RESUMO
OBJECTIVE: An early description, possibly the earliest, of attention deficit disorder in a 1753 Dutch medical book by Cornelius Kloekhof is presented. METHOD: The author of this text is briefly introduced and contextualized. The text is translated from Latin and afterwards, its impact on later scientific literature is discussed. RESULTS AND CONCLUSIONS: Kloekhofs description of attention deficit was one of the first and thoroughly inspired the subsequent literature, such as Adam Weikard, making this text an important moment in the rich history of ADHD.
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Transtorno do Deficit de Atenção com Hiperatividade , Humanos , Países Baixos , Transtorno do Deficit de Atenção com Hiperatividade/história , História do Século XVIIIRESUMO
BACKGROUND: Substance use disorders (SUD) pose significant challenges for healthcare systems, and there is a need to monitor the provision of effective, individualized care to persons accessing treatment. Patient-Reported Outcome Measures (PROMs) and Patient-Reported Experience Measures (PREMs) are increasingly used in healthcare services to measure treatment outcomes and quality of care as perceived by patients, and to guide service improvement. OBJECTIVES: This review aims to identify and characterize international developments regarding the use and systematic implementation of PROMs and PREMs in SUD treatment services. METHODS: A scoping review was conducted searching multiple databases to identify studies on the use and routine implementation of PROMs and PREMs in SUD treatment services. RESULTS: 23 articles were selected, all dating from 2016 onwards. There was large variation in the patient-reported measures that were used, how they were developed and how and when patient-reported data were collected. Treatment providers identified leadership support, the presence of an integrated electronic patient record, and regular feedback to be the most important facilitators of successful implementation of patient-reported measures into clinical practice, whilst treatment dropout and burden to staff and patients were the most important barriers to consider. CONCLUSIONS: PROMs and PREMs are increasingly used in SUD treatment services, but guidance is needed to support researchers and clinicians in selecting and implementing valid, meaningful, and comparable measures if we want to understand the effects of PROM and PREM data collection and feedback on treatment quality and results.
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Transtornos Relacionados ao Uso de Substâncias , Humanos , Resultado do Tratamento , Coleta de Dados , Transtornos Relacionados ao Uso de Substâncias/terapia , Medidas de Resultados Relatados pelo PacienteRESUMO
Baclofen may reduce the symptoms of alcohol withdrawal, as an alternative or as an adjuvant for benzodiazepines, but the available data are insufficient to support baclofen-assisted alcohol withdrawal. This study investigated the need for diazepam during acute alcohol withdrawal in patients receiving baclofen. In a single-blind, dose-dependent randomized controlled trial with three study arms, 63 patients with alcohol use disorder, starting in-patient benzodiazepine-assisted alcohol detoxification, were randomly assigned to receive placebo (n = 18), baclofen 30 mg/day (N = 20), or baclofen 60 mg/day (N = 25) for 7 days. Diazepam was provided as needed based on the withdrawal symptoms stated by Clinical Institute Withdrawal Assessment for Alcohol-revised. The primary outcome measure was the number of patients in need of diazepam during alcohol detoxification. Secondary outcome measure included the between-group difference in the amount of diazepam needed during alcohol detoxification. Using baclofen 60 mg/day, 32% of patients needed additional diazepam compared to 35% on baclofen 30 mg/day and compared to 72% on placebo (P = .013). The median total amount of diazepam needed was significantly lower in patients receiving baclofen 60 mg/day (0 ± 10 mg diazepam) and baclofen 30 mg/day (0 ± 10 mg diazepam) compared to placebo (10 ± 43 mg diazepam; P = .017). Adverse events were comparable between patients on baclofen and placebo. Baclofen can reduce the withdrawal symptoms during alcohol detoxification. Baclofen was well tolerated and may be considered for the management of alcohol withdrawal syndrome, especially useful in situations where benzodiazepines should be withheld, such as patients with liver impairment.
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Alcoolismo , Síndrome de Abstinência a Substâncias , Humanos , Alcoolismo/tratamento farmacológico , Diazepam/uso terapêutico , Diazepam/efeitos adversos , Baclofeno/efeitos adversos , Síndrome de Abstinência a Substâncias/tratamento farmacológico , Método Simples-Cego , Benzodiazepinas/uso terapêutico , Método Duplo-CegoRESUMO
OBJECTIVE: An exponential implementation of remote mental health care has been observed, but little data is available on experiences and barriers of remote health from a patient's perspective. This study investigated experiences associated with several forms of remote consultations (both telephone and online video) for mental health care during the COVID-19 coronavirus pandemic with a particular focus on patients' experiences. METHODS: This study includes results of an online web-based survey filled in by 512 patients on the use and experiences of remote mental health consultations and circulating between March and October 2021. RESULTS: Psychiatric consultations were initiated by the health care provider in 47.0% of cases, while psychological consultations were most often initiated in shared decision with the patient (54.9%). Only 28.8% of participants mentioned advantages regarding teleconsultations over face-to-face, compared to 39.3% for online video consultations. Moreover, 49.3% saw clear disadvantages for teleconsultations and 32.7% for video consultations. Positive factors associated with remote mental health care included when faced with transportation problems, followed by consultations primarily focusing on medication (for telephone consultations) or on more practical aspects (for video consultations). 25.0% of patients deemed conversations when being angry or sad to be feasible by telephone, and 33.0% considered these feasibly using video consultations. CONCLUSION: Remote consultations were deemed feasible, but the positive factors did not seem to outweigh the face-to-face contacts from a patient's perspective. Remote consultations will probably remain present in the following decades, although care must be taken when providing the possibility of remote mental health care.
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COVID-19 , Consulta Remota , Humanos , Consulta Remota/métodos , Saúde Mental , Pacientes , Avaliação de Resultados da Assistência ao PacienteRESUMO
OBJECTIVE: This study aims to assess the validity of the ADHD module of the Mini-International Neuropsychiatric Interview (MINI-Plus) in patients with substance use disorders (SUD), using the Conners' Adult ADHD Diagnostic Interview for DSM-IV (CAADID) as the external criterion. METHOD: A cross sectional international multi-center study in 10 countries was conducted in treatment seeking SUD patients. A sample of 1263 patients with both MINI-Plus and CAADID was analyzed to determine the psychometric properties of the MINI-Plus. RESULTS: According to the CAADID, 179 patients (14.2%) met criteria for adult ADHD, whereas according to the MINI-Plus 227 patients (18.0%) were identified as having adult ADHD. Sensitivity of the MINI-Plus ADHD module was 74%, specificity was 91%, positive predictive value was 60% and negative predictive value was 96%. Kappa was 0.60. CONCLUSION: The MINI-Plus has acceptable criterion validity for the screening of adult ADHD in treatment seeking SUD patients. SCIENTIFIC SIGNIFICANCE: On the basis of the results, The MINI-Plus may be used for the screening of ADHD in SUD patients.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Transtornos Relacionados ao Uso de Substâncias , Humanos , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Estudos Transversais , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Escalas de Graduação Psiquiátrica , Manual Diagnóstico e Estatístico de Transtornos MentaisRESUMO
An increase of psychopathology such as post-traumatic stress disorder (PTSD) is described in patients affected with COVID-19 that stayed at an intensive care unit (ICU). However, data on follow-up and on impact of contextual factors are limited. In a single-center, observational study, PTSD symptomatology was prevalent among 38% of participants (n=8), persisting in clinical PTSD in 2 participants after one year. In patients with initial PTSD symptoms, scores on depression, anxiety and insomnia scales were significantly higher. A higher mental burden due to avoidance of contact and a reduced quality of life was also retained in patients with PTSD symptoms.
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COVID-19 , Transtornos de Estresse Pós-Traumáticos , Humanos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/terapia , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Qualidade de Vida , Cuidados Críticos , Ansiedade/epidemiologia , Unidades de Terapia Intensiva , DepressãoRESUMO
INTRODUCTION: Excessive use of alcohol increases the risk to be involved in a road traffic accident. According to many legislations, certain maximal blood-alcohol-concentrations (BAC) have to be respected to be allowed to drive on public roads. Acute alcohol intoxication is evaluated by blood analysis or analysis of the exhaled alveolar air. In many cases, evaluation of the alcohol consumption during the past months can be useful. In this light, ethyl glucuronide (EtG), a direct alcohol biomarker which can be found in keratinized matrices (hair, nails) is valuable and can be used for the long-term follow-up of alcohol consumption. RESEARCH AIM: To compare the EtG concentration in hair and fingernails from teetotalers, and to propose a cut-off value for EtG in fingernails for alcohol abstinence. MATERIAL AND METHODS: Paired samples of hair and nails were collected from participants, with a minimum age of 18 years. They all stated alcohol abstinence for at least 6 months. Participants were asked to complete a questionnaire about age, gender and the use of hair care products and nail polish. Analysis of EtG in the nail and hair samples were conducted following a validated analytical method. RESULTS: From 126 participants a hair and nail sample were collected. Of this group, 15 participants were finally not included in the study because of insufficient amount of hair or nails collected. There were more female participants (65%) and the average age of participants was 39 years. The EtG concentration in hair was below the limit of detection of 2.1 pg/mg in all but 4 samples (2.1, 2.1, 2.9, and 3.5 pg/mg). The EtG concentration in nails was below the limit of detection in 97 of the 111 samples. The concentrations in nails ranged between 2.3 and 23 pg/mg. DISCUSSION AND CONCLUSION: In a population of 111 teetotalers, the 97.5% percentile of EtG concentrations in fingernails is 7.6 pg/mg. The highest EtG concentration observed was 23 pg/mg. These results suggest that the cut-off value for alcohol abstinence may be lower than the previous suggested 59 pg/mg and 37 pg/mg.
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Abstinência de Álcool , Alcoolismo , Adolescente , Adulto , Consumo de Bebidas Alcoólicas , Alcoolismo/diagnóstico , Biomarcadores/análise , Correlação de Dados , Etanol , Feminino , Glucuronatos/análise , Cabelo/química , Humanos , Unhas/química , Detecção do Abuso de Substâncias/métodosRESUMO
Recent advances in social neuroscience have highlighted the critical role of the cerebellum in social cognition, and especially the posterior cerebellum. Studies have supported the view that the posterior cerebellum builds internal action models of our social interactions to predict how other people's actions will be executed and what our most likely responses are to these actions. This mechanism allows to better anticipate action sequences during social interactions in an automatic and intuitive way and to fine-tune these anticipations, making it easier to understand other's social behaviors and mental states (e.g., beliefs, intentions, traits). In this paper, we argue that the central role of the posterior cerebellum in identifying and automatizing social action sequencing provides a fruitful starting point for investigating social dysfunctions in a variety of clinical pathologies, such as autism, obsessive-compulsive and bipolar disorder, depression, and addiction. Our key hypothesis is that dysfunctions of the posterior cerebellum lead to under- or overuse of inflexible social routines and lack of plasticity for learning new, more adaptive, social automatisms. We briefly review past research supporting this view and propose a program of research to test our hypothesis. This approach might alleviate a variety of mental problems of individuals who suffer from inflexible automatizations that stand in the way of adjustable and intuitive social behavior, by increasing posterior cerebellar plasticity using noninvasive neurostimulation or neuro-guided training programs.
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Cerebelo , Comportamento Social , Humanos , Cerebelo/fisiologiaRESUMO
BACKGROUND: GHB (gamma-hydroxybutyric acid; sodium oxybate) is a general anaesthetic that is clinically used for the treatment of narcolepsy, cataplexy, alcohol withdrawal and alcohol relapse prevention. In addition, GHB is recreationally used. Most clinical and recreational users regard GHB as an innocent drug devoid of adverse effects, despite its high dependence potential and possible neurotoxic effects. At high doses, GHB may lead to a comatose state. This paper systematically reviews possible cognitive impairments due to clinical and recreational GHB use. METHODS: PubMed and PsychINFO were searched for literature data about the acute and residual cognitive deficits following GHB use. This review is conducted using the PRISMA protocol. RESULTS: A total of 43 reports covering human and animal data on GHB-induced cognitive impairments were eligible and reviewed. This systematic review found no indication for cognitive impairments after clinical GHB use. However, it supports the view that moderate GHB use may result in acute short-term cognitive impairments, whereas regular high-dose GHB use and/or multiple GHB-induced comas are probably neurotoxic resulting in long-term residual cognitive impairments. CONCLUSION: These results emphasize the need for awareness among clinicians and recreational users to minimize negative health consequences of recreational GHB use, particularly when high doses are used and GHB-induced comas occur.
Assuntos
Alcoolismo , Disfunção Cognitiva , Drogas Ilícitas , Síndromes Neurotóxicas , Oxibato de Sódio , Síndrome de Abstinência a Substâncias , Alcoolismo/tratamento farmacológico , Animais , Disfunção Cognitiva/induzido quimicamente , Disfunção Cognitiva/tratamento farmacológico , Coma/induzido quimicamente , Coma/tratamento farmacológico , Humanos , Hidroxibutiratos , Drogas Ilícitas/efeitos adversos , Oxibato de Sódio/efeitos adversos , Síndrome de Abstinência a Substâncias/tratamento farmacológicoRESUMO
International Consensus Statement for the Screening, Diagnosis, and Treatment of Adolescents with Concurrent Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder Abstract. Background: Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for substance misuse and substance use disorder (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment and is associated with poor treatment outcomes. Research on the effect of treatment of childhood ADHD on the prevention of adolescent SUD is inconclusive, and studies on the diagnosis and treatment of adolescents with ADHD and SUD are scarce. Thus, the available evidence is generally not sufficient to justify robust treatment recommendations. Objective: The aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience. Method: A modified Delphi study to reach consensus based upon the combination of scientific data and clinical experience with a multidisciplinary group of 55 experts from 17 countries. The experts were asked to rate a set of statements on the effect of treatment of childhood ADHD on adolescent SUD and on the screening, diagnosis, and treatment of adolescents with comorbid ADHD and SUD. Results: After 3 iterative rounds of rating and adapting 37 statements, consensus was reached on 36 of these statements representing 6 domains: general (n = 4), risk of developing SUD (n = 3), screening and diagnosis (n = 7), psychosocial treatment (n = 5), pharmacological treatment (n = 11), and complementary treatments (n = 7). Routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings. Long-acting stimulants are recommended as the first-line treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should preferably be embedded in psychosocial treatment. The only remaining no-consensus statement concerned the requirement of abstinence before starting pharmacological treatment in adolescents with ADHD and concurrent SUD. In contrast to the majority, some experts required full abstinence before starting any pharmacological treatment, some were against the use of stimulants in the treatment of these patients (independent of abstinence), while some were against the alternative use of bupropion. Conclusion: This international consensus statement can be used by clinicians and patients together in a shared decision-making process to select the best interventions and to reach optimal outcomes in adolescent patients with concurrent ADHD and SUD.
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Transtorno do Deficit de Atenção com Hiperatividade , Estimulantes do Sistema Nervoso Central , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Adulto , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Estimulantes do Sistema Nervoso Central/uso terapêutico , Criança , Comorbidade , Humanos , Programas de Rastreamento , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/terapiaRESUMO
BACKGROUND: Misconceptions about ADHD stigmatize affected people, reduce credibility of providers, and prevent/delay treatment. To challenge misconceptions, we curated findings with strong evidence base. METHODS: We reviewed studies with more than 2000 participants or meta-analyses from five or more studies or 2000 or more participants. We excluded meta-analyses that did not assess publication bias, except for meta-analyses of prevalence. For network meta-analyses we required comparison adjusted funnel plots. We excluded treatment studies with waiting-list or treatment as usual controls. From this literature, we extracted evidence-based assertions about the disorder. RESULTS: We generated 208 empirically supported statements about ADHD. The status of the included statements as empirically supported is approved by 80 authors from 27 countries and 6 continents. The contents of the manuscript are endorsed by 366 people who have read this document and agree with its contents. CONCLUSIONS: Many findings in ADHD are supported by meta-analysis. These allow for firm statements about the nature, course, outcome causes, and treatments for disorders that are useful for reducing misconceptions and stigma.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Humanos , Metanálise em Rede , Viés de PublicaçãoRESUMO
BACKGROUND AND AIMS: Alcohol-related liver disease is the most frequent cause of cirrhosis and a major indication for liver transplantation. Several alcohol use biomarkers have been developed in recent years and are already in use in several centers. However, in patients with liver disease their diagnostic performance might be influenced by altered biomarker formation by hepatic damage, altered excretion by kidney dysfunction and diuretics use, and altered deposition in hair and nails. We systematically reviewed studies on the diagnostic accuracy of biomarkers of alcohol use in patients with liver disease and performed a detailed study quality assessment. METHODS: A structured search in PubMed/Medline/Embase databases was performed for relevant studies, published until April 28, 2019. The risk of bias and applicability concerns was assessed according to the adapted quality assessment of diagnostic accuracy studies-2 (QUADAS-2) checklist. RESULTS: Twelve out of 6,449 studies met inclusion criteria. Urinary ethyl glucuronide and urinary ethyl sulfate showed high sensitivity (70 to 89 and 73 to 82%, respectively) and specificity (93 to 99 and 86 to 89%, respectively) for assessing any amount of alcohol use in the past days. Serum carbohydrate-deficient transferrin showed low sensitivity but higher specificity (40 to 79 and 57 to 99%, respectively) to detect excessive alcohol use in the past weeks. Whole blood phosphatidylethanol showed high sensitivity and specificity (73 to 100 and 90 to 96%, respectively) to detect any amount of alcohol use in the previous weeks. Scalp hair ethyl glucuronide showed high sensitivity (85 to 100%) and specificity (97 to 100%) for detecting chronic excessive alcohol use in the past 3 to 6 months. Main limitations of the current evidence are the lack of an absolute gold standard to assess alcohol use, heterogeneous study populations, and the paucity of studies. CONCLUSIONS: Urinary and scalp hair ethyl glucuronide are currently the most validated alcohol use biomarkers in patients with liver disease with good diagnostic accuracies. Phosphatidylethanol is a highly promising alcohol use biomarker, but so far less validated in liver patients. Alcohol use biomarkers can complement each other regarding diagnostic time window. More validation studies on alcohol use biomarkers in patients with liver disease are needed.
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Consumo de Bebidas Alcoólicas/sangue , Biomarcadores/sangue , Hepatopatias/sangue , Humanos , Valor Preditivo dos Testes , Fatores de TempoRESUMO
Among patients with substance use disorders (SUD), adult attention deficit hyperactivity disorder (ADHD) is one of the most frequently co-occuring disorder. Those SUD patients with comorbid ADHD show earlier onset of substance use, more severe SUD and poor treatment outcomes. Therefore, early recognition of ADHD is highly rele - vant within this patient population. The results of available screening instruments may lay the foundation of timely ADHD diagnosis. Considering the integrated treatment of patients with a dual ADHD+SUD diagnosis, the applica tion of combined pharmaco- and psychotherapy is recommended. Based on the evidence-and consensus-based suggestions, prescription of long-acting methylphenidate, extended-release amphetamines and atomoxetine with up-titration might be the best choice in the treatment of patients who are either unresponsive to standard dose or characterized by therapy resistance. The main purpose of this manuscript is to establish a standing-ground for the effective screening, diagnosis and treatment of ADHD+SUD patients.
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Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Programas de Rastreamento , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/terapia , Adulto , Atenção , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Comorbidade , Humanos , Psicoterapia , Transtornos Relacionados ao Uso de Substâncias/tratamento farmacológico , Transtornos Relacionados ao Uso de Substâncias/epidemiologiaRESUMO
BACKGROUND: The outbreak of coronavirus disease 19 (COVID-19) has led to measures of social distancing and quarantine worldwide. This stressful period may lead to psychological problems, including increases in substance use. OBJECTIVE: To investigate changes in alcohol, tobacco, and cannabis consumption before and during COVID-19 lockdown and motives for these changes in substance use. METHOD: A web-based survey was filled out by an unselected population during the social distancing measures of the COVID-19 pandemic in Belgium that assessed changes in alcohol, tobacco, and cannabis consumption in the period before and during the COVID-19 lockdown and also asked about reasons for change. RESULTS: A total of 3,632 respondents (mean age 42.1 ± 14.6 years; 70% female) filled out the survey. Overall, respondents reported consuming more alcohol (d = 0.21) and smoking more cigarettes (d = 0.13) than before the COVID-19 pandemic (both p < 0.001), while no significant changes in the consumption of cannabis were noted. The odds of consuming more alcohol during the lockdown were associated with younger age (OR = 0.981, p < 0.001), more children at home (OR = 1.220, p < 0.001), non-healthcare workers (p < 0.001), and being technically unemployed related to COVID-19 (p = 0.037). The odds of smoking more cigarettes during the lockdown were associated with younger age (OR = 0.988, p = 0.027), current living situation (p < 0.001), lower education (p = 0.015), and working situation related to COVID-19 (p = 0.018). Boredom, lack of social contacts, loss of daily structure, reward after a hard-working day, loneliness, and conviviality were the main reasons for consuming more of the various substances. CONCLUSIONS: During the lockdown, individuals consumed slightly more alcohol and smoked marginally more cigarettes compared to the period before the lockdown. Further research focussing on follow-up of individuals at risk may be useful to provide appropriate care in post-COVID times.
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Consumo de Bebidas Alcoólicas/epidemiologia , Fumar Cigarros/epidemiologia , Infecções por Coronavirus , Uso da Maconha/epidemiologia , Pandemias , Pneumonia Viral , Quarentena/psicologia , Adulto , Fatores Etários , Consumo de Bebidas Alcoólicas/psicologia , Bélgica/epidemiologia , Betacoronavirus , Tédio , COVID-19 , Fumar Cigarros/psicologia , Escolaridade , Feminino , Humanos , Solidão , Masculino , Uso da Maconha/psicologia , Pessoa de Meia-Idade , Motivação , Características de Residência , SARS-CoV-2 , Autorrelato , Fatores Sexuais , Comportamento Social , Inquéritos e Questionários , Adulto JovemRESUMO
BACKGROUND: Childhood attention-deficit/hyperactivity disorder (ADHD) is a risk factor for substance misuse and substance use disorder (SUD) in adolescence and (early) adulthood. ADHD and SUD also frequently co-occur in treatment-seeking adolescents, which complicates diagnosis and treatment and is associated with poor treatment outcomes. Research on the effect of treatment of childhood ADHD on the prevention of adolescent SUD is inconclusive, and studies on the diagnosis and treatment of adolescents with ADHD and SUD are scarce. Thus, the available evidence is generally not sufficient to justify robust treatment recommendations. OBJECTIVE: The aim of the study was to obtain a consensus statement based on a combination of scientific data and clinical experience. METHOD: A modified Delphi study to reach consensus based upon the combination of scientific data and clinical experience with a multidisciplinary group of 55 experts from 17 countries. The experts were asked to rate a set of statements on the effect of treatment of childhood ADHD on adolescent SUD and on the screening, diagnosis, and treatment of adolescents with comorbid ADHD and SUD. RESULTS: After 3 iterative rounds of rating and adapting 37 statements, consensus was reached on 36 of these statements representing 6 domains: general (n = 4), risk of developing SUD (n = 3), screening and diagnosis (n = 7), psychosocial treatment (n = 5), pharmacological treatment (n = 11), and complementary treatments (n = 7). Routine screening is recommended for ADHD in adolescent patients in substance abuse treatment and for SUD in adolescent patients with ADHD in mental healthcare settings. Long-acting stimulants are recommended as the first-line treatment of ADHD in adolescents with concurrent ADHD and SUD, and pharmacotherapy should preferably be embedded in psychosocial treatment. The only remaining no-consensus statement concerned the requirement of abstinence before starting pharmacological treatment in adolescents with ADHD and concurrent SUD. In contrast to the majority, some experts required full abstinence before starting any pharmacological treatment, some were against the use of stimulants in the treatment of these patients (independent of abstinence), while some were against the alternative use of bupropion. CONCLUSION: This international consensus statement can be used by clinicians and patients together in a shared decision-making process to select the best interventions and to reach optimal outcomes in adolescent patients with concurrent ADHD and SUD.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Consenso , Prática Clínica Baseada em Evidências , Programas de Rastreamento , Transtornos Relacionados ao Uso de Substâncias , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/tratamento farmacológico , Estimulantes do Sistema Nervoso Central/administração & dosagem , Técnica Delphi , Feminino , Saúde Global , Humanos , Masculino , Fatores de Risco , Transtornos Relacionados ao Uso de Substâncias/complicações , Transtornos Relacionados ao Uso de Substâncias/terapia , Resultado do TratamentoRESUMO
The importance of protein glycosylation in regulating lipid metabolism is becoming increasingly apparent. We set out to further investigate this by studying the effects of defective glycosylation on plasma lipids in patients with B4GALT1-CDG, caused by a mutation in B4GALT1 with defective N-linked glycosylation. We studied plasma lipids, cholesteryl ester transfer protein (CETP) glyco-isoforms with isoelectric focusing followed by a western blot and CETP activity in three known B4GALT1-CDG patients and compared them with 11 age- and gender-matched, healthy controls. B4GALT1-CDG patients have significantly lowered non-high density lipoprotein cholesterol (HDL-c) and total cholesterol to HDL-c ratio compared with controls and larger HDL particles. Plasma CETP was hypoglycosylated and less active in B4GALT1-CDG patients compared to matched controls. Our study provides insight into the role of protein glycosylation in human lipoprotein homeostasis. The hypogalactosylated, hypo-active CETP found in patients with B4GALT1-CDG indicates a role of protein galactosylation in regulating plasma HDL and LDL. Patients with B4GALT1-CDG have large HDL particles probably due to hypogalactosylated, hypo-active CETP.
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Proteínas de Transferência de Ésteres de Colesterol/metabolismo , HDL-Colesterol/metabolismo , LDL-Colesterol/metabolismo , Defeitos Congênitos da Glicosilação/genética , Galactosiltransferases/genética , Adolescente , Estudos de Casos e Controles , Criança , Pré-Escolar , Proteínas de Transferência de Ésteres de Colesterol/genética , Defeitos Congênitos da Glicosilação/metabolismo , Feminino , Glicosilação , Homozigoto , Humanos , Lactente , Masculino , MutaçãoRESUMO
Ruptured anterior communicating artery aneurysms are commonly associated with deficits in memory and executive functions. However, little studies are available on the effect of surgical clipping (SC) and endovascular coiling (EC) on cognitive functioning. This study evaluates cognitive functioning in 35 patients with subarachnoid hemorrhage after ruptured anterior communicating artery aneurysm (ACoA) compared to 20 healthy controls (HC) and assesses the effect of SC (n = 19) compared to EC (n = 16) on cognitive performances. All participants were investigated with an extensive neuropsychological test battery assessing attention, memory and visuospatial and executive functions. The strength of this study is an in-depth investigation of several cognitive domains together and several memory functions together within the auditory-verbal and visuospatial memory domain for unrelated and related information. The ACoA group was significantly more deficient in attention, auditory-verbal and visuospatial memory and executive functions compared to HCs. No significant differences were found between both groups concerning visuospatial functions. Within the patient group, the SC group, as compared to the EC group, showed a significantly worse performance for auditory-verbal and visuospatial memory. No significant differences could be detected between both groups with regard to attention and visuospatial and executive functions. In conclusion, this study provides evidence for the advantage of EC in ACoA patients over SC in terms of cognitive outcome.
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Aneurisma Roto/terapia , Disfunção Cognitiva/terapia , Embolização Terapêutica , Procedimentos Endovasculares , Aneurisma Intracraniano/terapia , Procedimentos Neurocirúrgicos , Avaliação de Resultados em Cuidados de Saúde , Hemorragia Subaracnóidea/terapia , Adulto , Idoso , Aneurisma Roto/complicações , Disfunção Cognitiva/etiologia , Feminino , Humanos , Aneurisma Intracraniano/complicações , Masculino , Pessoa de Meia-Idade , Hemorragia Subaracnóidea/complicaçõesRESUMO
BACKGROUND: A reformation of psychiatry was set up in Belgium with the establishment of mobile crisis teams. SUBJECTS AND METHODS: We performed a retrospective analysis of the patients referred to the mobile team "Pharos" in the period between December 2013 and December 2018. RESULTS: The number of patients is growing over the years and the most common referral reasons are suicidal thoughts and depressive mood. We have a high percentage of inclusions, maybe because the main referrers are GPs. Alcohol withdrawal at home is feasable and safe. CONCLUSION: Many psychiatric crisis situations can be managed at home with support of mobile teams, but further research is needed to provide evidence on outcome and cost effectiveness.