Guidelines of the Brazilian Association of Studies on Alcohol and Other Drugs (ABEAD) for diagnosis and treatment of psychiatric comorbidity with alcohol and other substance and dependence.

In recent years, several studies have been focused on the comorbidity of psychiatric disorders with alcohol and other substance dependence. In this context, the Brazilian Association of Studies on Alcohol and Other Drugs initiated a project to establish Brazilian Guidelines. The aim of this study was to review diagnostic and therapeutic criteria for the most prevalent psychiatric comorbidities. Randomized clinical trials, epidemiological studies, animal testing and other forms of research are reviewed herein. The main psychiatric comorbidities are investigated and data published in the literature are reviewed, based on guidelines adopted by other countries. Epidemiological aspects, diagnostic criteria, integrated treatment and the organization of specialized service, as well as details regarding psychotherapy and pharmacological treatment are discussed. The guidelines of the Brazilian Association of Studies on Alcohol and Other Drugs reinforce the importance of adequate diagnosis and treatment regarding alcoholic and drug dependent patients suffering of comorbid psychiatric disorders.

Oral health assessment for users of marijuana and cocaine/crack substances.

The objective of this study was to assess the oral health status of users of illicit drugs such as marijuana and cocaine/crack and compare it with individuals not using these chemical substances. Questionnaires were applied to 35 illicit drugs users to gather information on demographic status, general health, and use of drugs. Then, a clinical assessment of the oral health condition was performed to collect data on decayed, missing and filled teeth (DMFT) index, salivary flow rate (SFR), and mucosal lesions. The control group was composed of 35 non-illicit drug users. In the experimental group, 91.43% were males, 80% were smokers, and 42.85% were alcoholics. Cocaine was the most common drug used (77.15%), followed by marijuana (68.6%), and crack (51.4%). The average DMFT index was 9.8 and the SFR was reduced in 60% of subjects. Mucosal alterations were detected, but no potentially malignant disorders or oral cancer were diagnosed. Compared to control group, significantly higher values for gender (40%, p = 0.0001), smoking (22.86%) and heavy drinking (5.7%) habits (p = 0.0001), SFR (31.4%; p = 0.0308), and oral lesions (p = 0.0488) were found for the experimental group, although significantly higher values were found in the control group for DMFT index (p = 0.0148). It can be concluded that the use of illicit drugs contributed to an increased prevalence of oral mucosa lesions. In addition, a decline on SFR and a reduced DMFT index was observed for illicit drug users.

[Guidelines of the Brazilian Association of Studies on Alcohol and Other Drugs (ABEAD) for diagnoses and treatment of psychiatric comorbidity with alcohol and other drugs dependence]. / Diretrizes da Associação Brasileira de Estudos do Alcool e outras Drogas (ABEAD) para o diagnóstico e tratamento de comorbidades psiquiátricas e dependência de álcool e outras substâncias.

Recently, several studies have focused on comorbity psychiatric disorders with alcohol and other substance dependence. The Brazilian Association of Studies on Alcohol and Other Drugs proposed the Brazilian Guidelines project. This study review diagnostic and therapeutic criteria to the most prevalent psychiatric comorbidities. Randomized clinical trials, epidemiological, animal studies and other forms of research are reviewed. The main psychiatric comorbidities are studied based on guidelines adopted by other countries and the literature data resumed. Epidemiological aspects, diagnoses, integrated treatment and service organization, as well as specific psychotherapic and pharmacological treatment are discussed. The Brazilian Association of Studies on Alcohol and Other Drugs Guidelines reassures the importance of adequate diagnoses and treatment regarding alcoholic and drug dependent patients suffering of comorbid psychiatric disorders.

[Neuropharmacological aspects of chronic alcohol use and withdrawal syndrome]. / Aspectos neurofarmacológicos do uso crônico e da síndrome de abstinência do alcool.

The objective of this paper is to review and describe the main neuropharmacological changes caused by the chronic use of alcohol and those observed during its withdrawal period. The results show international data referring to the involvement of monoamine systems, neurotransmitters and calcium channels in both neuroadaptation and tolerance to alcohol effects and withdrawal. Relevant studies showing the participation of other systems in those mechanisms, as opioids and other substances, are also shown. The article reinforces the importance, for both physicians and researchers, of an always growing understanding of alcohol central mechanisms of action. This understanding is necessary to new pharmacological options to alcohol harm reduction as well as to alcohol withdrawal treatment.

Anxiogenic-like profile of Wistar adult rats based on the pilocarpine model: an animal model for trait anxiety?

RATIONALE: There is extensive evidence indicating the influence of seizures on emotional responses observed in human and animals, but so far few studies are focusing on the behavioral profile of animals that do not have seizures despite being treated with convulsant agents. OBJECTIVES: We aimed to establish the behavioral profile, biochemical, and electrographic features of rats submitted to the pilocarpine model of temporal lobe epilepsy METHODS: Rats treated with pilocarpine (20 to 350 mg/kg, i.p.) that did not develop status epilepticus or spontaneous recurrent seizures were evaluated 1 month later in the elevated plus maze (EPM), T-maze (ETM), open-field (OF), and step-down avoidance tests. Electroencephalographic (EEG), glutamate uptake, and hippocampal neuronal death assays were also performed RESULTS: Pilocarpine (150 or 350 mg/kg) promoted anxiogenic-like effects in rats evaluated in the EPM, ETM, and OF tests, whereas only the highest dose evoked spike-wave discharges during EEG recordings. Hippocampal theta rhythm was increased by pilocarpine 150 or 350 mg/kg and only the highest dose reduced the L-[(3)H]-glutamate uptake and cell viability on hippocampal slices. CONCLUSIONS: Subconvulsant doses of pilocarpine promote long-lasting alterations on neural circuitry, reflected by an increased theta activity in the hippocampus and an anxiety-like profile of rats evaluated 1 month after the treatment which is independent of seizure occurrence and is not related to changes in glutamate uptake or hippocampal damage. These results prompt us to suggest that a systemic administration of subconvulsant doses of pilocarpine could be useful as a new tool to model trait anxiety in rats.

Abordagem e tratamento do tabagismo / Approach and treatment of smoking

O Sistema Único de Saúde (SUS) tem papel fundamental no auxílio às pessoas que desejam parar de fumar. Para tanto, é muito importante que os profissionais atuantes na atenção básica e assistência à saúde estejam preparados para oferecer esse auxílio. Considerando esse contexto, a Diretoria de Vigilância Epidemiológica da Secretaria de Estado da Saúde de Santa Catarina (DIVE/SES/SC), por meio de sua Gerência de Análises Epidemiológicas e Doenças e Agravos Não Transmissíveis (GADNT) e a Escola de Saúde Pública de Santa Catarina (ESPSC) disponibilizam o curso "Abordagem e Tratamento do Tabagismo".

Diretrizes da Associação Brasileira de Estudos do Alcool e outras Drogas (ABEAD) para o diagnóstico e tratamento de comorbidades psiquiátricas e dependência de álcool e outras substâncias / Guidelines of the Brazilian Association of Studies on Alcohol and Other Drugs (ABEAD) for diagnoses and treatment of psychiatric comorbidity with alcohol and other drugs dependence

O diagnóstico e tratamento de comorbidade psiquiátrica e dependência de álcool e outras substâncias tem sido objeto de inúmeros estudos nos últimos anos. A Associação Brasileira de Estudos do Alcool e Outras Drogas desenvolveu o projeto Diretrizes. Este trabalho visa o desenvolvimento de critérios diagnósticos e terapêuticos atualizados para as comorbidades psiquiátricas mais prevalentes. Ensaios clínicos randomizados, estudos epidemiológicos, com animais e outros estudos são revisados. As principais comorbidades psiquiátricas são estudadas e os dados de literatura resumidos, tendo como referência diretrizes adotadas em outros países. São abordados aspectos epidemiológicos, critérios diagnósticos, tratamento integrado e organização de serviço especializado, assim como especificidades do tratamento psicoterápico e farmacológico. As Diretrizes da Associação Brasileira de Estudos do Alcool e Outras Drogas reforçam a importância da abordagem adequada do dependente químico portador de comorbidade psiquiátrica.

Aspectos neurofarmacológicos do uso crônico e da Síndrome de Abstinência do Alcool / Neuropharmacological aspects of chronic alcohol use and withdrawal syndrome

O objetivo deste artigo é o de revisar e descrever as principais alteracões neurofarmacológicas causadas pela exposicão crônica ao álcool, assim como os fenômenos ocorridos durante o período de abstinência. São apresentados dados referentes às alteracões neuroadaptativas e de tolerância ocorridas nos principais sistemas de monoaminas, aminoácidos neurotransmissores e canais de cálcio, o que está relacionado a uma piora no prognóstico de portadores de comorbidades psiquiátricas com o consumo de álcool. São também descritos alguns estudos relevantes que demonstram o envolvimento de outros mecanismos de acão do álcool no sistema nervoso central, como o envolvimento de opióides, entre outras substâncias. O artigo reafirma a importância, para clínicos e pesquisadores, de um sempre maior entendimento do mecanismo de acão central do álcool, pois dele depende a busca por novas opcões farmacológicas, tanto para a reducão dos danos provocados pelo seu uso crônico, como para o tratamento da síndrome de abstinência a esta substância.

Reorganizaçäo sináptica e ocorrência de crises espontâneas em ratos / Synaptic reorganization and ocurrency of spontaneous sizures in rats

Trabalhos realizados em nosso laboratório mostram que ratos, submetidos a status epilpticus (SE) induzido pela pilocarpina, passam a apresentar crises espontâneas tardiamente (fase crônica). Este modelo apresenta características fenomenológicas semelhantes às crises parciais complexas humanas. Neste trabalho descrevemos o desenvolvimento da fase crônica e o aparecimento de reorganizaçäo sinaptica (RS) em ratos submetidos a 30 min, 1 hora, 2 ou 6 horas de SE. Estes animais foram acompanhados eletrográfica e comportamentalmente por até 120 dias. Após, seus cérebros foram processados de acordo com os métodos de Timm e/ou Nissl. Näo foram observadas alteraçöes nos animais submetidos a 30 minutos de SE. No grupo com 1h de SE, menos de 25% dos animais entraram na fase crônica, apresentando uma baixa freqüência de crises. Nestes animais foi detectada uma discreta perda neuronal no hipocampo e hilo do giro dentado (GD) e foram observados esparsos grânulos de Timm (RS), ao longo do terço interno da camada molecular do GD. No grupo com 2h de SE, 90% dos animais entraram na fase crônica, apresentando em média 1 crise/semana. Foi detectada uma significante perda neuronal e um moderado aumento da granulaçäo de Timm na camada molecular do GD. Todos os animais submetidos a 6h de SE apresentaram crises espontâneas (3 crises/semana). Foi detectada uma perda neuronal de mais de 90% e um intenso aumento na granulaçäo de Timm. Näo houve diferença entre este grupo e o grupo controle näo tratado durante o SE. Nossos resultados sugerem a existência de uma correlaçäo positiva entre a duraçäo do SE, o processo de RS, a ocorrência de crises espontâneas e a perda neuronal no hipocampo