica mostrou-se viável, com bom resultado, sendo importante por ser de baixo custo, breve, possibilitando atendimento a maior número de pacientes, além de ser um treinamento em um serviço de Residência em Psiquiatria

Transtorno por déficit de atençäo com hiperatividade e abuso de drogas na adolescência / Attention-deficit Hyperactivity Disorder and drug abuse in adolescence

Os autores discutem a importância clínica da persistencia do Transtorno por Déficit de Atençäo com Hiperatividade (TDAH) na adolescência e vida adulta e sua correlaçäo com o abuso de substancias psicoativas (SPA). A tendência a consolidaçäo do diagnóstico na nosografia internacional e ressaltada, bem como a abordagem terapêutica, na qual especial ênfase é dada ao uso de metilfenidato como farmaco de primeira escolha. O diagnóstico e o tratamento säo ilustrados com a apresentaço de casos clínicos