A review of the kappa opioid receptor system in opioid use.

The kappa opioid receptor (KOR) system is implicated in dysphoria and as an "anti-reward system" during withdrawal from opioids. However, no clear consensus has been made in the field, as mixed findings have been reported regarding the relationship between the KOR system and opioid use. This review summarizes the studies to date on the KOR system and opioids. A systematic scoping review was reported following PRISMA guidelines and conducted based on the published protocol. Comprehensive searches of several databases were done in the following databases: MEDLINE, Embase, PsycINFO, Web of Science, Scopus, and Cochrane. We included preclinical and clinical studies that tested the administration of KOR agonists/antagonists or dynorphin and/or measured dynorphin levels or KOR expression during opioid intoxication or withdrawal from opioids. One hundred studies were included in the final analysis. Preclinical administration of KOR agonists decreased drug-seeking/taking behaviors and opioid withdrawal symptoms. KOR antagonists showed mixed findings, depending on the agent and/or type of withdrawal symptom. Administration of dynorphins attenuated opioid withdrawal symptoms both in preclinical and clinical studies. In the limited number of available studies, dynorphin levels were found to increase in cerebrospinal fluid (CSF) and peripheral blood lymphocytes (PBL) of opioid use disorder subjects (OUD). In animals, dynorphin levels and/or KOR expression showed mixed findings during opioid use. The KOR/dynorphin system appears to have a multifaceted and complex nature rather than simply functioning as an anti-reward system. Future research in well-controlled study settings is necessary to better understand the clinical role of the KOR system in opioid use.

La salud mental en los modelos de atención de adolescentes infractores Los casos de Colombia, Argentina, Estados Unidos y Canadá / Mental health in the attention models for juvenile offenders. The cases of Colombia, Argentina, United States and Canada

Objetivo: indagar cómo se entiende y aborda la salud mental en los modelos de atención de la población infantil infractora en los centros de detención de Argentina, Colombia, Estados Unidos y Canadá. Metodología: se buscó literatura sobre el tema empleando las palabras clave adolescencia, salud mental, justicia juvenil, delincuencia juvenil, factores de riesgo e intervenciones. El buscador empleado para la consulta fue Pubmed. Adicionalmente, se utilizaron páginas de instituciones públicas de cada país. Conclusiones: la delincuencia juvenil se entiende ahora como un fenómeno multifactorial con múltiples áreas de intervención dentro de las cuales cobran relevancia las condiciones económicas, familiares y sociales, puesto que propician la aparición de conductas delictivas. Se encontró una similitud entre los sistemas de Colombia y Argentina, pues ambos se basan en una justicia restaurativa que busca reparación y no castigo; por ende, no hay medidas punitivas. Al comparar Canadá y Estados Unidos se ve que Canadá se parece más a los países latinoamericanos que a Estados Unidos, puesto que este último usa medidas punitivas centradas en el victimario.

Objective: To investigate how mental health is understood and approached in detention centers' attention models for convicted underage population in Argentina, Colombia, United States and Canada. Methodology: A literature search was conducted using the following key words: adolescence, mental health, juvenile justice, juvenile delinquency, risk factors, and interventions . Searches were done through the search engine Pubmed. Additionally, public institution websites for each country were consulted. Conclusions: Juvenile delinquency is now understood like a multi-factorial phenomenon with multiple areas of intervention within which economic, domestic and social factors are considered relevant, since these favor the development of criminal behavior. A similarity was found between Colombian and Argentinian systems; both are based in restorative justice that seeks reparation and not punishment; which is why there are no punitive measures. When comparing Canada and the United States, it can be seen that Canada bares more similarity with Latin- American countries' systems than the United States, given that the latter's' punitive measures target the offender.