ToM impairments are related to a range of interpersonal problems in psychiatric disorders such as schizophrenia (Sprong, Schothorst, Vos, Hox, & van Engeland, 2007), autism (Di Martino et al., 2009), bipolar disorder (Malhi et al., 2008), eating disorders (Dejong et al., 2013) and others (Chiavarino et al., 2013; Santangelo et al., 2012). By the same token, since substanceuse disorders are marked by severe social and interpersonal problems it has been suggested that ToM impairments may be involved in these conditions (Homer et al., 2008; Uekermann & Daum, 2008), a theory which has evidences by now (Henry, Mazur, & Rendell, 2009; Maurage et al., 2011; Uekermann, Channon, Winkel, Schlebusch, & Daum, 2007). There is also neuropsychological and physiological evidence to support this hypothesis – brain areas responsible for ToM functioning appear altered in drug dependents while performing ToM tasks (Gizewski et al., 2013; Roser et al., 2012). This evidence for ToM impairments in highlights a possible new approach to interventions for substanceuse disorders – the manipulation of biopsychosocial factors as part of an integrated approach to promoting recovery from drug addiction and the associated outcomes (e.g. social and interpersonal problems)
ER reference network has three psychiatrists. The psychiatric evaluation main objective in this study was to identify the absence or the presence of disorders related to alcohol and/or other psychoactive substances. Since this screening in the ER not used routinely scales or standardi- zed questionnaires to identify possible “problem drinkers” and the severity related to illegal substanceuse, for exam- ple. From a clinical perspective patients were referred to a psychiatric evaluation in an attempt to consolidate ER ac- tion routines. Furthermore, psychiatric evaluation intended to encourage early recognition necessity and proper treat- ment for depression, psychotic disorder, alcohol and drugs abuse, suggesting that improving mental illness diagnosis and treatment is an excellent suicide prevention strategy for general population 2,17,34 .
The psychiatry condition of F. (current PTSD and Crack Cocaine Dependence; past diagnosis of TBI), highlights the importance for clinicians to differentiate the co-occurrence of multiples diagnosis from cases in which one disorder is induced by another. In the clinical history of F. it was clear that after a car accident (in which she suffered a TBI), she developed many symptoms specifically related to the trauma and not necessarily to her neurological condition. These symptoms were persistent and did not remit in the first month, progressing to a PTSD diagnosis. Furthermore, despite the reasons that corroborated to F onset ofsubstanceuse were not fully understood, she developed a pattern of cocaine and crack use in the subsequent years, supporting SUD diagnosis. She had severe functional and psychosocial impairments that culminate to her hospitalization. In this sense, this clinical rational suggested the presence, independently, of all three diagnoses, not ignoring the possibility of a relationship in their course according F’s clinical history. In addition, despite our evaluation was based on DSM-IV diagnosis criteria, we believed that it remains unchanged even if we consider the DSM-V criteria. For example, in PTSD diagnosis, F. already presented symptoms of negative alteration of cognition and mood (e.g., numbing symptoms and cognitive distortion about the cause and consequences of the trauma), which comprehend the new cluster criteria (D criteria). Related to SubstanceUse Diagnosis, in which DSM-V did not distinguish anymore abuse from dependence, the appropriate nomenclature for F. case would be replaced by Crack Cocaine UseDisorder.
Test of the BADS Zoo Map : The BADS executive function battery is used for the evaluation of patients with disejecutive syndrome, a frontal lobe syndrome. Evaluate problem solving, attention, organizational skills over extended periods of time and daily life skills to prioritize competition demands. The Zoo map test is a BADS subtest that measures planning ability (a specific executive function). The test consists of two parts (with and without instructions). In each one of them the participant must visit different points in a map of a zoo (the house of the monkeys, the gallery of reptiles ...), following an ordered sequence under certain restrictions of passage, marking its route between points with pencils of different colors. For each part of the test the number of hits (a visited place in the position to be visited) is subtracted in the sequence (there are four correct sequences), the number of errors made in the proposed sequence (deviations, the shaded areas ...). These are the direct scores of the first and second part of the test that depending on their value and the time to complete the sequence is translated to a profile with a value between 0 and 4. The higher the profile number, the better Performed the test. The Zoo Map has shown high validity and reliability (inter-rater reliability κ> 0.96)  and several studies have shown that BADS has higher ecological validity indexes than other classic tests of executive functions [23,24].
Benzodiazepines act as CNS depressors with acute intoxication effects similar to those of alcohol. The risk of respiratory depression due to intoxication by benzodiazepines is important. However, this effect, as well as hypotension and bradycardia, tends to be more pronounced when the intoxication is associated with other substances. Although the excessive intake of benzodiazepines alone rarely induces deep coma and death, the patient may require assisted ventilation. Flumazenile, a speciic benzodiazepine antagonist, can be employed in severe cases with associated neurological or respiratory depression. The initial dose of 0.3mg IV can be followed by additional doses up to the limit of 2mg. In case this dose proves unable to reverse the patient’s condition within 5-10 minutes, other causes should be considered for CNS depression. Flumazenile has a shorter effect as compared with benzodiazepines. Therefore, the effects of the antagonist may be over before the intoxication has been overcome. In patients taking tricyclic antidepressants or other agents like aminophylline or
The project was approved by the Institutional Review Board (IRB) of Hospital de Clínicas de Porto Alegre (ap- proved as an IRB by the Office for Human Research Protections, United States of America, IRB 00000921). Written informed consent was obtained from all partici- pants and their parents. Subjects were recruited from a previous community case-control study assessing adoles- cents with ADHD/SUD (25). Of the 21 eligible subjects, 11 accepted to be enrolled in the study. We also recruited more subjects by advertisements in local newspapers and radio broadcasts; from this source, we screened 15 ado- lescents. Eleven youths had ADHD/SUD; however, 3 sub- jects met exclusion criteria (see below) and 3 refused to participate. The other 5 adolescents were included in the study, thus comprising our total sample size of 16 subjects. Inclusion criteria were age between 15 and 21 years, male gender, current diagnosis of abuse of or dependence on marijuana or cocaine, current diagnosis of ADHD, and stimulant-naive subjects. Exclusion criteria were the lack of a responsible adult to inform about possible childhood psychopathology or to take responsibility for the medica- tion, the need for inpatient treatment for drug abuse or psychiatric comorbidities, and the presence of a primary psychiatric condition that required immediate outpatient treatment (like moderate/severe depression). SUD treat- ment was not provided. Drug and alcohol abstinence was not required for study eligibility.
Family is one of the main agents capable of inluencing the individual vulnerability to initiate and establish prob- lematic patterns of consumption, both directly by genetic transmission or exposure to consumption within the fam- ily environment; and indirectly through violence, abuse, and continued stress, oten due to rigid or chaotic family structures, poor communication among family members, and attachment relationships marked by insecurity and/or abandonment 36-38 (B). On the other hand, positive relation-
Objective: To identify the perception of nursing professionals about drug therapy for people with mental disorders. Methods: An exploratory qualitative research was carried out in four Psychosocial Care Centers of Curitiba, Paraná, Brazil. Data, collected from January to March 2015 using an individual semi-structured interview applied to 56 nursing professionals, were submitted to qualitative data analysis and interpretation as proposed by Creswell. Results: The data were organized into three thematic categories: drug therapy improves the life of the person with a mental disorder; negative and positive consequences related to drug therapy; and drug therapy as one of the resources needed to treat mental health. Conclusion: Nursing staff perceive the importance of medications as a resource to treat people with mental disorders as psychotropic drugs minimize he acute symptoms of disorders and improve living conditions when associated with other therapeutic resources.
to be made to adapt ER procedures in order to facilitate the identification of such users upon their first ER visit. However, it is important to note that, even when such a drug test is positive, it does not necessarily indicate abuse or dependence. On the self-report questionnaire, only 9.9% of the sample admitted having used drugs within the last 24 hours, whereas the DAST-20 identified 15% as having some degree of problem related to substanceuse. Better techniques for measuring and identifying psychoactive substanceuse in the ER should be developed and established. Self-reported consumption of alcohol compared to the BAC estimate has been found to be a valid measure in previous ER studies. 1
This study aimed to analyze the evidence available in the literature about psychoac- tive substanceuse by persons with disabilities. We used integrative review of litera- ture in SciELO, PubMed, SCOPUS, BDENF, and PsychINFO databases, with the de- scriptors: pessoas com deficiência ; transtornos relacionados a uso de substâncias ; disabled persons; and substance-related disorders. Twelve articles were included in the sample. Data were analyzed and discussed descriptively. The studies’ results, with scientific evidence, were synthesized on two main themes: substanceuse by people with disabilities, and access of people with disabilities to treatment for substance- related disorders. The scientific evidences identified in studies reported disability as a risk factor for substance abuse, and also reported that disabled persons did not have access to treatment and rehabilitation services for substance abuse. Finally, the stu- dies analyzed pointed to the need for scientific research on this topic.
Behavior and eating patterns are complex, involve metabolic, physiological and environmental aspects and have inherited and species-specific circadian rhythmicity, with humans being essentially diurnal. The aim of this study is to describe the night eating syndrome, characterized by a delay of the circadian eating patterns and mediated by neuroendocrine stress. A review of the literature found in the Pubmed, Lilacs and Sirus databases published between 1955 and 2007 was done. The keywords used were: night eating syndrome, sleep, circadian rhythm, appetite, nocturnal eating. A total of 74 articles were found of which 26 were selected, whose central theme was the night eating syndrome. Despite all the studies done, there is still long way to go to understand the genesis of the night eating syndrome and its intrinsic relation with other physiological and pathogenic processes. Given that this syndrome is linked to the control of hunger and satiety and to the desynchronization between the eating rhythm and sleep / wake rhythm, understanding its genetic process can reveal the impact that the desynchronization of circadian eating rhythms has on the health-disease process and help understand the factors involved in the rising rates of obesity in modern society.
Abstract: Antiretroviral (ARV) medication for substance users has been a controversial issue with respect to whether current substance users can successfully maintain their medication regimens. This study compared ARV adherence across current substance users, former substance users and those with no history or current use and the relative impact of a medication adherence intervention on all three groups. Of the 481 predominantly African American and Latina women from Miami, New York and New Jersey enrolled in the SMARTEST Women’s Program, 338 participants were prescribed antiretroviral medication at study entry. All three groups, current users (n=60), former users (n=107) and never users (n=171), reported relatively high levels of adherence at baseline. Of those participants with less than 80% adherence at baseline, former users showed the most significant decrease in viral load post-intervention and at long term (two year) follow-up. These findings suggest former users to be the most reliable source of self-reported adherence and to profit most from the study intervention. They also suggest that additional research on targeted interventions for current substance users may be necessary to improve medication adherence for this group of women living with HIV.
We report a 19-year-old young male with a history of nightly sleep onset headbanging and bodyrocking since infancy. He was born a premature baby but psychomotor development was unremarkable. The patient was a senior high school student at the time of the first consultation. There was no family history of mental and neurological disorder and his personal history was unremarkable. Physical and neurological diagnostic workups were also unremarkable.
Studies of NSAID use and melanoma have conflicting results. Our finding of reduced risk with non-aspirin-only use, but not with aspirin is interesting. A few studies reported reduced risk of melanoma [72–74] including a recent large population-based study from Northern Denmark . On the other hand, some studies reported excess, although non-significant, risk of melanoma with non- aspirin use [76, 77]. A large Dutch population-based study reported a non- significant excess risk with non-aspirin NSAIDs but lower risk with continuous useof low-dose aspirin among women only . Although we found a lower risk of endometrial cancer with non-aspirin NSAID use and useof aspirin and non- aspirin NSAIDs together, we did not detect any dose response effect. Previous reports have conflicting results. While some studies reported lower endometrial cancer risk among obese women using NSAIDs [78, 79] other studies failed to detect any association [80, 81]. Our inability to find significant associations between any NSAID use and some cancers might be due to the lack of information on duration of long-term NSAID use [53, 82, 83]. For instance, a cohort study of 70,144 men demonstrated that the current aspirin or non-aspirin use was not associated with lower prostate cancer risk. However, consistent, long-duration useof non-aspirin NSAIDs ($30 pills/month for $5 years) was found to be related to a reduced risk of prostate cancer (relative risk 0.82, 95% CI (0.71 to 0.94). In addition, three large UK trials found that a daily useof aspirin only led to observable reductions in deaths due to several cancers after five years of follow-up, and benefit seemed to increase with duration of treatment . These data suggest that the duration ofuse may be important, and information on duration and consistency ofuse was limited in this study. That said, inflammation may contribute more to some cancers/categories of inflammation-related cancers and less to other cancers/categories of inflammation-related cancers, which could explain why we see an association for some cancers/category of inflammation- related cancers and not others.
provided by the courts, prison administrations and other agen- cies. In those two countries, 1594 murder convictions were reported between 1996 and 1999. Information was obtained from the courts in 1168 (73%) of the cases. Overall, 1434 (90%) of those convicted were men. Mental disorders were identified in one-third of the cases. Within that subgroup, most presented a single mental disorder, and the most common diagnoses were personality disorders and alcohol/drug dependence. A diagnosis of schizophrenia was made in 5% of the perpetrators. Of the 164 individuals who had a mental disorder at the time that the crime was committed, 76 (46%) p r e s e n t e d s y m p t o m s o f p s y c h o s i s ( d e l u s i o n s a n d hallucinations), and 101 (62%) presented symptoms of depression. One interesting finding is that the majority of perpetrators with a history of mental disorder were not acutely ill when the murder was committed, and most had never sought treatment at mental health facilities.
Purpose: To identify the effects of alcohol intake during pregnancy on the central auditory nervous system in relation to their possible diagnosis, Fetal Alcohol Syndrome, partial Fetal Alcohol Syndrome, Alcohol-Related Birth Defects and Alcohol-Related Neurodevelopmental Disorder, his extension and the hearing assessment method. Research strategy: Systematic and integrative review searched the databases PubMed, LILACS and SciELO, with terms in Portuguese and English “fetal alcohol syndrome”, “alcohol-related disorders” associated with “hearing”. Selection criteria: We identiied 123 abstracts, six were selected and published until May 2015. Data analysis: Were listed topics to be answered, characterization of the sample; the diagnosis result of fetal exposure; method of hearing assessment and described results. Results: Among the behavioral assessments, Verbal Dichotic Tests with syllables and sentences and Speech in Noise Test, were used. Among the electrophysiological tests, the Brainstem Auditory Evoked Potential was detected change neural synchrony, and Long-Latency Auditory Evoked Potential – P300, early latency values. Conclusion: There is evidence that children exposed to alcohol in utero present central auditory nervous system involvement signals, but it was not possible to identify the inluence of different subtypes and their losses. Cortical auditory pathways were the most investigated and the electrophysiological method as used with an unexpected result in two of them, early N2 and P300 latency.
often absent from class and those who developed serious alcohol-related problems and dropped out of school were left out of the sample. Second, despite emphasizing the importance of giving honest responses, the findings may have been underestimated due to self-censuring and/or a suspicion that school authorities could demand access to the answers on the questionnaires. Third, as the data were derived from self-administered questionnaires, memory lapses and a lack of attentiveness should be taken into consideration, despite the attempt to minimize these effects by showing the respon- dents pictures of standard portions of different types of alcoholic beverages. Fourth, information on the influence of friends and characteristics of friendship networks, such as density, size, quality of contacts, proximity and centrality, was not collected in the present study, despite the fact that binge drinking has been associated with such factors. Fifth, no investigation was conducted into the qual- ity of the relationships between the adolescents and their parents, how long they had lived together or whether they engaged in regular conversations. According to the results of the post hoc test, the sample power was low for some variables, which may represent a type II error and fail to reveal sig- nificant associations. However, the test power for the variables of interest (risk of increased tobacco use, religiousness and family members who drink) demonstrates that the sample was sufficient for the evaluation of associations with binge drinking. The frequency of the response variable cannot be extrapolated to the student population of the city of Belo Horizonte.
Hepatitis B surface antigen (HBsAg) quantiication has recently been introduced to guide treatment in chronic hepatitis B virus (HBV) patients. No information is currently available on useof HBsAg levels to guide HBV immune globulin (HBIG) administration after liver transplantation (LT). We performed a retrospective analysis of a prospectively collected database. Patients were included if: adults ( ≥ 18 years); recipients of a primary liver graft; HBsAg-positive and HBV DNA-negative at transplantation; hepatitis C and/or HIV-negative; not transplanted for fulminant hepatic failure; on nucleoside analogues. All patients were administered 30,000 IU HBIG, perioperatively, and hepatitis B surface antibody (HBsAb) was tested at day 7, 14, 28, and monthly thereafter. A further 30,000 HBIG were administered if HBsAb <100 mIU/mL and/or HBsAg >100 IU/mL on day 7. The primary endpoint was the eicacy of HBIG as a percentage of patients achieving HBsAg <100 IU/mL and HBsAb ≥ 100 mIU/mL at day 7. Secondary endpoints were performance of HBsAg levels in predicting HBsAg loss at day 7, HBV recurrence, graft, and patient survival at last follow-up. 41 LT recipients - transplanted between January 2011 and June 30, 2013 - were included (median age 54 years; male 78%). Hepatocellular carcinoma was present in 24 (58.5%) and hepatitis delta in 19 patients (46.4%); 7 (17.1%) patients did not achieve eicacy at day 7 and were boosted with additional 30,000 HBIG. A pre-transplant HBsAg level ≥1,000 IU/mL was associated with 60-fold odds for failure at day 7 (p=0.0002). At a median follow-up of 14 months after LT, graft and patient survival were 100% and no case of HBV recurrence had been observed. Based on our results, we advocate the useof HBsAg titre to guide HBIG prophylaxis after LT.