Dark chocolate (70% cocoa) reduces craving in smokers with severe cardiovascular comorbidities without interference in anthropometric measures / Chocolate amargo (70% cacau) reduz fissura em tabagistas com comorbidades cardiovasculares graves sem interferir nas medidas antropométricas

ABSTRACT Objective: Analyze craving in smokers with cardiovascular comorbidities submitted to a nutritional approach. Methods: Two groups were randomized and submitted to clinical intervention (n = 32): Group 1 (G1, n = 15): ingested 40 g of chocolate containing 70% cocoa/day and behavioral intervention for smoking cessation for one month; Group 2 (G2, n = 17): control group, only behavioral intervention. Questionnaire of Smoking Urges-Brief (QSU-Brief) - Brazil version measured total craving and its factors. Anthropometric measurements verified the nutritional interference of the procedure and the serum assessment verified the interference of inflammatory processes related to smoking. The study was registered on the Brazilian Registry of Clinical Trials (ReBEC): RBR-83jr3. Results: After one month, compared to the initial evaluation, the G1 reduced the craving evaluated by the QSU-Brief and its Factors 1 and 2. Total QSU-Brief: 44.27 ± 15.82 x 27.00 ± 18.03 (p = 0.008); Factor 1: 21.90 ± 7.70 x 12.90 ± 8.87 (p = 0.006); Factor 2: 11.90 ± 6.30 x 7.00 ± 6.63 (0.007). G2 showed a reduction in total QSU-Brief and Factor 1, but not in Factor 2. QSU-Brief total 28.17 ± 17.24 x 19.52 ± 9.50 (p = 0.049); Factor 1: 14.47 ± 8.74 x 9.23 ± 6.11 (p = 0.046). Serum levels of cortisol, leptin, serotonin, C-Reactive Protein (CRP) and insulin did not show differences (p > 0.05). No anthropometric differences were found. Conclusion: The results demonstrate that daily consumption of chocolate for one month (70%) reduced craving in smokers at the beginning of treatment. Chocolate potentiated the well-known effect of behavioral counseling on Factor 1 (pleasurable drug effects) and also interfered with factor 2 (unpleasant withdrawal effects).

RESUMO Objetivo: Analisar o craving em fumantes com comorbidades cardiovasculares submetidos a uma abordagem nutricional. Métodos: Intervenção clínica (n = 32) com dois grupos randomizados: Grupo 1 (G1, n = 15): recebendo 40 g de chocolate contendo 70% de cacau/dia e intervenção comportamental para cessação do tabagismo por um mês; Grupo 2 (G2, n = 17): grupo controle, recebendo apenas intervenção comportamental pelo mesmo período. O Questionnaire of Smoking Urges-Brief (QSU-Brief) - versão Brasil foi utilizado para avaliar o craving. As medidas antropométricas verificaram a interferência nutricional do procedimento e a avaliação sérica, a interferência de processos inflamatórios relacionados ao tabagismo. O estudo foi registrado no Registro Brasileiro de Ensaios Clínicos (ReBEC), RBR-83jr3. Resultados: Um mês depois, comparado à avaliação inicial, o G1 reduziu o craving total e seus fatores (1 e 2). QSU-Brief total: 44,27 ± 15,82 x 27,00 ± 18,03 (p = 0,008); Fator 1: 21,90 ± 7,70 x 12,90 ± 8,87 (p = 0,006); Fator 2: 11,90 ± 6,30 x 7,00 ± 6,63 (0,007). G2: redução no QSU-Brief total e Fator 1, mas não no Fator 2. QSU-Brief total 28,17 ± 17,24 x 19,52 ± 9,50 (p = 0,049); Fator 1: 14,47 ± 8,74 x 9,23 ± 6,11 (p = 0,046). Níveis séricos de cortisol, leptina, serotonina, proteína C-reativa (PCR) e insulina não apresentaram diferenças (p > 0,05). Não foram encontradas diferenças antropométricas significativas. Conclusão: Os resultados demonstram que o consumo diário de chocolate por um mês (70%) reduziu o craving em fumantes no início do tratamento. O chocolate potencializou o conhecido efeito do aconselhamento comportamental sobre o Fator 1 (efeitos prazerosos da droga) e também interferiu no fator 2 (efeitos desagradáveis da abstinência).

Inteligencia emocional como mediador del craving y el riesgo de recaída en adultos en tratamiento por consumo de alcohol

Objetivos: Analizar el efecto de craving sobre el riesgo de recaída en adultos en tratamiento por alcohol, considerando la Inteligencia Emocional Percibida (IEP) como mediador. Materiales y métodos: Estudio descriptivo, transversal, predictivo, de comprobación de modelo con análisis de mediación. La muestra fue de 274 adultos internos en Centros de Rehabilitación contra las Adicciones (CRCA). Los instrumentos utilizados fueron una Cédula de Datos Sociodemográficos, Cuestionario de Craving por Alcohol, Inventario de Cociente Emocional y Cuestionario de Variables Predictoras de Abandono y Adhesión al Tratamiento. Resultados: Existe una relación inversa entre la IEP, el riesgo de recaída (r = -,381, p <,001) y el craving (r = -,354, p <,001). El craving y el riesgo de recaída se relacionaron positivamente (r = ,218, p <,001). Se reporta un efecto total significativo del craving sobre el riesgo de recaída cuando es mediado por la IE, el cual explica el 11 % de la varianza (B = ,1389; t = 5,688; p <,001). Conclusiones: Los resultados de este estudio indican que IEP se asocia inversamente con el craving y el riesgo de recaída, además de que la IEP desempeña un papel significativo como mediador en esta relación. Esto sugiere que las personas con altos niveles de IEP disponen de más recursos para gestionar sus emociones, lo que podría ayudar a reducir las conductas de craving y, consecuentemente, sufrir un menor riesgo de recaída en el consumo de alcohol.

Objectives: To analyze the effect of craving on the risk of relapse in adults undergoing alcohol treatment, considering the Perceived Emotional Intelligence (PEI) as a mediator. Materials and methods: Descriptive, cross-sectional, predictive study, model checking with mediation analysis. The sample consisted of 274 adults interned in Rehabilitation Centers against Addictions (CRCA). The instruments used were a Sociodemographic Data Card, Alcohol Craving Questionnaire, Emotional Quotient Inventory and Questionnaire of Variables Predictors of Abandonment and Adherence to Treatment. Results: There is an inverse relationship between PEI, the risk of relapse (r = -, 381, p <,001) and craving (r = -, 354, p <,001). Craving and risk of relapse were positively related (r = ,218, p <,001). A significant total effect of craving on the risk of relapse is reported when mediated by EI, which explains 11% of the variance (B = ,1389; t = 5,688; p <,001). Conclusions: The results of this study indicate that PEI is inversely associated with craving and risk of relapse, and that PEI plays a significant role as a mediator in this relationship. This suggests the notion that people with high PEI levels have more resources to manage their emotions, which could help reduce craving behaviors and consequently, suffer a lower risk of relapse into alcohol consumption.

Effects of attentional bias training on attention bias, psychological craving and relapse rate in male patients with alcohol dependence / 中华行为医学与脑科学杂志

Objective:To explore the effect of attentional bias training on the attentional bias, psychological craving and relapse rate of alcohol dependent patients during rehabilitation.Methods:A randomized controlled trial was used to select 90 alcohol-dependent patients and randomly divide them into an intervention group and a control group. The alcohol cue pictures and neutral pictures were imported into E-Prime software at a ratio of 1∶1.The patients in the two groups were trained for eight times with attentional bias and without attentional bias by point delection paradigm. After each training, the software automatically records the response time and correct rate of the cue pictures and neutral pictures, and before intervention(T0), after 4 interventions(T4), and after 8 interventions(T8), the alcohol craving score was assessed by visual analogue scale and the relapse situation was followed up 1 month after the intervention. SPSS 24.0 software was used for statistical analysis.Repeat measure ANOVA, χ2 test and t-test were used to compare the response time, accuracy and psychological craving of the two groups. Results:Repeated measurement analysis of variance showed that there were interaction between group and time in cue-map response time, line chart accuracy and psychological craving score of the two groups ( F=5.218, 6.939, 147.14, all P<0.01). Simple effect analysis showed that there was no significant difference in cue pictures response time, cue pictures accuracy and psychological craving score between the intervention group and the control group at T0(all P>0.05), but there was significant difference at T4 and T8 (all P<0.05), and there was significant difference in neutral pictures reaction only at T8 ( P<0.05). The comparison between two groups showed that the intervention group showed a downward trend in cue pictures response, T4 and T8 were lower than T0, with statistical difference (both P<0.001), while there was no difference in the control group. In the intervention group, the correct rate of cue pictures increased, T4 and T8 were higher than T0, and there were statistical differences (both P<0.001), while there was no difference in the control group( P>0.05). The psychological craving scores of both the intervention group and the control group showed a downward trend, T4 and T8 were lower than T0, there were statistical differences (both P<0.001), but the difference between T4 and T8 in the control group remained unchanged. One month after the end of the intervention, the difference in the rate of relapse between the intervention group and the control group was marginal (11.10%, 26.70%, P=0.059). The total number of days of abstinence in the intervention group was longer than that in the control group ((28.33±4.99)d, (26.47±6.66)d, P=0.010). Conclusion:Attentional bias training can improve the mental craving and attentional bias of alcohol-dependent patients during the rehabilitation period, and the relapse rate decreased one month after the intervention.

Effect of rTMS combined with CBT on alcohol craving and cognitive function in patients with alcohol dependence / 中华行为医学与脑科学杂志

Objective:To explore the effect of repetitive transcranial magnetic stimulation (rTMS) combined with cognitive behavioral therapies (CBT) on the cognitive function and alcohol craving in patients with alcohol dependence.Methods:From March 2019 to September 2021, a total of 150 patients with alcohol dependence were enrolled and randomly divided into rTMS treatment group (rTMS+ sham CBT, n=41), CBT treatment group (CBT+ sham rTMS, n=34), rTMS+ CBT treatment group( n=36) and control group (sham rTMS+ sham CBT, n=39). At baseline (before treatment), 2nd week, 8th week, 12th week and 24th week, alcohol dependence scale (ADS) was used to evaluate the degree of alcohol dependence, the obsessive compulsive drinking scale (OCDS) was used to assess patients' drinking craving, and Montreal cognitive assessment scale (MoCA) was used to assess the overall cognitive level of patients.SPSS 23.0 statistical software was used to compare the differences of ADS, OCDS and MoCA scale scores of the four groups by repeated measure ANOVA and simple effect analysis. Results:(1)The patients in the four groups were evaluated with ADS scale at baseline, 12th week and 24th week respectively.The interaction of group×time( F=1.279, P=0.279) and the main effect of group were not significant ( F=0.882, P=0.454), and the main effect of time was significant ( F=12.925, P<0.001) .Further simple effect analysis showed that the ADS score of rTMS+ CBT group was lower than that of baseline(14.48±5.70, 10.00±6.51) ( P=0.01) at 24th week.(2)Patients in the four groups were assessed with OCDs scale at baseline, 2nd week, 8th week, 12th week and 24th week, and the interaction of group×time was significant ( F=2.015, P=0.042). Further simple effect analysis showed that the OCDs scores of rTMS group and rTMS+ CBT group at each follow-up time node were lower than those at baseline period (all P<0.05). (3)Patients in the four groups were assessed with MoCA scale at baseline, 8th week, 12th week and 24th week, and the interaction of group×time was not significant ( F=1.660, P=0.106), and the main effect of group and the main effect of time were significant ( F=2.964, P=0.038; F=14.239, P<0.001). Further simple effect analysis showed that the score of MoCA scale in CBT group at the 24th week was higher than that at baseline (21.73±5.81, 24.60±3.98)( P=0.029), the score of MoCA scale in rTMS+ CBT group at the 24th week was higher than that at the 8th week (23.50±6.01, 25.95±2.87) ( P=0.006), and the score of MoCA scale in rTMS group at the 12th week was higher than that in control group (22.08±6.64, 26.64±2.46)( P=0.009). Conclusion:rTMS combined with CBT can be effective in improving alcohol craving and cognitive function in patients with alcohol dependence, and has a good long-term effect.

The body asks and the mind judges: the episode of food craving, its triggers and nutritional treatment

ABSTRACT Food desires are defined as motivations that drive the search for and consumption of food. However, when domains of intensity and urgency are activated, these desires can become intense (i.e. food craving), being then characterized by episodes or cognitive events loaded with affectivity, in which food is associated with obtaining pleasure or relief, which is the only attentional focus. Specificity and urgency mark the differentiation between food desires and cravings. The process of elaboration with vivid images, the retention in working memory, the emergence of a negative affect state (awareness of the lack), and a committed attentional focus to seek food are characterized as stages of an episode of food craving. Individuals with eating disorders have the lowest levels of food craving when it comes to anorexia nervosa and the subsequent increase to bulimia nervosa and binge eating disorder. Some environmental and cultural triggers and internal factors of cognition and emotions play a crucial role in the emergence of food craving episodes. The external factors include positive/negative events, food environment, advertisements, cultural beliefs about food, specific locations, and food itself. The internal factors comprise dietary restriction, food reward, impulsivity/inflexibility, emotions, thoughts and feelings about food, hunger/satiety/appetite, and anxious/depressive symptoms. Treatment involves the association of flexibility, awareness, and questioning strategies about dietary practices based on three principles: unconditional permission to eat, eating more for physical than emotional reasons, and tuning in with the body's signs of hunger and satiety (intuitive eating).

Cannabidiol for the treatment of crack-cocaine craving: an exploratory double-blind study

Objective: To assess the efficacy of cannabidiol (CBD) in the management of crack-cocaine craving and the treatment of frequent withdrawal symptoms. Methods: Thirty-one men with a diagnosis of crack-cocaine dependence were enrolled in a randomized, double-blind, placebo-controlled trial. We applied neuropsychological tests and assessed craving intensity, anxiety and depression symptoms, and substance use patterns at baseline and at the end of the trial. The participants were treated with CBD 300 mg/day or placebo for 10 days. During this period, we used a technique to induce craving and assessed the intensity of symptoms before and after the induction procedure. Results: Craving levels reduced significantly over the 10 days of the trial, although no differences were found between the CBD and placebo groups. Craving induction was successful in both groups, with no significant differences between them. Indicators of anxiety, depression, and sleep alterations before and after treatment also did not differ across groups. Conclusion: Under the conditions of this trial, CBD was unable to interfere with symptoms of crack-cocaine withdrawal. Further studies with larger outpatient samples involving different doses and treatment periods would be desirable and timely to elucidate the potential of CBD to induce reductions in crack-cocaine self-administration.

Adicción a los Alimentos y Antojos en Preescolares referidos por sus Cuidadores / Food Addiction and Cravings in Preschoolers Residents Recognized by Their Caregivers

Resumen Objetivos: 1) Identificar y contrastar los síntomas de adicción a los alimentos en preescolares con y sin sobrepeso-obesidad (SP-OB), 2) Identificar y contrastar la frecuencia e intensidad de los antojos por alimentos en preescolares con y sin SP-OB, 3) Identificar factores que determinan el índice de masa corporal (IMC) del preescolar. Materiales y Métodos: Estudio descriptivo correlacional, participaron 201 cuidadores. Se aplicó la Escala Adicción a los Alimentos de Yale para Niños (YFAS-C) y Cuestionario Características de Antojos por los Alimentos. Se midió peso y talla del preescolar. Resultados: El coeficiente de fiabilidad Kuder-Richardson de YFAS-C, fue 0.635. El 91% de los cuidadores fueron madres. La media de síntomas de adicción a los alimentos en preescolares con SP-OB fue=0.3488 (n = 43) y sin SP-OB ẋ = 0.3987 (n = 158), U = 3351.00, p ˃ 0.05. Anticipación de refuerzo positivo fue la característica de antojo con la media más alta (ẋ= 9.05, DE = 4.21) y la más baja emociones (ẋ = 2.40, DE = 0.878), no se encontraron diferencias significativas. No se encontró relación entre los síntomas de adicción a los alimentos y el IMC del preescolar. Los antojos contribuyeron al IMC del preescolar, varianza explicada 12.2%. Conclusiones: La escala YFAS-C es la única diseñada para evaluar los síntomas de adicción a los alimentos en niños, sin embargo, en el presente estudio no se identificaron síntomas. Se recomienda continuar explorando este concepto, en este grupo de edad.

Abstract Objective: 1) To identify and to compare the food addiction symptoms of preschoolers with and without overweight-obesity (OW-OB), 2) To identify and to compare the frequency and intensity of food preschoolers cravings with and without overweight-obesity, 3) To identify factors that determine of preschooler BMI. Material and Methods: Descriptive correlational study, participated 201 caregivers. The Yale Food Addiction Scale for Children YFAS-C and Food Cravings Characteristics Questionnaire were applied. Preschooler weight and height were measured. Results: Kuder-Richardson reliability coefficient of YFAS-C was 0.635. A 91% of caregivers were mothers. Food addiction symptoms mean of preschoolers with OW-OB ẋ = 0.3488 (n = 43) and without OW-OB ẋ = 0.3987 (n = 158), U = 3351.00, p ˃ 0.05. The positive reinforcement anticipation was craving characteristic with the highest mean (ẋ = 9.05, SD = 4.21) and the lowest was emotions (ẋ = 2.40, SD = 0.878), no significant differences were found. No relation between food addiction symptoms and preschooler BMI was found. Cravings contributed to the preschool BMI, variance explained 12.2%. Conclusions: The YFAS-C scale is the only one designed to evaluate the food addiction symptoms of children, however none food addiction symptoms were identified. It is recommended to continue exploring this concept in this age group.

Food Craving and Symptoms of Premenstrual Syndrome among University Students

@#Introduction: Food craving was one of the common symptoms of premenstrual syndrome (PMS) among women. This study aimed to examine level of food craving during pre-menstruation and PMS symptoms; its association and predictor of PMS symptoms on food craving during pre-menstruation among university students. Methods: A cross-sectional study was conducted among female undergraduate students from International Islamic University Malaysia, Kuantan Campus. Screening phase for eligibility was conducted. Three questionnaires consisted of Health History Questionnaire, Food Craving Questionnaire-Trait-reduced and Premenstrual Tension Syndrome Rating Scale were distributed among eligible students. Descriptive analysis, Pearson correlation test and multiple linear regression were performed using SPSS version 22.0. P value was set at p<0.05 as statistically significant. Results: 129 students were eligible as study respondents. A total of 48% of the respondents showed clinically relevant traits of food craving. The highest food craving among respondents were sweet foods (45.7%) followed by fatty (18.6%), spicy (10.9%), salty (8.5%) and sour (2.3%) food. 60% respondents had moderate to severe PMS symptoms level. There was a significant association between food craving and PMS symptoms (p=0.001). PMS symptoms significantly predicted food craving (p=0.002). Conclusion: This study is at the forefront in reporting food craving and PMS symptoms among undergraduate students which were prevalent during pre-menstruation. Food craving was significantly associated with PMS symptoms. This research provides further insight related to food craving among women particularly the role of PMS symptoms as predictor. Strategies in preventing substantial calories intake during pre-menstruation is therefore required in this population.

Craving por mentolados: a propósito de un caso

Se describe un caso de craving por dulces mentolados, una paciente de 53 arios con cuadro de consumo excesivo de dulces mentolados (100 unidades/día). Ingresó con el antecedente de artritis reumatoide, con obesidad, en estado de ansiedad asociado con onicofagia y pellizcos de la piel. Se descartó la organicidad mediante paraclínicos y se le dio asistencia hospitalaria. Al alta, la paciente estaba estable; sin embargo, por progresión del dolor por la enfermedad reumática, ha sufrido síntomas depresivos, por lo que ha requerido ajuste de la medicación. Conclusiones: El food craving y la ansiedad presentan similitudes fisiopatológicas. Las mentas tienen distintos mecanismos o modos en que pueden contrarrestar o controlar estos síntomas, entre los que está el aumento de serotonina, la unión a receptores GABA-A y la estimulación del receptor nicotínico en las células nerviosas.

We describe a case of craving for menthol sweets in a 53-year-old woman with excessive consumption of menthol sweets (100 units/day). She was admitted with a history of rheumatoid arthritis, obesity, anxiety associated with onychophagia and pinching of the skin. Organic disorders were ruled out with paraclinical tests and in-hospital treatment was administered. At discharge, the patient's condition was stable, but because of exacerbated pain due to the rheumatological disease, she presented depressive symptoms, requiring her medication to be adjusted. Conclusions: The "food craving" and anxiety present pathophysiological similarities. Mints have different mechanisms or ways in which they can counteract or control these symptoms, including an increase in serotonin, binding to GABA-A receptors and stimulation of the nicotinic receptor in nerve cells.

Impaired control in heavy drinking and its association with alcohol craving and alcohol use disorder severity / Deterioro del control en el consumo excesivo de alcohol y su asociación con el deseo de consumo y la gravedad del trastorno por uso de alcohol

Abstract Introduction Impaired control over drinking has been frequently cited in diverse theoretical descriptions regarding harmful alcohol use and is considered a DSM criterion for alcohol use disorder. Differences in the frequency of endorsement of impaired control have been viewed as a reflection of the severity of the problem. Moreover, it has been posited that the ability to place a limit on alcohol consumption may be mediated through enhanced craving. Objective In this study, we addressed the relationship between impaired control, self-reported craving, and alcohol dependence severity among heavy drinkers. Method We conducted a latent class analysis of impaired control dimensions (perceived control, failed control, and attempted control) of 208 heavy drinkers. To determine whether the identified classes could represent different forms of severity of the disorder, the best-fit model was contrasted with scores on the Alcohol Dependence Scale. Furthermore, we assessed the relationship between impaired control criteria (using the Impaired Control Scale [ICS]) with alcohol craving. Results We identified a three-class solution based on impaired control severity. A graded increase of the craving scores and alcohol severity among the three classes was also identified. Only the ICS items comprising perceived control and partially those related to failed control, but not those evaluating attempted control, distinguished the gradient among the latent classes. Discussion and conclusion This study provides further support of the proposal of a unidimensional continuum of severity among heavy drinkers and strengthens the theoretical relationship between impaired control and alcohol craving.

Resumen Introducción El deterioro del control sobre el consumo del alcohol se ha mencionado con frecuencia en diversas descripciones teóricas relativas al uso nocivo y es un criterio clínico del DSM para el trastorno por uso de alcohol. Las diferencias en la frecuencia con que se admite el deterioro del control se han considerado como un reflejo de la gravedad del problema. Además, se ha postulado que la capacidad de poner un límite al consumo de alcohol puede estar mediada por el deseo de consumirlo (craving). Objetivo En este estudio se abordó la relación entre el deterioro del control, el autoreporte del craving y la gravedad de la dependencia del alcohol en un grupo de bebedores fuertes. Método Se realizó un análisis de clases latentes usando las dimensiones del deterioro del control (control percibido, control fallido e intento de control) de 208 bebedores fuertes. Para determinar si las clases identificadas podían representar diferentes formas de gravedad del trastorno se contrastó el modelo más adecuado con las puntuaciones de la Escala de Dependencia del Alcohol. Además, se evaluó la relación entre los criterios de deterioro del control (utilizando la Escala de Control Deficiente, ECD) y el craving. Resultados Identificamos una solución de tres clases basada en la gravedad del deterioro de control. En esa solución se identificó una relación con el aumento graduado de las puntuaciones de craving y la gravedad de la dependencia entre las clases. Sólo los elementos de la ECD que comprenden el control percibido y parcialmente los relacionados con el control fallido, pero no los que evalúan el intento de control, distinguieron el gradiente entre las clases latentes. Discusión y conclusión Este estudio proporciona más apoyo a la propuesta de un continuum unidimensional de gravedad entre los usuarios de alcohol y refuerza la relación teórica entre el fenómeno de deterioro del control y el craving.

Cognitive and clinic profile of volatile substance users / Perfil cognitivo y clínico de usuarios de sustancias volátiles

Abstract Introduction Inhalant use disorder has increased in spite of its adverse medical consequences. Due to the inherent difficulties of working with this population, so far there has been no quantifiable clinical evidence of the cognitive characteristics of inhalants users in early withdrawal and the clinic effect of consumption time. Objective To evaluate the clinical and cognitive performance of inhalant users and the clinic effects of consumption time. Method A cross-sectional study in which 28 adult users of inhalants were included, divided in two groups according to their consumption time: less than or greater than seven years. They were all evaluated in terms of clinical and neuropsychological values. Results Consumers of inhalant showed presence of craving (M = 479.14, SD = 213.51), altered frontal behavior before (M = 119.18, SD = 29.53) and now (M = 130, SD = 33.03), sleeping problems (M = 8.93, SD = 3.4), and cognitive difficulties (inhibitory control, planning, decision-making, working memory, verbal fluency, and cognitive flexibility); all these tasks were statistically significant (p = < .05). Discussion and conclusion Executive functioning is impaired with inhalant use disorder; these alterations increase with withdrawal and craving and changes remain independent from the use time.

Resumen Introducción El trastorno por uso de inhalables ha aumentado a pesar de las consecuencias médicas adversas. Debido a las dificultades que entraña trabajar con estas poblaciones, hasta hace poco no había evidencia clínica cuantificable de las características cognitivas de los usuarios de inhalables en la abstinencia temprana y de los efectos clínicos del tiempo de consumo. Objetivo Se analizó el rendimiento clínico y cognitivo de usuarios de inhalables y los efectos clínicos del tiempo de consumo. Método Estudio transversal en el que se incluyeron 28 adultos usuarios de inhalables, divididos en dos grupos dependiendo del tiempo de consumo, menor o mayor a siete años. Todos fueron evaluados en términos de valores clínicos y neuropsicológicos. Resultados Los consumidores de inhalables mostraron presencia de craving (M = 479.14, SD = 213.51), comportamiento frontal alterado antes (M = 119.18, SD = 29.53) y actualmente (M = 130, SD = 33.03), problemas para dormir (M = 8.93, SD = 3.4) y dificultades cognitivas (control inhibitorio, planificación, toma de decisiones, memoria de trabajo, fluidez verbal y flexibilidad cognitiva); todas estas tareas fueron estadísticamente significativas (p = < .05). Discusión y conclusión El funcionamiento ejecutivo se ve afectado en el trastorno por uso de inhalables. Estas alteraciones aumentan en la abstinencia y en la apetencia, y los cambios se mantienen independientes del tiempo de uso.

Características clínicas, neuropsicológicos y psicofisiológicos del trastorno por atracón: Resultados preliminares / Clinical, neuropsychological and psychophysiological features of binge eating disorder: Preliminary results

Resumen El trastorno por atracón (TA) es una condición compleja en la que se han descrito diferentes aspectos clínicos y fallas neuropsicológicas en los sujetos que lo padecen. En este estudio se compararon variables clínicas (VC), neuropsicológicas (VNPS) y psicofisiológicas (VPFS) entre participantes sanos (n = 15) y con TA (n = 15) evaluados en la [Omitido por el editor]. Las VC incluyeron el inventario del anhelo por el consumo de alimentos (IACA), sintomatología depresiva (SD), ansiedad (SA) e impulsividad. Se utilizaron la Tarea de Cartas de Wisconsin para evaluar flexibilidad cognitiva (FC) y la Tarea de Señal de Alto para control inhibitorio (CI) dentro de las VNPS; en las VPFS se obtuvo la variabilidad de la frecuencia cardiaca (VFC) durante una prueba de exposición a imágenes de alimentos. Los resultados muestran que los participantes con TA obtuvieron puntuaciones mayores en los instrumentos IACA (p < .0001), SD (p < .0001) y SA (p < .0001); mientras que en las VNPS mostraron fallas en la FC con incremento en el porcentaje de errores totales (p = .01), errores perseverativos (p = .03) y CI (p = .004). Para las VPFS se encontró una reducción de la VFC (p < .0001) en aquellos participantes con TA.

Abstract Binge eating disorder (BED) is a complex condition in which different clinical aspects and neuropsychological faults have been treated in subjects who have it. In this study, clinical (VC), neuropsychological (VNPS) and psychophysiological (VPFS) variables were compared between healthy participants (n = 15) and with BED (n = 15) evaluated in the medicine school of the Autonomous University of Querétaro. The VC included the evaluation of the food craving scale (FCS), depressive symptomatology (DS), anxiety (AS) and impulsivity. It is used in the Wisconsin Cards Sorting Test for Cognitive Flexibility (CF) and the Stop Signal Task for Inhibitory Control (IC) within the VNPS; In the VPFS, the heart rate variability (HRV) was obtained during an exposure test to food images. The results showed that the participants obtained high scores in the evaluation instruments for FCS (p < .0001), SD (p < .0001) and SA (p < .0001); whereas in the VNPS it failed in the FC with an increase in the percentage of total errors (p = .01), perseverative errors (p = .03) and CI (p = .004). For the VPFS, a reduction in HRV (p < .0001) was found in those participants with AT.

Deseo intenso por alimentos apetecibles: validación y estandarización del Food Craving Questionnaire-Trait en México / Intense craving for appetizing foods: validation and standardization of the Food Cravings Questionnaire-Trait in Mexico

Resumen Introducción: El food craving o “ansia por comer” es una respuesta motivacional y fisiológica por comer alimentos específicos, principalmente con alto contenido calórico. Para evaluarlo se usa, entre otros, el Food Craving Questionnaire Trait, estructurado multidimensionalmente y validado en diversos países, el cual ha mostrado ser sensible y adaptable a los cambios contextuales-culturales. Objetivos: Validar y estandarizar el Food Craving Questionnaire-Trait en adultos de la Ciudad de México. Método: Estudio no experimental, transversal y aleatorizado de 1059 sujetos de uno y otro sexo, entre 18 y 84 años; 71.86 % del sexo femenino. Se examinaron propiedades psicométricas con análisis factoriales exploratorios y confirmatorios. Resultados: Se redujeron los factores del cuestionario y los ítems se reorganizaron de forma diferente al original. El análisis factorial confirmatorio mostró ajuste adecuado y estandarización aceptable de los factores. Se encontró alta consistencia interna para el cuestionario global (a = 0.973 y rho = 0.975) para cada uno de los factores. Conclusión: Este estudio determina la viabilidad del Food Craving Questionnaire para población de la Ciudad de México.

Abstract Introduction: Food craving is a motivational and physiological response for eating specific foods, mainly with high caloric content. To assess food craving, self-reports, inventories and questionnaires are used. The Food Cravings Questionnaire-Trait is multi-dimensionally structured and has been validated in several countries, since it is sensitive and adaptable to contextual-cultural changes. Objectives: To validate and standardize the Food Cravings Questionnaire-Trait in adults of Mexico City. Method: Non-experimental, cross-sectional, randomized study of 1059 subjects of both genders, between 18 and 84 years of age; 71.86 % of the female gender. Psychometric properties were examined with exploratory and confirmatory factor analyses. Results: The domains of the questionnaire were reduced and the items were reorganized differently from the original version. The confirmatory factor analysis showed an adequate fit and acceptable standardization of factors. High internal consistency was found for the global questionnaire (a = 0.973 and rho = 0.975) for each one of the domains. Conclusion: This study determines the viability of the Food Cravings Questionnaire for the population of Mexico City.

Estratégias de enfrentamento do craving em dependentes de crack em tratamento em Comunidades Terapêuticas* / Estrategias de afrontamiento en craving de dependiente de crack em tratamiento en Comunidades Terapéuticas / Coping strategies of craving in crack-cocaine dependents in treatment in Therapeutic Communities

OBJETIVOS: identificar e descrever as estratégias de enfrentamento utilizadas perante o craving por usuários de crack que estavam em tratamento internados em Comunidades Terapêuticas. MÉTODO: a amostra foi composta por 133 homens. Os instrumentos utilizados foram: Questionário sociodemográfico e rastreio do uso de drogas, Mini-Exame do Estado Mental e uma Escala de Perguntas sobre craving. A análise utilizada foi a estatística descritiva e de frequências para análise exploratória com nível de significância de 5%. RESULTADOS: os participantes relataram um predomínio da categoria Força de Vontade e de comportamento de Esquiva em resposta ao craving. CONCLUSÃO: esses resultados são importantes contribuições na compreensão do enfrentamento do craving, sinalizando a importância do trabalho da prevenção de recaídas, da família e tratamentos eficazes.

OBJECTIVES: to identify and describe the coping strategies used in the face of craving by crack-cocaine users who were under treatment in the Therapeutic Communities. METHOD: the sample consisted of 133 men. The instruments were a socio-demographic questionnaire and on drug use screening, the Mini-Mental State Examination and the scale of questions on craving. The analysis used was descriptive and frequency statistics for exploratory analysis with significance level of 5%. RESULTS: the results demonstrate a predominance of the Willpower category and Dodge in response to craving. CONCLUSION: these results are important contributions in understanding the coping of craving, signaling the importance of relapse prevention work, of the family and of effective treatments.

OBJETIVOS: el objetivo del estudio fue identificar y describir las estratégias de afrontamiento utilizadas frente al craving por consumidores de crack que estaban em tratamiento internados en Comunidades Terapéuticas. MÉTODO: la muestra consistió en 133 hombres. Los instrumentos fueron: cuestionario sociodemográfico y la detección del consumo de drogas; Mini Examen del Estado Mental y Craving Cuestionario. El análisis utilizada fue descriptiva y las estadísticas de frecuencia para el análisis exploratorio con un nivel de significación del 5%. RESULTADOS: los resultados muestran el predominio de la categoría de fuerza de voluntad y el comportamiento de Esquivar en respuesta a las ansias. CONCLUSIÓN: estos resultados son importantes contribuciones en la comprensión de la cofia antojo, lo que indica la importancia de la labor de prevención de recaídas, la familia y los tratamientos eficaces.

Craving for heroin: difference between methadone maintenance therapy patients with and without ADHD / Fissura por heroína: diferença entre pacientes em terapia de manutenção com metadona com e sem TDAH

Abstract Introduction Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder persisting in adulthood in 40-60% of cases. Clinical and neuroimaging studies suggest that patients affected by both drug addiction and ADHD show higher rates of craving for drug than patients without ADHD. We designed a pilot open-label study to investigate the effects of ADHD on craving for heroin in methadone maintenance therapy patients. Method Patients were recruited from outpatient facilities in an addiction treatment unit in the municipality of Alba, Italy. They were assessed using the Structured Clinical Interview for DSM-5 (SCID-5), the SCID-5 for Personality Disorders (SCID-5-PD), the Diagnostic Interview for Adult ADHD, second edition (DIVA 2.0), and the Clinical Opiate Withdrawal Scale (COWS). Categorical variables were examined using the chi-square test, and continuous variables, the t-test and Mann-Whitney's U test for normally and non-normally distributed data, respectively. Data distribution was evaluated using Shapiro-Wilk's test. Significance was set at p=0.05. Bonferroni correction was applied (0.0063) to avoid type I error. Results A total of 104 patients were included in the study: 14 affected by ADHD (13.5%) and 90 were not affected (86.5%). Patients with ADHD showed higher intensity of craving for heroin than patients without ADHD in the absence of withdrawal symptoms. Conclusion Drug addiction and ADHD share various neurobiological mechanisms that mutually influence the evolution of both disorders. In particular, dopamine dysfunction within various brain circuits may influence impulsivity levels, motivation, inhibitory control, executive functions, and behavior and, consequently, the intensity of craving.

Resumo Introdução O transtorno de déficit de atenção e hiperatividade (TDAH) é um transtorno do neurodesenvolvimento que persiste na idade adulta em 40-60% dos casos. Estudos clínicos e de neuroimagem sugerem que pacientes afetados tanto por adição quanto por TDAH apresentam maiores índices de fissura (craving) por droga do que pacientes sem TDAH. Este estudo piloto aberto investigou os efeitos do TDAH sobre fissura por heroína em pacientes em terapia de manutenção com metadona. Método Os pacientes foram recrutados em serviços ambulatoriais em uma unidade de tratamento de adição na cidade de Alba, Itália. Eles foram avaliados usando os seguintes instrumentos: Structured Clinical Interview for DSM-5 (SCID-5), SCID-5 for Personality Disorders (SCID-5-PD), Diagnostic Interview for Adult TDAH, second edition (DIVA 2.0) e Clinical Opiate Withdrawal Scale (COWS). Variáveis categóricas foram examinadas utilizando o teste do qui-quadrado, e variáveis contínuas, o teste t e o teste U de Mann-Whitney para dados com distribuição normal e não normal, respectivamente. A distribuição dos dados foi avaliada usando o teste de Shapiro-Wilk. O nível de significância foi estabelecido em p=0,05. A correção de Bonferroni foi aplicada (0,0063) para evitar erro tipo I. Resultados Um total de 104 pacientes foram incluídos no estudo: 14 com TDAH (13,5%) e 90 sem (86,5%). Pacientes com TDAH mostraram maior intensidade de fissura por heroína do que pacientes sem TDAH na ausência de sintomas de abstinência. Conclusão Adição e TDAH compartilham mecanismos neurobiológicos que influenciam mutuamente a evolução dos dois transtornos. Em particular, a disfunção da dopamina em vários circuitos cerebrais pode influenciar os níveis de impulsividade, motivação, controle inibitório, funções executivas e comportamento, e, portanto, a intensidade da fissura.

Crack e sonhos: a visão dos usuários / Crack cocaine and dreams: the view of users

Resumo O objetivo deste artigo é descrever os conteúdos dos sonhos dos usuários de crack, de acordo com sua visão, e analisar a interferência que produzem no processo de abstinência. Pesquisa qualitativa com 21 usuários de crack. Consumir a droga durante o sonho significou o fracasso ou uma forma compensatória de prazer ou de alerta a potenciais recaídas; não consumir a droga significou sintomas de abstinência ou o sucesso em ter vencido a dependência. A interpretação dada aos sonhos pode levar os usuários de crack à fissura e recaída. Os resultados podem contribuir para intervenções terapêuticas eficazes.

Abstract This paper aims to describe the dream content of crack cocaine users as per their view and analyze its interference in the drug withdrawal process. This is a qualitative research with 21 crack cocaine users. Consuming crack cocaine during the dream meant a proof of failure or compensatory pleasure or warning of potential relapse; not consuming the crack cocaine meant the emergence of withdrawal symptoms or the success at overcoming drug dependence. Dream interpretation may lead users to craving and relapse. The outcomes may contribute to effective therapeutic interventions.

Exploring the structural and construct validity of the Brazilian Food Cravings Questionnaire-Trait-reduced (FCQ-T-r)

Objective: Food cravings play an important role in the neurobiology of appetitive behavior, being positively associated with negative feelings, eating disorders, and obesity. This study aimed to assess the psychometric properties of the Brazilian Food Cravings Questionnaire-Trait-reduced (FCQ-T-r), a short version of the most widely used measure of this behavior. Methods: Undergraduate students (n=505) completed the full version of the FCQ-T and the Three-Factor Eating Questionnaire. Respondents' height and weight were also measured. Exploratory factor analyses were performed. Results: The FCQ-T-r exhibited a single-factor structure and satisfactory internal consistency (α > 0.80). A positive correlation was observed between FCQ-T-r scores and those of the original version. Furthermore, FCQ-T-r scores correlated positively with uncontrolled eating and emotional eating behaviors. No correlation was found between body mass index and FCQ-T-r scores. Considering our sample characteristics, we suggested specific FCQ-T-r cutoff points for males and females in the Brazilian population. Conclusion: Our results support the structure of the Brazilian adaptation of the FCQ-T-r, which seems to be a viable instrument to investigate food cravings, particularly in time-constrained settings. Further studies are needed to verify these findings in other age ranges and clinical samples.

Validação brasileira do Alcohol Craving Questionnaire ­ Short Form Revised (ACQ-SFR) / Brazilian validation of Alcohol Craving Questionnaire ­ Short Form Revised (ACQ-SFR)

Introdução: A avaliação do craving é importante para o tratamento de pacientes com Transtornos por uso de substâncias psicoativas. O objetivo deste estudo foi realizar a validação do Alcohol Craving Questionnaire-Short Form Revised- Versão Brasileira (ACQ-SFR ­ Versão Brasileira). Métodos: Foi um estudo observacional transversal, com uma amostra não aleatória de 121 participantes alcoolistas, do sexo masculino, internados para desintoxicação em unidade especializada. Os instrumentos utilizados foram: entrevista clínica com dados sociodemográficos e de padrão de uso de substâncias, MMSE, ACQ-SFR ­ Versão Brasileira, EAV do craving, BDI, BAI, estímulo visual indutor de craving. Resultados: Na análise fatorial, foram encontrados dois fatores: o fator 1 representa o craving pelo reforço positivo e negativo do álcool, e o fator 2, o propósito de consumir o álcool associado ao prazer. O alfa de Cronbach total foi de 0,91 (12 itens), o do Fator 1 foi 0,92 (8 itens) e o do Fator 2 foi 0,70 (3 itens). O total de pontos da escala foi correlacionado com a Escala Analógico-Visual (r=0,658; p<0,01). Conclusão: Conclui-se que o ACQ-SFR ­ Versão Brasileira demonstrou ter propriedades psicométricas satisfatórias. (AU)

Introduction: The assessment of craving is important in the treatment of patients with psychoactive substance use disorders. The purpose of this study was to validate the Brazilian version of the Alcohol Craving Questionnaire ­ Short Form Revised (ACQ­SFR ­ Brazilian Version). Methods: A cross-sectional observational study was conducted, with a non-random sample of 121 male alcoholic participants admitted for detoxification in a specialized unit. The instruments used to collect data were clinical interview with sociodemographic data and substance use pattern, MMSE, ACQ-SFR ­ Brazilian version, VAS of craving, BDI, BAI, and visual inducer of craving. Results: In a factorial analysis, two factors were found: factor 1 represents craving due to positive and negative reinforcement of alcohol use, and factor 2, the purpose of consuming alcohol associated with pleasure. Overall Cronbach's alpha was 0.91 (12 items), while factor 1 was 0.92 (8 items) and factor 2 was 0.70 (3 items). Total scale score correlated with VAS score (r = 0.658; p < 0.01). Conclusions: AACQ-SFR ­ Brazilian version presented satisfactory psychometric properties. (AU)

Trastornos del ánimo, nutrición y craving / Mood disorders, nutrition and craving

Resumen Objetivos: La relación entre diversas variaciones de la ingesta alimentaria y los trastornos del ánimo es un fenómeno bien conocido para diversos clínicos. No obstante estos fenómenos han sido escasamente estudiados a la fecha. Los métodos de evaluación del atracón o "craving" son diversos, lo que ha generado hallazgos heterogéneos y superficiales. El objetivo de esta revisión es un análisis de la fenomenología del craving y las diversas relaciones entre nutrición y trastornos del ánimo, específicamente con el trastorno bipolar (TBP). Método: Se realizó una revisión narrativa a través de una búsqueda no sistemática de la literatura a través de la base de datos MEDLINE, utilizando términos MeSH. Resultados: Los resultados en esta área a la fecha son escasos y diversos. Se evaluó la evidencia a la fecha en torno a la relación bidireccional entre TBP y nutrición, y con trastornos de la conducta alimentaria (TCA), específicamente el trastorno por atracones (TA). Por otro lado se revisó la literatura en cuanto a la comprensión del concepto de craving (antojo o deseo intenso) por carbohidratos, su neurobiología y sus relaciones con los trastornos del ánimo, específicamente con el TBP. Conclusiones: A pesar de que los desórdenes analizados aquí presentan relaciones conocidas de larga data por los clínicos dedicados a trastornos del ánimo, la literatura de investigación ha sido bastante limitada acerca de tales relaciones. Considerando las importantes implicancias que pueden llegar a tener en el diagnóstico, evolución y terapéutica de los pacientes, parece necesario un esfuerzo por continuar avanzando en la comprensión de los mecanismos más íntimos de estos trastornos, sus aspectos clínicos y sus diversas relaciones.

Objectives: The relationship between food intake alterations and mood disorders is a well-known phenomenon for various clinicians. However, these phenomena have been scarcely studied to date. The methods of evaluation of craving are diverse, generating heterogeneous and superficial findings. A more refined analysis of the phenomenology of craving and the various relationships between nutrition and mood disorders, specifically Bipolar Disorder (BPD), are the objetives of the present review. Method: A narrative review was carried out through a non-systematic search of the literature through the MEDLINE database, using MeSH terms. Results: The results in this area to date are scarce and diverse. We evaluated the evidence to date about the bidirectional relationship between BPD and nutrition, and Eating Disorders (ED), specifically, Binge Eating Disorder (BEA). On the other hand, the literature was revised in terms of understanding the concept of craving for carbohydrates, its neurobiology, and its relationships with mood disorders, specifically BPD. Conclusions: Despite being concepts and relationships long-known by clinicians dedicated to mood disorders, literature and research was quite limited in relation to this. Independent academic efforts remain pending to continue developing in the understanding of the intimate mechanisms of these disorders, their clinical phenomena and diverse relationships, considering the important implications that they may have on the diagnosis, evolution and therapies of patients.

Neurobiological Basis of Craving and Anti-Craving Medications / 신경정신의학

Clinical studies published over the past two decades have consistently demonstrated the therapeutic efficacy and safety of anti-craving medications. To use anti-craving agents more effectively in clinical settings, it is important to set clear treatment goals. Because alcoholic patients have lost control of drinking alcohol, it is recommended to set ‘abstinence’ as a goal rather than ‘controlled drinking’. Indeed, the therapeutic effects of anti-craving medication are higher when abstinence is set as the target. On the other hand, if abstinence is the sole criterion, it is difficult to elicit the motivation of a patient who lacks motivation in clinical practice. In the case of patients who have not yet gained insight, the initial goal might be set to gradually reduce the amount of alcohol consumed and prevent at-risk heavy drinking. Even in this case, anti-craving can help clinically. To increase the effectiveness of anti-craving medications, it is best to start at least four to seven days after the patient has stopped drinking. If the patient has alcohol withdrawal symptoms, they should be treated first.