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1.
Pediatrics ; 144(6)2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31767716

RESUMO

An estimated 8.7 million children live in a household with a substance-using parent or guardian. Substance-using caretakers may have impaired judgment that can negatively affect their child's well-being, including his or her ability to receive appropriate medical care. Although the physician-patient relationship exists between the pediatrician and the child, obligations related to safety and confidentiality should be considered as well. In managing encounters with impaired caretakers who may become disruptive or dangerous, pediatricians should be aware of their responsibilities before acting. In addition to fulfilling the duty involved with an established physician-patient relationship, the pediatrician should take reasonable care to safeguard patient confidentiality; protect the safety of their patient, other patients in the facility, visitors, and employees; and comply with reporting mandates. This clinical report identifies and discusses the legal and ethical concepts related to these circumstances. The report offers implementation suggestions when establishing anticipatory procedures and training programs for staff in such situations to maximize the patient's well-being and safety and minimize the liability of the pediatrician.


Assuntos
Transtornos Relacionados ao Uso de Álcool/psicologia , Cuidadores/psicologia , Julgamento , Tutores Legais/psicologia , Pais/psicologia , Pediatras/ética , Transtornos Relacionados ao Uso de Substâncias/psicologia , Criança , Maus-Tratos Infantis , Bem-Estar da Criança , Confidencialidade , Humanos , Notificação de Abuso , Consentimento dos Pais , Papel do Médico , Relações Médico-Paciente
2.
Lancet Psychiatry ; 6(12): 1068-1080, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31630984

RESUMO

Alcohol use disorder is a major contributor to the morbidity and mortality burden worldwide. It often coexists with other psychiatric disorders; however, the nature of this comorbidity is still a matter of debate. In this Series paper, we examine the main psychiatric disorders associated with alcohol use disorder, including the prevalence of co-occurring disorders, the temporal nature of the relationship, and mechanisms that might explain comorbidity across the lifespan. Overall, this disorder co-occurs with a wide range of other psychiatric disorders, especially those disorders involving substance use and violent or aggressive behaviour. The causal pathways between alcohol use disorder and other psychiatric disorders are heterogeneous. Hypotheses explaining these relationships include reciprocal direct causal associations, shared genetic and environmental causes, and shared psychopathological characteristics of broader diagnostic entities (eg, externalising disorders). Efforts to untangle the associations between alcohol use disorder and other disorders across the lifespan remain a crucial avenue of research.


Assuntos
Transtornos Relacionados ao Uso de Álcool/epidemiologia , Comorbidade , Diagnóstico Duplo (Psiquiatria) , Transtornos Mentais/epidemiologia , Transtornos Relacionados ao Uso de Álcool/psicologia , Humanos , Transtornos Mentais/psicologia , Prevalência , Escalas de Graduação Psiquiátrica , Violência/psicologia
3.
J Abnorm Psychol ; 128(8): 813-822, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31657596

RESUMO

Between-subjects literature has established that trait-like negative mood predicts coping motives, which predict alcohol-related problems and that trait-like positive mood predicts mood enhancement motives, which then predict alcohol consumption. However, there is considerable within-person variation in drinking motives, and the relationship between mood, motives, and alcohol outcomes must be more closely examined at a daily level. The current study used ecological momentary assessment (EMA) to measure mood, motives, alcohol use, and alcohol consequences in 101 college drinkers over a 15-day period. At the between-subjects level, positive mood predicted enhancement motives, which in turn predicted alcohol consumption and consequences. Negative mood predicted coping motives, which were associated with only alcohol-related consequences. At the within-subjects level, daily anxious and depressed mood were associated with endorsing coping motives, but coping motives were not associated with alcohol consumption or problems. Positive mood was associated with enhancement motives, which was associated with both daily alcohol consumption and problems. These results corroborate previous findings that enhancement motives are most predictive of outcomes in the college population and highlight the importance of considering within-subject variance in drinking motives. The relationships between mood, motives, and alcohol outcomes differ when examined as between-subjects versus within-subject constructs. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Afeto/fisiologia , Consumo de Álcool na Faculdade/psicologia , Transtornos Relacionados ao Uso de Álcool/fisiopatologia , Transtornos Relacionados ao Uso de Álcool/psicologia , Relações Interpessoais , Motivação/fisiologia , Adolescente , Adulto , Avaliação Momentânea Ecológica , Feminino , Humanos , Masculino , Estudantes/psicologia , Universidades , Adulto Jovem
4.
Psychol Addict Behav ; 33(6): 520-528, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31414850

RESUMO

Few studies have investigated alcohol-related problems among Asian American college students, perhaps because of the model minority myth, or the false stereotype that Asian Americans are academically and economically successful and thus do not experience significant physical or mental health problems. However, drinking patterns among Asian Americans are complex and there is evidence that alcohol use may be increasing among Asian American college students. One potential risk factor for alcohol-related problems among Asian American college students is racial discrimination. Although past research has revealed a link between experiences of racial discrimination and alcohol use, few studies have examined the psychological processes underlying this association. Furthermore, only a few studies have examined the association between discrimination and alcohol-related problems using longitudinal designs. The present study longitudinally examined the direct and indirect effect of discrimination on alcohol-related problems through the frequency in which they engaged in drinking to cope within a sample of 311 underage Asian American college students. Controlling for alcohol use and baseline alcohol-related problems, Wave 2 drinking-to-cope motives were directly associated with Wave 3 (1 year later) alcohol-related problems. Wave 1 discrimination was indirectly associated with Wave 3 alcohol-related problems through drinking to cope. These findings have important implications for the prevention of alcohol-related problems among an understudied group, Asian American college students. They highlight the necessity of considering how sociocultural factors such as racism contribute to alcohol-related problems as well as examining how psychological processes such as drinking to cope put certain students at increased risk. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Adaptação Psicológica , Transtornos Relacionados ao Uso de Álcool/psicologia , Americanos Asiáticos/psicologia , Racismo/psicologia , Estudantes/psicologia , Consumo de Álcool por Menores/psicologia , Adolescente , Transtornos Relacionados ao Uso de Álcool/etnologia , Correlação de Dados , Feminino , Humanos , Estudos Longitudinais , Masculino , Motivação , Fatores de Risco , Consumo de Álcool por Menores/etnologia , Adulto Jovem
5.
Psychol Addict Behav ; 33(6): 529-539, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31343200

RESUMO

The college years are a period of peak vulnerability for sexual victimization (SV) and substance misuse. During college, students with SV histories report riskier substance use patterns, yet little is known about the influence of SV on substance use behaviors as students begin to transition away from the college environment. This was the purpose of the present study. College seniors (N = 480; 61% female) reported on their alcohol and drug use behaviors across 5 time points spanning 1 calendar year. For many, this year included the transition out of college. Latent growth curve analysis was used to determine whether trajectories for alcohol and drug use as well as alcohol and drug consequences differed based on SV histories (no SV, precollege SV, college SV, precollege + college SV). Results revealed that at the start of senior year, young adults with SV histories reported greater substance use and consequences relative to nonvictimized peers. Over the year, SV histories were associated with steeper declines in substance use and consequences. Despite the declines, those who were revictimized across developmental time periods (precollege + college SV) consistently reported higher alcohol use and consequences across the transitional year, although this did not replicate for other drugs. In sum, although alcohol and other drug involvement among those with SV histories decreased over time, precollege + college SV histories continued to be a persistent risk factor for heavier alcohol use behaviors. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Transtornos Relacionados ao Uso de Álcool/psicologia , Alcoolismo/psicologia , Vítimas de Crime/psicologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/psicologia , Delitos Sexuais/psicologia , Estudantes/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adolescente , Consumo de Bebidas Alcoólicas/epidemiologia , Consumo de Bebidas Alcoólicas/psicologia , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Alcoolismo/epidemiologia , Vítimas de Crime/estatística & dados numéricos , Estudos Transversais , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Feminino , Seguimentos , Humanos , Masculino , Grupo Associado , Fatores de Risco , Delitos Sexuais/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Universidades , Adulto Jovem
6.
Int J Behav Med ; 26(4): 401-414, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31161592

RESUMO

BACKGROUND: Smartphone-based interventions are a potentially effective way to minimize alcohol-related harm in young adult, non-dependent drinkers. This pilot study is the first to evaluate the benefits and feasibility of a personalized alcohol harm-minimization intervention delivered via smartphones. METHODS: Within a single-blind, randomized controlled design, 45 young adults were randomly assigned to either the intervention app (n = 25; 18 females; Mage = 21.36 years, SDage = 4.15 years) or the control app (n = 20; 18 females; Mage = 22.75; SDage = 4.41). The two primary outcomes were frequency of risky drinking and drinking-related harms, and the secondary outcome was frequency of protective behavioral strategies (PBS) use. All outcomes were measured at baseline and immediately post-intervention. Using the Enlight framework [1], usability was evaluated via structured one-on-one phone interviews with a subgroup of six participants from the intervention group (3 females; Mage = 19.5 years, SDage = 1.64). RESULTS: There was no significant reduction in the primary outcomes from baseline to post-intervention across the groups. For the secondary outcome, the application of PBS within drinking contexts increased at follow-up for those in the intervention group but not for control participants. End-users rated the app as highly usable but had some concerns with repetition of the app-recommended strategies. CONCLUSIONS: This intervention, designed to reduce risky drinking behaviors among young adults, was rated as highly usable and was shown to increase the application of harm minimization strategies within drinking contexts. While the intervention and its delivery show promise, it did not appear to mitigate risky drinking behaviors. Implications of this research and future directions are discussed. TRIAL REGISTRATION: This trial is registered at the Australian New Zealand Clinical Trials Registry: BLINDED.


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Transtornos Relacionados ao Uso de Álcool/terapia , Terapia Comportamental/métodos , Smartphone , Consumo de Bebidas Alcoólicas/efeitos adversos , Transtornos Relacionados ao Uso de Álcool/psicologia , Austrália , Feminino , Humanos , Masculino , Projetos Piloto , Método Simples-Cego , Adulto Jovem
7.
Pediatrics ; 144(1)2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31235608

RESUMO

Alcohol use continues to be a major concern from preadolescence through young adulthood in the United States. Results of recent neuroscience research have helped to elucidate neurobiological models of addiction, substantiated the deleterious effects of alcohol on adolescent brain development, and added additional evidence to support the call to prevent and reduce underage drinking. This technical report reviews the relevant literature and supports the accompanying policy statement in this issue of Pediatrics.


Assuntos
Transtornos Relacionados ao Uso de Álcool , Consumo de Álcool por Menores , Adolescente , Desenvolvimento do Adolescente/efeitos dos fármacos , Transtornos Relacionados ao Uso de Álcool/diagnóstico , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Transtornos Relacionados ao Uso de Álcool/psicologia , Transtornos Relacionados ao Uso de Álcool/terapia , Bebidas Alcoólicas/efeitos adversos , Encéfalo/efeitos dos fármacos , Humanos , Fatores de Risco , Consumo de Álcool por Menores/prevenção & controle , Consumo de Álcool por Menores/psicologia , Consumo de Álcool por Menores/estatística & dados numéricos , Estados Unidos/epidemiologia
8.
Pediatrics ; 144(1)2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31235610
9.
Exp Clin Psychopharmacol ; 27(5): 455-465, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31120282

RESUMO

There is a growing awareness of the need to explore the social and environmental milieus that drive alcohol consumption and related cognitions. The current study examined the extent to which alcohol-congruent and incongruent drinking contexts modulate alcohol-related inhibitory control using a novel go/no-go task. One hundred and eight participants (Mage = 20 years; SD = 4.87) were instructed to inhibit their responses to visual alcoholic (alcohol/no-go condition, n = 50) or nonalcoholic stimuli (alcohol/go condition, n = 58) depicted in an alcohol-congruent (pub), incongruent (library), or context-free (control) condition. Participants in the alcohol/go condition exhibited higher false alarm rates (FAR) toward nonalcoholic stimuli and faster reaction times (RTs) to alcoholic stimuli depicted in the alcohol-congruent and incongruent context compared with the alcohol/no-go condition. In contrast, FAR toward alcoholic stimuli (alcohol/no-go condition) were not significantly affected by drinking context, but RT was faster when nonalcoholic stimuli were presented in alcohol-incongruent (i.e., library) compared with alcohol-congruent (i.e., pub) contexts. The discussion turns to potential explanations for these findings, suggesting that social drinkers might exhibit approach tendencies toward alcoholic images that translate into errors toward nonalcoholic stimuli, and that image complexity influences response inhibition. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Transtornos Relacionados ao Uso de Álcool/psicologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Tempo de Reação/fisiologia , Adulto Jovem
10.
Pharmacol Biochem Behav ; 181: 69-76, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30946883

RESUMO

Interoception, the sensing of bodily signals, is related to emotional reactivity and may contribute to the pathophysiology of addiction. Evidence is accumulating that individuals with alcohol use disorders and other substance-dependences show altered interoceptive processing, however little is known about the acute effects of alcohol on interoception and how this may influence the perception of drug induced effects. In a double-blind design, fifty (30 females) healthy young participants were given a beverage containing either a low (0.4 g/kg, n = 18) or high (0.6 g/kg, n = 15) alcohol dose or a placebo (n = 17). After alcohol administration, participants completed two interoceptive paradigms, the heart-beat tracking and heart-beat discrimination tasks, both assessing different accuracy and metacognitive measures of interoception. Subjective feelings elicited by alcohol administration were also measured. Participants under the low alcohol dose had lower metacognitive interoceptive awareness on the discrimination task compared to placebo. Participants under alcohol experienced feelings of light-headedness, which were positively associated with increased interoceptive awareness in the cardiac discrimination task. These results provide evidence for a relationship between interoceptive processing and the perception of drug-induced mood changes. This finding, showing how interoceptive awareness of cardiac discrimination contributes to the appraisal of subjective light-headedness generated by alcohol administration, brings novel perspectives to the understanding of drug discrimination and reinforcement mechanisms.


Assuntos
Conscientização/efeitos dos fármacos , Etanol/administração & dosagem , Etanol/farmacologia , Interocepção/efeitos dos fármacos , Adolescente , Adulto , Afeto/efeitos dos fármacos , Transtornos Relacionados ao Uso de Álcool/etiologia , Transtornos Relacionados ao Uso de Álcool/psicologia , Análise de Variância , Conscientização/fisiologia , Testes Respiratórios , Tontura/etiologia , Relação Dose-Resposta a Droga , Método Duplo-Cego , Feminino , Frequência Cardíaca/fisiologia , Humanos , Interocepção/fisiologia , Masculino , Metacognição/efeitos dos fármacos , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
11.
Int J Geriatr Psychiatry ; 34(6): 836-845, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30854733

RESUMO

OBJECTIVES: Impaired awareness of functional deficits is often observed in people with Korsakoff syndrome (KS) and may result in refusal of care, although this area has been understudied. This study aimed to investigate levels of impaired awareness and their relationships with neuropsychiatric symptoms (NPS) in people with KS residing in specialized nursing homes. METHODS: A cross-sectional, observational study was conducted among 215 residents with KS or other alcohol-related cognitive disorders. Awareness was measured with the Patient Competency Rating Scale (PCRS). NPS and subsyndromes were measured with the Neuropsychiatric Inventory-Questionnaire (NPI-Q). Adjusted multilevel regression analyses were performed to examine the relationships between the level of awareness and NPS. RESULTS: The mean level of impaired awareness was 39.3 (SD = 19.9) indicating moderate impairment. Twenty-nine percent of the residents had no or mildly impaired awareness; 37% were moderately impaired, and 34% were severely impaired. Residents with moderately impaired awareness showed more severe apathy than residents with no or mildly impaired awareness (difference 1.23; 95% CI 1.02-1.48; p = 0.03). No associations were found between the level of awareness and other NPI outcomes. Cognitive functioning seems to have the strongest impact on the association between level of awareness and NPS in KS residents. CONCLUSIONS: Impaired awareness of functional deficits is highly common in KS residents; however, apart from apathy, is not significantly related with NPS. Additional research should further examine, which interventions are effective in dealing with impaired awareness in these people, particularly when apathy is present.


Assuntos
Transtornos Relacionados ao Uso de Álcool/psicologia , Conscientização , Transtornos Cognitivos/psicologia , Síndrome de Korsakoff/psicologia , Casas de Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Apatia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
12.
Soc Psychiatry Psychiatr Epidemiol ; 54(10): 1231-1241, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-30903238

RESUMO

PURPOSE: The aim of the present study was to contribute to the inconsistent literature on the comorbid relationship of alcohol problems and depressive symptoms from late adolescent to emerging adulthood by accounting for their trajectories and their conjoint relationship while controlling for the influence of externalising symptoms. METHODS: We utilised data, from a longitudinal school cohort from Northern Ireland (Belfast Youth Developmental Study), over three time points where the participants were 16, 17 and 21 years of age. A total of 3118 participants were included, 1713 females and 1405 males. Second-order latent growth models were applied to examine growth trajectories. Parallel process growth models were used to assess whether growth trajectories of the symptoms were associated. Externalising symptoms were subsequently added as a covariate. RESULTS: Alcohol problems among males significantly increased over time but decreased in females. Depressive symptoms initially increased then decreased in both genders. Results indicated associations of the alcohol problems and depression, both initially and with time. Accounting for externalising symptoms only somewhat diminished this effect in males but not in females. An increase of initial levels of depression was associated with a decrease in alcohol problems over time. This association was only true among females. After controlling for externalising symptoms, the relationship was no longer observed. CONCLUSIONS: The present study provides further evidence of a significant relationship of alcohol problems and depression in adolescents and further supports a small literature indicating that depression may have protective effects of alcohol problems. Finally, the study shows the importance of accounting for externalising symptoms.


Assuntos
Transtornos Relacionados ao Uso de Álcool/epidemiologia , Depressão/epidemiologia , Adolescente , Transtornos Relacionados ao Uso de Álcool/psicologia , Comorbidade , Depressão/psicologia , Feminino , Humanos , Controle Interno-Externo , Estudos Longitudinais , Masculino , Irlanda do Norte/epidemiologia , Fatores Sexuais , Fatores de Tempo , Adulto Jovem
13.
Drug Alcohol Depend ; 197: 280-287, 2019 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-30875649

RESUMO

BACKGROUND: How youth perceive harmfulness of risk behaviors such as substance use relates to their engagement in those behaviors. Yet, little is known about how different substance use modes (i.e., variations in amounts and use frequencies) are perceived. We investigated how adolescent perceptions of harmfulness of various alcohol- and cannabis use modes changed over time, compared to one another, and related to actual substance use behaviors. METHODS: We examined nationally-representative repeated cross-sectional samples of 16-year olds in Norway, assessed in 2007, 2011, and 2015 (NTotal = 9296) as part of the European School Survey Project on Alcohol and Other Drugs (ESPAD). Adolescents reported their: 1) lifetime alcohol- and cannabis use, and 2) perceived harmfulness of various alcohol- and cannabis use modes. RESULTS: Prevalence estimates for perceived harmfulness: 1) remained high and stable, or increased for alcohol use modes, and 2) declined for all cannabis use modes (i.e., using 1-2 times, occasionally, and regularly) since 2007-cohort. High quantity daily drinking was more commonly perceived as harmful than minimal or occasional cannabis use. Even though culturally-relevant use modes (i.e., weekend heavy drinking and experimental cannabis use) were not most commonly endorsed as harmful, only perceptions of those use modes as harmful were inversely associated with actual substance use. CONCLUSIONS: How adolescents from Norway perceived harmfulness of alcohol- and cannabis use depended on the specific substance, its use modes, and secular cohort. Perceived harmfulness was associated with measures of actual substance use predominantly along the culturally- and adolescent-relevant modes of use.


Assuntos
Comportamento do Adolescente , Consumo de Bebidas Alcoólicas/psicologia , Transtornos Relacionados ao Uso de Álcool/psicologia , Comportamentos de Risco à Saúde , Abuso de Maconha/psicologia , Adolescente , Estudos Transversais , Feminino , Humanos , Masculino , Noruega , Percepção , Prevalência , Inquéritos e Questionários , Adulto Jovem
14.
J Gambl Stud ; 35(3): 829-847, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30778813

RESUMO

Substantial changes were made with the creation of the Substance Related and Addictive Disorders category in the fifth edition of the Diagnostic and Statistical Manual (DSM-5; APA in Diagnostic and statistical manual of mental disorders, 5th edn, American Psychiatric Publishing, Arlington, 2013a), including the addition of gambling disorder to the category and a reduction in the minimum threshold of diagnostic criteria required for a gambling disorder. As gambling shares many similarities with substance use disorders, it stands to reason that comorbidity rates of other psychiatric disorders would be similar among gambling and substance use disorders. The current study examines whether changes in gambling diagnostic criteria from DSM-IV to DSM-5 correspond to changes in prevalence of comorbid psychiatric disorders among disordered gamblers that result in prevalence rates more similar to those observed in alcohol and cannabis use disorders. This study utilized data from the National Epidemiological Survey for Alcohol and Related Conditions (NESARC). Results suggested that the prevalence for any comorbid disorder among disordered gamblers appeared to be similar from DSM-IV (56.7%) to DSM-5 (53.7%). Comorbidity using DSM-5 criteria were just slightly closer to, but still noticeably higher than, comorbidity prevalence observed in alcohol (25.3%) and cannabis (37.7%) disorders, with similar trends across addictions observed in most examined comorbid disorders/groupings. Our findings suggest that lowering the threshold for minimum diagnosis of gambling disorder resulted in a slight decrease in comorbidity rates though substantial differences remain between comorbid rates of disordered gambling and substance use disorders. Future DSM editions may consider a further diagnostic threshold reduction, which might result in comorbidity rates being more similar to other substance use disorders and increasing disorder similarity within the Substance Related and Addictive Disorders category.


Assuntos
Comportamento Aditivo/psicologia , Jogo de Azar/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto , Transtornos Relacionados ao Uso de Álcool/psicologia , Comportamento Aditivo/epidemiologia , Comorbidade , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Jogo de Azar/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Distribuição por Sexo , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto Jovem
15.
Psychiatry Res ; 272: 587-594, 2019 02.
Artigo em Inglês | MEDLINE | ID: mdl-30616128

RESUMO

Despite accumulated evidence linking trauma exposure to major depressive disorder (MDD), there is limited understanding as to why some trauma survivors subsequently develop MDD. The behavioral model of depression points to a negative reinforcement cycle of trauma-related avoidance and depressed mood, but no study has evaluated this framework in trauma survivors. This study tested the hypothesis that traumatic stress symptom-related interference with daily activities and with relationships and self-medicating traumatic stress symptoms with alcohol and with drugs would predict MDD onset in a nationally representative sample after controlling for established risk factors. Data were drawn from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) using two samples: adults reporting lifetime trauma exposure but no history of MDD at Wave 1 (n = 8301) and a subset of those participants who met criteria for lifetime PTSD prior to Wave 1 (n = 1055). Younger age, female gender, a greater number of different trauma types, traumatic stress-related interference with daily activities, and self-medicating traumatic stress symptoms with alcohol significantly predicted MDD onset in both groups. Findings underscore the role of traumatic stress-related interference and self-medication in the development of MDD.


Assuntos
Aprendizagem da Esquiva , Transtorno Depressivo Maior/psicologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Inquéritos e Questionários , Sobreviventes/psicologia , Adolescente , Adulto , Transtornos Relacionados ao Uso de Álcool/diagnóstico , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Transtornos Relacionados ao Uso de Álcool/psicologia , Aprendizagem da Esquiva/fisiologia , Transtorno Depressivo Maior/diagnóstico , Transtorno Depressivo Maior/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Transtornos Relacionados ao Uso de Substâncias/epidemiologia
16.
Psychol Addict Behav ; 33(1): 35-49, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30676037

RESUMO

Alcohol use disorder (AUD) diagnosis in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) contains a severity gradient based on number of criteria endorsed, implicitly assuming criteria are interchangeable. However, criteria vary widely in endorsement rates, implying differences in the latent severity associated with a symptom (e.g., Lane, Steinley, & Sher, 2016) and demonstrating criteria are not interchangeable (Lane & Sher, 2015). We evaluated whether variation in the severity of criteria could be resolved by employing multiple indicators of each criterion varying in item-level severity. We assessed 909 undergraduate students aged 18 years or older with at least 12 drinking occasions in the past year. Participants self-administered questions on alcohol consumption and past year AUD symptoms via an online survey. For each of the 11 AUD criteria, we selected three indicators based on the difficulty values of the one-parameter logistic item response theory model ranging from low to high. We first tested a higher order AUD factor defined by 11 lower order criterion factors, χ2(551) = 2,959.35, p < .0001; root mean square error of approximation = 0.09. The 33 items were used to create severity scores: a criterion count (0-11), symptom count (0-33), and factor scores derived from a bifactor model. Though our new scores resulted in incremental validity over DSM-5 across a range of external validators, when the standardized regression estimates were compared, the new scores did not consistently outperform the DSM-5 suggesting this approach is viable for developing more sensitive diagnostic instruments but needs further refinement. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Consumo de Álcool na Faculdade/psicologia , Alcoolismo/diagnóstico , Adolescente , Adulto , Consumo de Bebidas Alcoólicas , Transtornos Relacionados ao Uso de Álcool/diagnóstico , Transtornos Relacionados ao Uso de Álcool/psicologia , Alcoolismo/psicologia , Manual Diagnóstico e Estatístico de Transtornos Mentais , Feminino , Humanos , Modelos Logísticos , Masculino , Índice de Gravidade de Doença , Estudantes/psicologia , Inquéritos e Questionários , Adulto Jovem
17.
Subst Use Misuse ; 54(6): 899-907, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30618337

RESUMO

BACKGROUND: College student substance use has been a problem for many years. In particular, heavy alcohol consumption can create issues with academics, social relationships, and overall functioning. Unitary measures of generic alcohol consumption (e.g., drinking frequency) are important predictors of alcohol-related negative consequences, but the small amount of specific-beverage research available suggests that assessing beverage type consumed may enhance prediction. OBJECTIVES: The purpose of the present study was to expand knowledge of alcoholic beverage preference in relation to negative consequences and confirm the factor structure of the RAPI proposed by Martens et al. ( 2007 ) in a college student sample. METHODS: In addition, the present study expanded current knowledge by assessing beverage preference type in relation to specific negative consequences on the RAPI. RESULTS: Results replicated the three-factor structure originally found by Martens et al. ( 2007 ). Moreover, results found that individuals consuming shots of liquor or alcohol mixed with caffeine reported higher overall RAPI scores and higher scores on the Abuse/Dependence and Personal Consequences factors but not the Social Consequences factor than those consuming mixed drinks, beer, or wine. Conclusions/Importance: This research might inform discussions with incoming college freshman about not only alcohol consumption and negative consequences but the dangers of drinking specific types of alcohol beverages such as shots and/or alcohol mixed with caffeine.


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Transtornos Relacionados ao Uso de Álcool/psicologia , Bebidas Alcoólicas/estatística & dados numéricos , Comportamento do Consumidor/estatística & dados numéricos , Estudantes/psicologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Feminino , Humanos , Masculino , Sudeste dos Estados Unidos/epidemiologia , Universidades , Adulto Jovem
18.
Psychiatry Res ; 271: 208-213, 2019 01.
Artigo em Inglês | MEDLINE | ID: mdl-30502556

RESUMO

People with alcohol use disorder (AUD) are at an increased risk for cardiovascular diseases (CVD). Physical fitness is a predictor of CVD and premature mortality. Currently, no existing measures of physical fitness used in the general population have been tested for validity and reliability in this vulnerable population. Therefore, we examined the reproducibility, feasibility and correlates of the Eurofit test battery in this population. From 32 men (age = 40.8 ±â€¯13.8years; illness duration = 10.2 ±â€¯10.3years; body mass index, BMI = 24.8 ±â€¯3.8) and 13 women (age = 41.9 ±â€¯12.1years; illness duration = 13.7 ±â€¯13.1years; BMI = 26.3 ±â€¯4.9) with AUD two trials of the Eurofit test, administered within one week, were analyzed. All patients also completed the International Physical Activity Questionnaire, the Positive Affect and Negative Affect Scale and Alcohol Use Disorders Identification Test. All Eurofit items showed good reproducibility with intraclass correlation coefficients ranging from 0.82 for the flamingo balance test to 0.97 for the standing broad jump and handgrip strength tests. Better performance on Eurofit test items was associated with younger age, a shorter illness duration, a lower BMI and higher physical activity levels. The current study demonstrates that the Eurofit test can be recommended as a reliable test for evaluating the physical fitness of inpatients with alcohol use disorder.


Assuntos
Transtornos Relacionados ao Uso de Álcool/fisiopatologia , Teste de Esforço/estatística & dados numéricos , Medição de Risco/estatística & dados numéricos , Adulto , Transtornos Relacionados ao Uso de Álcool/complicações , Transtornos Relacionados ao Uso de Álcool/psicologia , Índice de Massa Corporal , Doenças Cardiovasculares/etiologia , Exercício Físico , Teste de Esforço/métodos , Estudos de Viabilidade , Feminino , Força da Mão , Humanos , Masculino , Pessoa de Meia-Idade , Aptidão Física , Reprodutibilidade dos Testes , Medição de Risco/métodos , Fatores de Risco
19.
Artigo em Inglês | MEDLINE | ID: mdl-30145183

RESUMO

A 1-day fear memory in ethanol withdrawn (ETOH) rats is resistant to destabilization-reconsolidation process. However, d-cycloserine (DCS) reverts this disturbance. Considering that the formation of pathological fear memories in humans often occurs long time before the requirement of an intervention, the study of older memories is relevant in ETOH rats. In addition, the resistance to destabilization and DCS effect on this memory phase at molecular level in ETOH rats have not been corroborated yet. Firstly, we examined the effect of a pharmacological intervention after reactivation on reconsolidation of a 7-day fear memory in ETOH rats. Then, and considering that enhanced GluN2B expression and ubiquitin-proteasome system (UPS) activity are involved in destabilization, we evaluated them following reactivation in ETOH rats. Furthermore, DCS effect on such destabilization markers was examined. It was found that the pharmacological intervention after reactivation did not affect the 7-day fear memory in ETOH rats with DCS reversing this resistance. Memory reactivation increased GluN2B expression, polyubiquitination levels and proteasome activity in the basolateral amygdala complex (BLA) of control (CON) rats only; without affecting these molecular events in ETOH rats. Finally, ETOH rats treated with DCS and CON animals displayed elevated and similar UPS activities in the BLA after reactivation. In conclusion, the reactivation of an older fear memory formed during ethanol withdrawal does not trigger the molecular events associated with destabilization, and DCS facilitates this memory phase by enhancing the UPS activity.


Assuntos
Transtornos Relacionados ao Uso de Álcool/metabolismo , Medo/fisiologia , Memória/fisiologia , Síndrome de Abstinência a Substâncias/metabolismo , Síndrome de Abstinência a Substâncias/psicologia , Transtornos Relacionados ao Uso de Álcool/psicologia , Animais , Antimetabólitos/farmacologia , Complexo Nuclear Basolateral da Amígdala/efeitos dos fármacos , Complexo Nuclear Basolateral da Amígdala/metabolismo , Depressores do Sistema Nervoso Central/efeitos adversos , /fisiologia , Ciclosserina/farmacologia , Etanol/efeitos adversos , Medo/efeitos dos fármacos , Masculino , Memória/efeitos dos fármacos , Distribuição Aleatória , Ratos Wistar , Receptores de N-Metil-D-Aspartato/metabolismo
20.
Subst Use Misuse ; 54(1): 78-88, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30395760

RESUMO

BACKGROUND: Social Learning Theory suggests how one conceptualizes time will be passed from parent to child (Bandura & Walters, 1963). Through the lens of Behavioral Economics Theory (Vuchinich & Simpson, 1998), impaired control may be characterized as consuming alcohol as a form of immediate gratification as a choice over more distal rewards. Because impaired control reflects a self-regulation failure specific to the drinking situation, it may be directly related to time-perspectives. OBJECTIVES: This investigation explored whether or not the indirect influences of perceived parenting styles on alcohol use and related problems is mediated by both facets of time-perspective (e.g. hedonism, present-fatalism, future, past-positive, past-negative) and impaired control over drinking. METHODS: We examined a structural equation model with 391 (207 women; 184 men) college student drinkers. We used an asymmetric bias-corrected bootstrap technique to conduct mediational analyses (MacKinnon, 2008). RESULTS: Higher levels of past-positive time-perspective were indirectly linked to both less alcohol use and fewer alcohol-related problems through less impaired control. In contrast, higher levels of present-fatalism were indirectly linked to more alcohol use through more impaired control. Higher levels of father permissiveness and mother authoritarianism were indirectly linked to both more impaired control and alcohol use through more present-fatalism. In addition, higher levels of father authoritarianism were indirectly linked to more alcohol use through more hedonism. CONCLUSIONS/IMPLICATIONS: Our results support the notion that drinking beyond one's self-prescribed limits is associated with time-perspectives related to negative aspects of the parent-offspring socialization process, such as fatalism.


Assuntos
Consumo de Bebidas Alcoólicas/psicologia , Autoritarismo , Poder Familiar/psicologia , Permissividade , Aprendizado Social , Adolescente , Adulto , Transtornos Relacionados ao Uso de Álcool/psicologia , Feminino , Humanos , Masculino , Relações Pais-Filho , Inquéritos e Questionários , Adulto Jovem
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