Implications of Impulsivity on Criminal Behavior in Individuals With Substance Use Disorder.

OBJECTIVE: Our aim was to analyze the association between criminal behavior and impulsivity in individuals with drug addiction and investigate whether impulsiveness mediates the relationship between drug use severity and legal problems. METHODS: This cross-sectional study included 773 men diagnosed with addiction (295 alcohol users and 478 users of crack/polysubstance) while undergoing addiction treatment. The BIS-11 and ASI-6 were applied to assess impulsivity, criminal behavior, and drug use. RESULTS: The prevalence of criminal behavior was 41.7% (n = 123) in alcohol users and 64.9% (n = 310) in users of crack/polysubstance. Earlier use of different substances and higher impulsivity scores were observed in individuals with criminal history. Mediation analyses revealed that impulsiveness acts as a mediator factor between substance use and criminal behavior, enhancing the severity of legal problems. CONCLUSION: Our findings can help in deciding on tailored treatment strategies, focusing not only on substance use, but also on the prevention of social problems, criminality, and impulsivity.

The hidden stigma of aging and COVID-19: aggravating factors and strategies to mitigate the impact of the pandemic in older adults, a text mining analysis.

OBJECTIVE: To identify factors associated with mental health of older adults during the pandemic and to provide strategies to mitigate their psychosocial impact in the elderly. METHOD: An integrative text mining analysis in Medline was performed to identify studies on the mental health of older adults during the pandemic. Subsequently, statistical topic modeling was performed to identify the most prevalent terms and topics discussed in included studies. RESULTS: A total of 29 studies were retrieved until July 1st 2020, including a majority of letters (12 studies) and commentaries (8 studies). The most frequent terms overall were: loneliness (n = 137), support (n = 132), home (n = 102), suicide (n = 96) and help (n = 94). The most prevalent terms were then divided in five topics: home (33%), suicide (32%), apps (15%), loneliness (12%) and physical activity (9%). Additionally, a section focused on low- and middle-income countries was included. A summary of strategies to mitigate the effects of pandemic in mental health of older adults was also provided. CONCLUSION: These factors demonstrate the importance of developing strategies for psychosocial support that take into consideration the particularities of the elderly. Different levels of care are immediately necessary to diminish the devastating impact of the pandemic in the mental health of older adults.

Concurrent Use of Alcohol and Crack Cocaine is Associated with High Levels of Anger and Liability to Aggression.

Objective: To evaluate aggressiveness in individuals receiving treatment for alcohol and crack cocaine use, both alone and in combination with one another, in order to compare them to control subjects with no history of drug problems, using the State-Trait Anger Expression Inventory. Method: The sample consisted of 67 men aged 18-65 years, divided into four groups: alcohol (n = 13); crack cocaine (n = 25); crack cocaine + alcohol (n = 16) and controls (n = 13). Participants completed the following instruments: socioeconomic questionnaire, the Wechsler Abbreviated Scale of Intelligence and the State-Trait Anger Expression Inventory. Results: Individuals with alcohol dependence alone, or comorbid with crack cocaine dependence, showed elevated levels of aggression and anger, though these varied according to the drug of abuse. Concurrent users of alcohol and crack cocaine had the highest levels of aggression, followed by isolated alcohol users, suggesting an association between alcohol consumption and aggression. Conclusion: The present findings suggest that alcohol and aggression levels may be associated with violent behavior. Concurrent use of alcohol and crack cocaine was related to higher levels of aggression, which may be associated with more severe alterations in behavior and impulse control.

Re-traumatization Cycle: Sexual Abuse, Post-Traumatic Stress Disorder and Sexual Risk Behaviors among Club Drug Users.

Background: Club drug users are high risk and vulnerable population for adverse drug-related consequences and sexual risk behaviors. Few investigations have addressed the possible interrelationship between early trauma and PTSD among young club drug using populations. Objective: Exposure to traumatic experiences - especially in childhood, has been linked to risk behaviors exposure and substance use disorder. This study aimed to assess and compare drug use patterns and the presence of childhood sexual abuse (CSA) experiences among ecstasy and LSD users with and without Posttraumatic Stress Disorder (PTSD). Method: This cross-sectional study employed targeted sampling and ethnographic mapping approaches via face-to-face interviews conducted at bars and electronic music festivals. The Global Appraisal of Individual Needs questionnaire was used as the primary assessment instrument. Participants were from 18 to 39 years of age, had used ecstasy and/or LSD in the 90 days prior to the interview, and were not in treatment for alcohol and other drug problems. Results: Out of the 240 participants, 123 (51.2%) presented PTSD symptoms. Those presenting PTSD were younger, less educated, with lower income, and presented higher drug use severity than those without PTSD symptoms. Moreover, a higher prevalence of sexual risk behavior was verified among those with PTSD. There was an association between PTSD symptoms and CSA history, where 64.2% of individuals with PTSD also presented CSA, compared to 47% among those without PTSD (p = .028). Individuals with co-occurring history of CSA and PTSD symptoms reported earlier use of ecstasy, LSD, and cocaine compared to individuals with a history of CSA but without PTSD. Conclusions: In the present study, participants with a history of PTSD demonstrate a history of CSA, as well as pronounced severity in several areas - precocity of use, severity of addiction, and greater exposure to situations of sexual risk. Thus, a cycle of traumatization may be established through early potential trauma, which can remain unprocessed and contribute to earlier and more severe substance use and sexual risk behaviors. Identification of PTSD symptoms and risk for HIV and other STIs among young club drug users is critical to address focused treatment approaches for this vulnerable population.

A network analysis of early trauma and impulsive behavior in individuals with mono- and poly-dependence of alcohol and crack cocaine.

OBJECTIVE: To investigate the relationship between impulsivity and early trauma through a network analysis in individuals diagnosed with different substance use disorders (SUD). METHODS: This cross-sectional study includes a sample of 556 men with SUD (195 with alcohol use, 157 with crack cocaine use and 214 with multiple substance use). The Childhood Trauma Questionnaire was applied to investigate early trauma and the Barratt Impulsiveness Scale to assess impulsive behavior. The connection between trauma and impulsivity was assessed using network analysis through Fused Graphical Lasso algorithm. RESULTS: No connection was observed between impulsivity and trauma networks in individuals with alcohol use. In cocaine users, networks were linked through the motor domain and sexual abuse nodes. Inversely connections were observed between emotional neglect node and perseverance and not planning nodes. In poly-use, the connection between impulsivity and trauma networks was weak, with cognitive complexity being the node that connects to the trauma network through physical abuse. There were inversely proportional connections between motor domain and emotional neglect nodes, and cognitive instability and physical neglect. CONCLUSIONS: Our results suggest that the relationship between the type of early (childhood) trauma and the expression of impulsivity could lead to a different substance use profile.

Association between telomere length with alcohol use disorder and internalizing/externalizing comorbidities in a Brazilian male sample.

BACKGROUND: Shortening telomere length (TL) is an important ageing marker associated with substance use disorder (SUD). However, the influence of psychiatric and clinical comorbidities and alcohol-related outcomes has not been much explored in the context of TL in individuals with alcohol use disorder (AUD) and may be a source of heterogeneity in AUD studies. Therefore, our aim was to investigate the influence of AUD, alcohol-related outcomes, and common psychiatric comorbidities on TL in men with AUD and healthy controls (HC). METHODS: Men with AUD (n = 108, mean age = 52.4, SD = 8.6) were recruited in a detoxification unit, and HC (n = 80, mean age = 50.04, SD = 9.1) from the blood bank, both located in Brazil. HC had no current or lifetime diagnosis of any substance use disorder. Psychiatric comorbidities were assessed using SCID-I. TL ratio was measured in triplicates using quantitative multiplex PCR. RESULTS: Telomere length did not differ between individuals with AUD and HC (p = 0.073) or was associated with AUD-related outcomes, trauma, or clinical comorbidities. Individuals with externalizing disorders had longer TL when comparing with those with internalizing disorders (p = 0.018) or without comorbidity (p = 0.018). CONCLUSION: Our findings indicate that TL was influenced by the presence of psychiatric comorbidity rather than case or control status. These results were adjusted for potential confounders, such as age.

Early discharge predictors among inpatients crack cocaine users.

INTRODUCTION: High rates of early hospital discharge are often observed in crack cocaine users and are related to adverse outcomes and increased public spending. This study evaluated clinical and sociodemographic factors associated with early treatment discharge among crack users. METHODS: The sample comprised 308 men diagnosed with crack cocaine use disorder (crack only), aged 18 to 65 years, admitted between 2013 and 2017 to a male-only hospital unit to treat substance use disorders. Sociodemographic and clinical data were obtained using the Addiction Severity Index, 6th version, and a Sociodemographic Questionnaire. RESULTS: Early discharge (within 7 days) was significantly associated with lack of own income, insufficient family support, being single, and recent homelessness. Regarding drug use, lower treatment retention was related to younger age of crack use onset, recent alcohol use, and nicotine use. Factors such as age, skin color, and educational level showed no relation to the outcome. CONCLUSION: Our findings suggest that presence of characteristics verifiable at the time of admission may be related to crack users' treatment retention. Identification of these factors can contribute to target interventions in order to improve treatment adherence in crack cocaine users.

High COVID-19 morbidity and mortality risk among smoked drug users in Brazil.

ABSTRACT: In much of the West, including Brazil, drug use has increased since social distancing began in response to the pandemic. Use of smoked and modified drugs, and their impacts on health, may contribute to aggravate the effects of the pandemic. However, studies on the relationship between use of smoked drugs and the new coronavirus are still scarce and have not received enough attention in global health recommendations. This paper aims to briefly review the relationship between use of smoked drugs and acute respiratory syndrome coronavirus 2 [SARS-CoV-2]. Recent studies also suggest that drug consumption increases the risk of contamination by SARS-CoV-2 and leads to worse prognosis, particularly consumption of drugs that affect lung function. Use of smoked drugs, especially tobacco, is strongly associated with lung diseases that are risk factors for contamination by SARS-CoV-2. It is essential to develop strategies based on specific characteristics of drug users and for mental health professionals to be included in strategic teams. It is also necessary to invest in information campaigns regarding risks and prevention of harm caused by smoked drugs as well as to design strategies that facilitate access to psychosocial treatment during the pandemic.

Psychometric properties of the Brazilian Portuguese version of the Copenhagen Burnout Inventory (CBI) in healthcare professionals.

INTRODUCTION: Burnout syndrome (BS) in healthcare professionals (HCP) has been a major concern, and even more so during the coronavirus disease 2019 (COVID-19) pandemic. The need for adequate tools to assess BS is urgent. The objective of this study was to validate the Brazilian Portuguese version of the Copenhagen Burnout Inventory (CBI) in HCP. METHODS: The sample comprised 1,054 Brazilian HCP. Data were collected for 1 month (May-2020 to June-2020) using an online self-administered questionnaire. RESULTS: All three CBI dimensions demonstrated optimal reliability. All consistency measures attained values > 0.90. Split-half correlation values with Spearman-Brown reliability were higher than 0.8. The parallel analysis suggested two factors: personal burnout (PB) and work-related burnout (WB) items were associated with factor 1, and client-related burnout (CB) items were associated with factor 2. CONCLUSION: Our study corroborates the validity of the Brazilian Portuguese version of the CBI, pointing to a close relation between PB and WB in HCP. A public domain tool with evidence quality to ensure sufficient content validity can aid in burnout evaluation and encourage both expansion of the research field and accurate detection and treatment of this syndrome in Brazilian HCP.

Assessment of cognitive functioning using the Mini Mental State Examination in men with Alcohol and Crack Cocaine Use Disorder.

INTRODUCTION: Consumption of substances has been associated with cognitive impairment. The Mini Mental State Examination (MMSE) is an easy-to-apply screening tool used to assess cognitive functions. OBJECTIVES: To evaluate the cognitive performance of individuals with alcohol (AUD) and/or crack cocaine use disorder (CUD) and polysubstance use using the MMSE and to investigate the impact of substance use profile and the moderation effect of educational level on MMSE performance. METHODS: Cross-sectional study with 508 adult male inpatients diagnosed with substance use disorders (245 with AUD, 85 with CUD, and 178 with polysubstance use). Cognitive performance was assessed using the MMSE scale (total and composite scores). RESULTS: Individuals with AUD had worse total MMSE scores and scored worse for all three MMSE components compared to individuals with polysubstance use (p < 0.001, oral/written language comprehension, p < 0.001, attention/memory, and p = 0.007, motor functions). MMSE scores were positively correlated with educational level (p < 0.017), but were not associated with age, recent drug use, or years of drug use. Educational level moderated the impact of substance use on MMSE performance, especially total score and composite language comprehension score. Individuals with a low educational level (≤ 8 years) had worse performance than those with a high educational level (≥ 9 years), mainly in individuals with AUD (p < 0.001). DISCUSSION: Individuals with a low educational level and alcohol use are more prone to present cognitive impairment than crack cocaine users, especially involving language aspects. Better-preserved cognitive function could impact treatment adherence and might guide the decision of therapeutic strategies.

Serum BDNF levels increase during early drug withdrawal in alcohol and crack cocaine addiction.

Brain-derived neurotrophic factor (BDNF) is involved in several drug-induced brain neuroadaptations. The impact of withdrawal from substances that have different neurological mechanisms on BDNF levels is unclear. Our goal was to compare serum BDNF levels in inpatients with alcohol or crack cocaine use disorders during the early withdrawal period, and to evaluate the association with substance-related outcomes. We performed a follow-up study with 101 men under detoxification treatment (drug preference: alcohol [n = 37] and crack cocaine [n = 64]). Blood samples were collected on the 1st and 15th days of hospitalization to measure serum BDNF levels. Serum BDNF levels increased during the early stage of withdrawal (28.2 ± 10.0 vs. 32.6 ± 13.3, p < 0.001), similarly in individuals with alcohol and crack cocaine use. In the alcohol group, BDNF levels on the 15th day of hospitalization were negatively correlated with age (r = -0.394, p = 0.023). Delta BDNF levels were also negatively correlated with BDNF on the 1st day of hospitalization (p = 0.011). No significant correlation was found regarding substance-related outcomes. This is the first study to compare BDNF levels in alcohol and crack cocaine users undergoing similar treatment conditions. These findings could be related to clinical improvement after abstinence or even to drug withdrawal itself, decreasing neuronal injury. Furthermore, age may be a crucial factor, hindering the recovery of neuroplasticity in alcohol users.

Proposing an integrative, dynamic and transdiagnostic model for addictions: dysregulation phenomena of the three main modes of the predostatic mind.

Several theories have been proposed to explain the complex diagnostic aspects related to addiction disorders and their development. Recent frameworks tend to focus on dimensional perspectives of symptoms rather than categorical systems, since substance use disorders are frequently comorbid with other psychiatric and especially personality disorders. However, useful transdiagnostic models that could integrate clinical evaluation derived from neuroscientific theories are lacking. In the present manuscript, the authors propose a model based on a new paradigm, in an attempt to better explain this complex, multifaceted phenomenon. The new paradigm presupposes that emotions and behavior are a response to risk prediction. Individuals make choices and engage in actions to manage potential risks/rewards in order to seek or maintain homeostasis in their internal and external environments - a mechanism that the authors call predostatic (predictive mechanism with homeostatic purpose). The model considers three main modes of the predostatic mind: (1) Alarm Mode, activated by high and/or imminent risk prediction; (2) Seek Mode, activated by long-term risk or reward prediction; and (3) Balance Mode, a self-regulating state of mind related to low risk prediction, a soothing system and a calm state. Addiction is seen as a chronic dysregulation of organism systems leading to internalizing or externalizing phenomena mainly related to the Seek and Alarm Modes, which are persistently activated by reward and risk prediction, respectively, thus hindering Balance. Addiction neuroscience research has shown that chronic drug use or engagement in addictive behaviors can lead to neuroadaptations in the brain reward circuitry, disrupting normal balance and the regulation of reward processes. This dysregulation can contribute to persistent drug-seeking/addictive behaviors despite negative consequences. This newly proposed dynamic and integrative model, named dysregulation based on externalizing and internalizing phenomena of the three main modes of the predostatic mind (DREXI3), proposes six dysregulation dimensions with basic emotional and behavioral symptoms, such as neurophysiological alterations, impulsivity, compulsion, cognitive impairment/psychosis, mood, and anxiety/anger. In this paper, the authors explain the rationale behind DREXI3 and present some hypothetical clinical examples to better illustrate the use of the model in clinical practice. The development of this innovative model could possibly guide tailored treatment interventions in the addiction field.

Childhood trauma subtypes may influence the pattern of substance use and preferential substance in men with alcohol and/or crack-cocaine addiction.

OBJECTIVE: To compare the prevalence and subtypes of childhood maltreatment (CM) between individuals with and without substance use disorder (SUD) and investigate the influence of different traumas on the preferential use of substances and the severity of dependence. METHODS: The sample consisted of 1,040 men with SUD (alcohol users [n=315], crack-cocaine users [n=406], multiple-substance users [n=319]) and 201 controls. The Childhood Trauma Questionnaire (CTQ) and the Addiction Severity Index-6 (ASI-6) were used to assess CM and drug-use patterns. RESULTS: Individuals with SUD had a higher prevalence of CM than controls (63.4 vs. 28.1%, respectively). Exposure to physical trauma was associated with alcohol use disorder and severity of alcohol use. In contrast, emotional trauma was associated with use of multiple substances and severity of drug use in crack-cocaine users. CONCLUSIONS: This study corroborates the association of CM with SUD susceptibility. Our results suggest that the type of CM may influence preferential substance use and addiction severity. In this sense, physical traumas are more associated with alcohol use, while emotional and sexual traumas favor use of multiple drugs, especially crack cocaine. These findings may help the development of tailored prevention and intervention strategies.

Mental health help-seeking among Brazilian medical students: Who suffers unassisted?

INTRODUCTION: Several barriers for mental health help-seeking were identified among medical students, including minimizing mental illness. Studies examining aspects particular to those who perceive psychological impairment but do not access treatment are necessary for planning interventions. AIMS: To identify help-seeking barriers based on the students' perception about their need for treatment and psychiatric symptoms. Methods: Cross-sectional study assessing 436 Brazilian medical students (833 attending the medical school = 52.3% response rate). Data collection covered sociodemographic data, mental health, academic environment, and Beck Inventories of Depression (BDI) and Anxiety (BAI). Non-parametric tests and hierarchical logistic regression were used to compare students undergoing treatment, those willing to access treatment, and the ones reporting no need for treatment. RESULTS: Among the 382 students who completed the survey (87.6% completion rate), 38.5% (n = 147) were in treatment, and 33% (n = 126) were in need. Moderate to severe risk of alcohol abuse was observed in 45.9% (n = 50) of students reporting no need for treatment. Regression models suggested that perceiving need for treatment - whether already undergoing it or not - was associated with the severity of depressive symptoms (OR 1.14 [95% CI 1.07-1.21]), female assigned sex (OR 2.18 [95% CI 1.23-3.88]), LGBTQ+ (OR 2.47 [95% CI 1.09-5.60]) and reporting good relationship with the family (OR 0.26 [95% CI 0.08-0.83]). Models comparing students in treatment and those in need, pointed that the factors associated with lacking mental health care were age (OR 0.90 [95% CI 0.82-0.99]), perception of a heavy workload (OR 2.43 [95% CI 1.35-4.38]) and good relationship with colleagues (OR 3.51 [95% CI 1.81-6.81]). DISCUSSION: Social variables and the severity of depressive symptoms are positively associated with perceived need for treatment. Age and academic environment factors were related to help-seeking behavior among students with appropriate self-awareness. We discuss these findings' implications for planning interventions.

Differential impact on suicide mortality during the COVID-19 pandemic in Brazil.

OBJECTIVES: To compare suicide rates observed in Brazil after the onset of the COVID-19 pandemic with the estimated rate based on suicide deaths between 2010 and 2020, and identify sociodemographic variables associated with this outcome. METHODS: Ecological time-series study. Data were obtained from Brazilian Unified Health System Department of Information Technology (DATASUS), with the structural break of the data set in March 2020. The number of actual suicides observed and the number of expected suicides if there were no COVID-19 pandemic were analyzed through bayesian structural time series modeling. RESULTS: The overall incidence of suicides in Brazil remained stable after the start of the COVID-19 pandemic compared to what would be expected. However, there was a significant increase in suicide deaths among women (6.9%) and older adult (9.1%). Analysis by macro-regions of the country showed significant increases in suicide deaths in the Center-West (7.4%), Northeast (5.7%), and Southeast (10%). Stratified analyses revealed differences according to age, sex, education, and skin color. CONCLUSIONS: Despite stability in the overall number of suicides, this phenomenon occurs heterogeneously among different population groups and regions of Brazil. Rates have increased in populations with a history of poor access to health, which may have been more severely impacted by the pandemic.

Inflammatory cytokines and alcohol use disorder: systematic review and meta-analysis.

OBJECTIVE: To assess differences in blood inflammatory cytokines between people with alcohol use disorder (AUD) and healthy controls (HC). METHODS: Searches were performed from inception through April 14, 2021. Meta-analyses with random-effects models were used to calculate the standardized mean difference ([SMD], 95%CI), and potential sources of heterogeneity were explored trough meta-regressions and subgroup analysis. RESULTS: The meta-analysis included 23 studies on the following 14 cytokines: tumor necrosis factor (TNF)-a, IL-1, IL-1RA, IL-2, IL-4, IL-5, IL-6, IL-7, IL-8, IL-10, IL-13, IL15, interferon (IFN)-g and sCD14. There were significantly higher concentrations of IL-6 (n=462 AUD and 408 HC; SMD = 0.523; 95%CI 0.136-0.909; p = 0.008) in AUD than HC. No significant differences were found in the other 13 cytokines. CONCLUSION: We found that IL-6 levels were significantly higher in individuals with AUD than HC and that other cytokines were not altered. This can be explained by the small number of studies, their methodological heterogeneity, and confounding factors (active use, abstinence, quantity, and physical or psychiatric illnesses, for example). Despite a great deal of evidence about alcohol and inflammatory diseases, studies assessing the role of neuroimmune signaling in the development and severity of AUD are still lacking.

Gender differences in progression to crack-cocaine use and the role of sexual and physical violence.

OBJECTIVE: This study aimed to evaluate whether progression from first drug use to crack-cocaine use differs according to gender, and whether the report of sexual or physical violence impacts the time of progression. METHODS: We interviewed 896 crack-cocaine users (548 men; 348 women) from addiction treatment units. Cox regression models evaluated the time of progression from first drug use to crack use. We analyzed gender differences according to the absence or presence of sexual or physical violence, also considering whether violence, when present, had occurred before or after the onset of crack use. RESULTS: Women presented a faster progression to crack use regardless of exposure to sexual or physical violence (p < 0.05). Compared to unexposed men, there was a similar progression for men exposed to sexual or physical violence before the first use of crack (p = 0.167 and p = 0.393, respectively). In both genders, we observed a faster progression among individuals exposed to these types of violence after the onset of crack use (p < 0.01). CONCLUSIONS: We found a faster progression to crack use among women and among individuals exposed to sexual and physical violence after the onset of crack use. These results encourage differentiated treatment strategies, focused on gender and individual characteristics.

Increase in serum brain-derived neurotrophic factor levels during early withdrawal in severe alcohol users.

INTRODUCTION: Changes in brain-derived neurotrophic factor (BDNF) have been linked to the neuroadaptative consequences of chronic alcohol use and associated with disease severity and prognosis. Few studies have evaluated the influence of drug withdrawal and clinical and sociodemographic data on BDNF levels in severe alcohol users. OBJECTIVES: Our goals were (1) to evaluate variation in BDNF levels during alcohol withdrawal and, (2) to assess the influence of putative confounding factors on BDNF levels. METHODS: Our sample consists of 62 men with alcohol use disorder undergoing a detoxification process. Serum BDNF levels were measured using a commercial sandwich-ELISA kit, at two points: before and after the detoxification period. RESULTS: We found an increase in BDNF levels during alcohol withdrawal (25.4±9.6 at admission vs. 29.8±10.2 ng/ml at discharge; p < 0.001), even after controlling for potential confounders (positive family history, number of days between blood sample collections, and age) (Generalized Estimating Equation: coefficient = -4.37, 95% confidence interval [95%CI] -6.3; -2.4; p < 0.001). Moreover, individuals who had first-degree relative with alcohol dependence had smaller increases in BDNF levels than individuals with no family history (14.8 [95%CI -5.3; 35.6] vs. 35.3 [95%CI 15.4; 74.8]; p = 0.005). CONCLUSIONS: In summary, variation in BDNF levels seems to be influenced by withdrawal in severe alcohol users. A positive family history of alcohol dependence could also be a factor that influences variation in this biomarker.

Anger and substance abuse: a systematic review and meta-analysis.

OBJECTIVE: Conduct a systematic review and meta-analysis to evaluate levels of anger among substance users compared to non-user controls and to analyze the possible association between anger and psychoactive substance use (PSU). METHODS: The procedures of this review followed the Meta-Analyzes of Observational Studies in Epidemiology (MOOSE) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Four electronic databases (MEDLINE, EMBASE, BIREME, PsycINFO) were searched. RESULTS: Twelve studies were included in the meta-analysis; 10 used the State-Trait Anger Expression Inventory (STAXI) anger trait subscale and two used the Buss-Perry-Aggression Questionnaire (BPAQ) anger subscale. The sample included 2,294 users of psychoactive substances and 2,143 non-users, all male. The mean difference in anger scale scores between users and non-users was 2.151 (95%CI 1.166-3.134, p ≤ 0.00, inconsistency index [I2] = 98.83) standard deviations. Age and abstinence duration did not moderate the difference in anger between substance users and non-users. CONCLUSION: Users of psychoactive substances had elevated anger scores compared to non-users, which represents a high risk of relapse. It is suggested that PSU treatment programs include intensive anger management modules, focusing on factors such as dealing with daily stressors, family conflicts, frustrations, and problems.

The Sum of Fears in Cancer Patients Inside the Context of the COVID-19.

The pandemic resulting from COVID-19 has led to the collapse of the health system in dozens of countries. Parallel to clinical risk, the appearance or intensification of psychiatric symptoms has also been documented. The identification of groups at risk is essential for the establishment of preventive and therapeutic strategies. Cancer patients appear to be especially vulnerable both from a clinical and psychiatric perspective. Problems related to contamination and the cancer treatments themselves are intertwined, causing a sum of patients' fears to arise, which can cause mental effects. This study aims to review and investigate the impact of COVID-19 on the mental health of cancer patients and indicate possible support strategies.