Resting-state functional connectivity alterations of ventral tegmental area in adult male smokers: a functional magnetic resonance imaging study / 中华行为医学与脑科学杂志

Objective:To investigate the alterations of resting-state functional connectivity (RSFC) in ventral tegmental area (VTA) and substantia nigra (SN) among male smokers, and its correlation with clinical characteristics of smoking.Methods:The resting-state functional magnetic resonance data of 131 subjects recruited from January 2014 to December 2018 were analyzed retrospectively, including 76 smokers (smoking group) and 55 non-smokers (control group). VTA/SN was selected as regions of interest (ROI), and then calculated RSFC between VTA/SN and the whole brain.Based on SPM12 software, independent sample t-test was conducted to compare the differences in RSFC between smoking group and control group.Based on SPSS 22.0 software, Pearson correlation analysis was used to investigate the relationships between the RSFC of brain regions with significant differences and Fagerstr?m test for nicotine dependence (FTND) score, pack-year of smokers. Results:Compared with control group, the results showed decreased RSFC between VTA and the brain regions related default mode network (DMN)(including posterior cingulate cortex, right anterior cuneiform lobe, bilateral superior temporal gyrus, right middle temporal gyrus and right inferior parietal lobule), and regions of limbic system(including right marginal lobe and right angular gyrus), right calcarine (MNI: x, y, z=24, -55, -14) and left insula(MNI: x, y, z=-35, -11, 9) in smoking group(GRF corrected, voxel level P<0.005, cluster level P<0.05). Taking SN as the seed, there was no significant difference between smoking group and control group ( P>0.05). RSFC of VTA-left superior temporal gyrus was positively correlated with pack-year( r=0.243, P=0.034) and FTND ( r=0.282, P=0.014). VTA-left insula RSFC was positively correlated with FTND ( r=0.316, P=0.006). Conclusion:The RSFC in the mesolimbic system and the VTA-DMN circuit exist abnormal changes in smokers.To some extent, it may explain the reward deficits and dysfunction of emotion regulation in smokers, which may provide clues for further understanding the mechanism of tobacco addiction.

Programa com jogos de raciocínio para adolescentes em situação de dependência de substâncias psicoativas / A thinking games program for adolescents in a situation of psychoactive-substance dependence / Programa con juegos de pensamiento para adolescentes en situación de dependencia a sustancias psicoactivas

OBJETIVO: verificar impactos da aplicação de um programa com uso de jogos de raciocínio embasado na metodologia Mind Lab nas funções executivas atenção, flexibilidade e planejamento em adolescentes em situação de dependência de substâncias psicoativas. MÉTODO: estudo quantitativo quase-experimental com aplicação de instrumentos de avaliação neuropsicológica pré e pós-intervenção. Participaram 35 adolescentes com idades entre 12 e 17 anos internados em um Centro de Atenção Integrada à Saúde Mental na cidade de São Paulo. RESULTADOS: evidenciou-se melhora na atenção após a aplicação do programa com jogos. Quanto às funções planejamento e flexibilidade, foram observadas melhoras, porém estas não foram significativas. CONCLUSÃO: foi possível verificar a importância da utilização de jogos de raciocínio como recurso lúdico no tratamento de adolescentes em condição de dependência de substâncias psicoativas, possibilitando a construção de estratégias que auxiliem no processo de recuperação e reabilitação.

OBJECTIVE: to analyze the impacts of the application of a program using thinking games based on the Mind Lab methodology on the executive functions: attention, flexibility and planning in adolescents in a situation of psychoactive-substance dependence. METHOD: quasi-experimental quantitative study with the application of neuropsychological assessment tools before and after intervention. Thirty-five adolescents aged 12 to 17 years old, admitted to an Integrated Mental Health Care Center in the city of São Paulo, participated in this study. RESULTS: there was evidence of attention improvement after application of the games program. Regarding the planning and flexibility functions, improvements were observed, but they were not significant. CONCLUSION: it was possible to observe the importance of using thinking games as a playful resource in the treatment of substance-dependent adolescents, thus enabling the construction of strategies that assist in their recovery and rehabilitation process.

OBJETIVO: verificar impactos de la aplicación de un programa utilizando juegos de pensamiento basados en la metodología Mind Lab sobre las funciones ejecutivas de atención, flexibilidad y planificación en adolescentes en situación de dependencia a sustancias psicoactivas. MÉTODO: estudio cuantitativo cuasiexperimental con aplicación de instrumentos de evaluación neuropsicológica antes y después de la intervención. Treinta y cinco adolescentes de 12 a 17 años, ingresados en un Centro Integrado de Atención de Salud Mental en la ciudad de São Paulo, participaron en este estudio. RESULTADOS: hubo evidencia de mejora en la atención después de la aplicación del programa con juegos. Con respecto a las funciones de planificación y flexibilidad, se observaron mejoras, pero estas no fueron significativas. CONCLUSIÓN: fue posible verificar la importancia del uso de juegos de pensamiento como recurso lúdico en el tratamiento de adolescentes en condición de dependencia de sustancias psicoactivas, permitiendo la construcción de estrategias que ayuden en el proceso de recuperación y rehabilitación.

Changes in salivary composition of chemically dependent subjects / Cambios en la composición salival de personas químicamente dependientes

Abstract Chemically dependent subjects may present relevant changes in the volume and composition of salivary fluid because the secretion of the salivary glands is controlled by the parasympathetic and sympathetic system. The aim of this study was to compare the salivary concentration of total proteins, amylase, urea, calcium, phosphate and flow rate between chemically dependent and non-chemically dependent subjects. Saliva flow rate, calcium, phosphate, total protein, amylase and urea concentrations were measure in both groups: chemical dependent group (n=27) and control group (n=27). Saliva samples, from the chemically dependents, were taken one day before the beginning of the detoxification treatment. Statistical analysis was undertaken using t-test. The salivary flow and the urea concentration did not present statistically significant difference between the groups. However, total proteins, amylase, calcium and phosphate concentrations were statistically higher on the chemical dependents group. Saliva composition seems to be modified by the chronic use of alcohol and illicit drugs.

Resumen Los dependientes químicos pueden presentar cambios relevantes en el volumen y la composición de la saliva, debido a que la secreción de las glándulas salivales es controlada por el sistema parasimpático y simpático. El objetivo de este estudio fue comparar la concentración salival de proteínas totales, amilasa, urea, calcio, fosfato y la velocidad de flujo salival entre personas con dependencia química y no dependientes. Cada grupo fue formado por 27 participantes. La velocidad del flujo salival y las concentraciones de calcio, fosfato, proteína total, amilasa y urea se midieron en ambos grupos. Las muestras de saliva de los dependientes químicos se tomaron un día antes de comenzar el tratamiento de desintoxicación. El análisis estadístico se realizó por medio del test t de student. El flujo salival y la concentración de urea no presentaron diferencias estadísticamente significativas entre los grupos. Sin embargo, las concentraciones de proteínas totales, amilasa, calcio y fosfato fueron estadísticamente mayores en el grupo de dependientes químicos. El uso crónico de alcohol y de drogas ilícitas provocan modificaciones en la composición salival.

Research progress of gut microbiota in substance dependence / 上海交通大学学报（医学版）

Substance dependence is a pervasive worldwide problem, of which the mechanism remains unclear, and there is no effective intervention. In recent years, it has been showed that the gut microbiota is closely related to substance dependence. As discussed in this review, gut microbiota is significantly affected by the substances of abuse, and may serve as an important regulator in the development of substance dependence. This article reviews the research progress of gut microbiota in the most widely used substances, in order to provide ideas for future studies on underlying mechanisms and further interventions in substance dependence.

A importância da dinâmica de grupo no tratamento da dependência de substâncias psicoativas em uma comunidade terapêutica / The importance of group dynamics in the treatment of psychoactive substances in a therapeutic community

Introdução: o uso de substâncias psicoativas é um grave problema social e de saúde pública em nossa realidade. A Dinâmica de Grupo trata-se de um instrumento de intervenção que auxilia no desenvolvimento do relacionamento grupal e interpessoal, na motivação, no aprendizado e no amadurecimento de um indivíduo. Objetivo: verificar a importância da dinâmica de grupo no tratamento da Dependência de Substâncias Psicoativas em uma Comunidade Terapêutica. Método: trata-se de um estudo descritivo exploratório com abordagem qualitativa, que teve como instrumento para a coleta de dados a observação sistemática. Para a análise dos resultados foi utilizada a técnica de análise de conteúdo de Bardin. Resultados: as dinâmicas desenvolvidas promoveram reflexões importantes e auxiliaram no desenvolvimento da autoestima, valorização da família, desejo de reconquistar espaço no mercado de trabalho, necessidade de ajudar o próximo no seu tratamento, aumento do nível de comunicação interpessoal, além de ter proporcionado conhecimento sobre a necessidade de substituição dos prazeres existentes com o uso de drogas por outros prazeres. Conclusão: a dinâmica de grupo é um instrumento de intervenção psicossocial importante durante o tratamento em Comunidade Terapêutica.

Introduction: the use of psychoactive substances is a serious social and public health problem in our reality. Group Dynamics is an intervention instrument that assists in the development of group and interpersonal relationships, in the motivation, learning and maturation of an individual. Objective: this study aimed to verify the importance of group dynamics in the treatment of Psychoactive Substance Dependence in a Therapeutic Community. Method: it is an exploratory descriptive study with a qualitative approach, which had as instrument for the data collection the systematic observation. For the analysis of the results, the Bardin content analysis technique was used. Results: the developed dynamics promoted important reflections and helped in the development of self-esteem, the valorization of the family, the desire to regain space in the labor market, the need to help others in their treatment, increase the level of interpersonal communication, the need to replace existing pleasures with the use of drugs for other pleasures. Conclusion: group dynamics is an important psychosocial intervention instrument during treatment in the Therapeutic Community.

Abordagem do comportamento de uso abusivo de substâncias psicoativas no Brasil: o estado da arte / Approach to abusive behavior of psychoactive substances in Brazil: the state of the art / Abordaje del comportamiento abusivo de sustancias psicoactivas en Brasil: estado del arte

O problema complexo do tratamento do uso abusivo de substâncias psicoativas coloca a comunidade científica diante da responsabilidade social. O objetivo do presente estudo foi conhecer a produção científica nacional a respeito da reabilitação do usuário. Realizou-se uma revisão bibliográfica integrativa, cobrindo os últimos cinco anos. Dos 60 artigos obtidos pelo Google Acadêmico e o portal revistas Capes, 32 desenvolveram o tratamento da dependência como tema principal. Foram subdivididos em: modelos e programas (9 artigos); e aspectos específicos do tratamento (23 artigos). As pesquisas empíricas selecionadas sobre tratamento estão concentradas, principalmente, no sul do País. Percebe-se uma proliferação de estratégias e programas na literatura, acompanhados, contudo, pelo objetivo em abordar a pessoa como um todo e adaptar as necessidades individuais de cada sujeito como guia do tratamento.

The complex problem of treating the abusive use of psychoactive substance puts the scientific community before its social responsibility. The goal of the present article was to know the Brazilian scientific production regarding the rehabilitation of the user. An integrative literature study was undertaken, covering the last 5 years. From the 60 articles obtained through Google Scholar and the CAPES journal gate, 32 focused on treatment of dependency, as the main theme. They were subdivided into: models and programs (09 articles); and specific aspects of treatment (23 articles). Empirical research on treatment is strongly concentrated in the South of the country. The literature shows a proliferation of techniques and treatment programs, accompanied by the goal to approach the person as a whole and to adapt the treatment to the individual needs of each person.

El complejo problema del tratamiento del uso abusivo de sustancias psicoactivas coloca a la comunidad científica delante de su responsabilidad social. El objetivo del presente estudio fue conocer la producción científica nacional a respecto de la rehabilitación del dependiente químico. Se realizó una revisión bibliográfica integrativa, cubriendo los últimos cinco años. De los 60 artículos obtenidos por el Google Académico y del Portal Revistas CAPES, 32 abordaron el tratamiento de la dependencia como tema principal. Los artículos fueron subdivididos en: modelos y programas (09 artículos) y aspectos específicos del tratamiento (23 artículos). Las investigaciones empíricas sobre el tratamiento se concentran en el Sur del país. Se observa una proliferación de estrategias y programas en la literatura, sin embargo, se reconocen las características y necesidades individuales de cada sujeto como guía del tratamiento.

Consumo de modafinilo en profesionales de la salud mental: reporte de un caso y revisión bibliográfica / Modafinil use in mental health professionals: case report and bibliographic review

INTRODUCCIÓN El presente estudio busca comenzar un abordaje inicial del fenómeno del consumo de Modafinilo en profesionales de la Salud Mental en Chile y los factores precipitantes que promueven el consumo de esta sustancia psicoestimulante. OBJETIVOS: Realizar una revisión bibliográfica respecto del consumo de Psicoestimulantes en Profesionales de la Salud Mental; identificar el psicoestimulante de más fácil acceso; buscar y contactar a profesionales de la salud mental del SSMC que consuman activamente Modafinilo e Identificar los posibles factores precipitantes asociados al consumo de Modafinilo. MATERIAL Y MÉTODOS: Reporte de caso y análisis de discurso de una entrevista en profundidad, identificando las categorías centrales que estructuran la experiencia del profesional respecto de su consumo. RESULTADOS Y DISCUSIÓN: De acuerdo al análisis de la entrevista, podemos destacar cuatro factores que desencadenan el consumo habitual de la sustancia psicoestimulante: la narcolepsia, sobrecarga laboral, sobrecarga emocional y el fácil acceso al Modafinilo. CONCLUSIONES: La bibliografía existente es muy escasa; este estudio se constituye como una primera aproximación al abordaje de este tema a nivel nacional; la sobrecarga emocional cobra gran importancia ya que complementa la dependencia fisiológica; los estados emocionales que generan y mantienen el consumo en el profesional se ven asociados a eventos ambientales, y la dependencia psicológica es una realidad inseparable de la dependencia fisiológica.

BACKGROUND: The present study aims to start an initial approach to the phenomenon of Modafinil use in mental health professionals in Chile, and the precipitating factors that promote the consumption of this psychostimulant substance. OBJETIVES: To carry out a bibliographic review regarding the use of Psychostimulants in Mental Health Professionals; to identify the most easily accessible psychostimulant; to find and contact mental health professionals who actively consume Modafinil and to identify the possible precipitating factors associated with consumption of Modafinil. METHODS: Case report and discourse analysis of an in-depth interview, identifying the central categories that structure the professional's experience regarding their consumption. RESULTS AND DISCUSSION: According to the analysis of the interview, we can highlight four factors that trigger the habitual consumption of the psychostimulant substance: Narcolepsy, work overload, emotional overload and easy access to Modafinil. CONCLUSIONS: The existing literature is very scarce; this study constitutes a first approach of this topic at national level; emotional overload is of great importance since it complements the physiological dependence; the emotional states that generate and maintain consumption in the professional are seen associated with environmental factors, and psychological dependence is an inseparable reality of physiological dependence.

A Comparative Prevalence Of Personality Disorder Among Male Patients Suffering With Psychoactive Substance Dependence

Objectives of this study are to determine the comparative prevalence of personality disorder in prisoners suffering with substance dependence and to find the relationship of personality disorder (PD) with pattern and severity of substance dependence (SD). Methods: This is a single-blind case controlled design prison hospital based study. A period sample of nineteen months was taken. Convenience samples of first 250 prisoners admitted in de-addiction ward fulfilling study criteria were taken as study participants and equal numbers of inmates were taken as control participants. Main outcome measure of the study was the presence of PD, whether it is related to the psychoactive substance dependence. Results: There was severe substance dependence among PD cases with the severity of dependence scale, SDS score of 10.7 ± 1.7 vs. 9.6 ± 1.3 in those without PD. Difference in duration of substance use of those with and without PD was statistically significant. However, the difference in age of onset of substance use and duration of substance dependence was not statistically significant. Prevalence of personality disorder in study was found to be 40.8% and was significantly higher than in control participants, i.e. 18.4%. Dissocial PD was noted as the most common type of PD in both study and control participants, i.e. 20.8% and 8%, respectively. In study participants, other most common types of PD were borderline, impulsive and anankastic PD at 7.2%, 5.6% 3.2%, respectively. More than 80% study participants were dependent on various types of substance-related use, i.e. alcohol, opioid and cannabis. Frequency of participants with use of greater than two substances at a time was much more common in participants with PD, than in those without a PD. Conclusions: In those prisoners, suffering from SD is usually of severe intensity. Prevalence of PD in prisoners suffering from SD is much higher than in non-SD population. In both groups, dissocial PD is the majority type of PD. Alcohol, cannabis and opioid are most commonly used substance. Prevalence on more than one substance was higher in those participants suffering from PD than those without PD. ASEAN Journal of Psychiatry, Vol. 18 (1): January – June 2017: XX XX

Características do uso e da dependência de benzodiazepínicos entre usuários: atenção primária à saúde / Characteristics of benzodiazepine use and dependence: primary health care / Características del uso y la dependencia de las benzodiacepinas: la atención primaria de salud

Objetivo: analisar as características sociodemográficas, de história de uso e dependência de benzodiazepínicos. Método: estudo transversal, cuja amostra intencional foi composta de 219 usuários de benzodiazepínicos cadastrados em quatro equipes de saúde da família de um município da região Oeste de Minas Gerais. A coleta de dados foi realizada entre os meses de janeiro a maio de 2013, por meio da aplicação de um questionário semiestruturado. Para a tabulação e a análise descritiva dos dados utilizou-se os softwares Epidata 3.1 e EPINFO 6.04. Resultados: a maior parte de consumidores de benzodiazepínicos é do sexo feminino, com idade entre 53 e 60 anos. O Clonazepam foi o benzodiazepínico mais utilizado. Verificou-se que 181 indivíduos (82,6%) possuem dependência química de benzodiazepínicos. Conclusão: fatores como a imagem positiva, o baixo custo e troca de benzodiazepínicos, a medicalização de problemas pessoais, sóciofamiliares e profissionais, inadequações do tratamento contribuem para a dependência de benzodiazepínicos.

Objective: to analyze benzodiazepine users' socio-demographic characteristics, use history and dependence. Method: in this cross-sectional study of an intentional sample of 219 benzodiazepine users enrolled with four family health teams in the western Minas Gerais State, data was collected between January and May 2013 by applying an adapted questionnaire. Epidata 3.1 and EPINFO 6.04 software were used for data tabulation and descriptive analysis. Results: most of the benzodiazepine users were female, and 53 to 60 years old. Clonazepam was the benzodiazepine most commonly used, and 181 individuals (82.6%) were found to be chemically dependent on benzodiazepines. Conclusion: factors such as the positive image, low cost and swapping of benzodiazepines, medicalization of personal, social, family and professional problems, and treatment inadequacies contributed to benzodiazepine dependence..

Objetivo: analizar las características sociodemográficas, historial de uso y la dependencia de las benzodiacepinas. Métodos: estudio transversal, cuya muestra intencional fue compuesta por 219 usuarios de benzodiacepinas registrados en cuatro equipos de salud de la familia de una ciudad de la región oeste de Minas Gerais. La recolección de datos se llevó a cabo entre los meses de enero a mayo de 2013, mediante la aplicación de un cuestionario semiestructurado. Para la tabulación y el análisis descriptivo de los datos se utilizaron los softwares EpiData 3.1 y EPINFO 6.04. Resultados: la mayoría de los consumidores benzodiacepinas son mujeres, con edades comprendidas entre 53 y 60 años. El Clonazepam fue el benzodiacepínico más utilizado. Se encontró que 181 pacientes (82,6%) tienen dependencia química a benzodiacepinas. Conclusión: los factores tales como la imagen positiva, el bajo costo y el intercambio de las benzodiacepinas, la medicalización de los problemas personales, sociales-familiares y profesionales y las inadecuaciones del tratamiento contribuyen a la dependencia a las benzodiacepinas.

Mujeres, adicción y rehabilitación: Reflexiones desde la frontera noroeste de México / Women, addiction and rehabilitation: Reflections from the northwestern border of Mexico

Desde que la adicción adquirió reconocimiento como enfermedad mental, los estudios relativos al tratamiento y modelos terapéuticos han tendido a centrarse en sus dimensiones psiquiátricas y psicológicas. El objetivo de este artículo es destacar la centralidad de la dimensión social, no solo como potencial detonante de comportamientos adictivos y estigmas sobre ellos, sino como variable que permea también su diagnóstico y tratamiento. Las reflexiones parten del trabajo de campo realizado en centros de rehabilitación para mujeres consumidoras de drogas, en la ciudad fronteriza de Tijuana, al noroeste de México. Los resultados arrojan que los modelos terapéuticos predominantes en la ciudad se basan en el rol tradicional de la mujer y lo reproducen. Se analizan las implicaciones sociales de este hecho, y finalmente se sugiere que esos centros podrían ser igualmente aprovechados en el proceso de construcción de una sociedad con mayor equidad de género.

Since the recognition of addiction as a mental illness, studies concerning treatment and therapeutic models have tended to focus on its psychiatric and psychological dimensions. The aim of this article is to highlight the centrality of the social dimension, not only as potential trigger of addictive behaviors and of stigma regarding these behaviors, but also as a variable that permeates diagnosis and treatment. The reflections are based on fieldwork carried out in rehabilitation centers for drug-consuming women in the border city of Tijuana, northwestern Mexico. The results show that the predominant therapeutic models in the city are based in and reproduce the traditional role of women. The social implications of this finding are analyzed, and it is suggested that these centers could be better utilized in the process of building a society with greater gender equality.

Estructura y tipología familiar en pacientes con dependencia o abuso de sustancias psicoactivas en un centro de rehabilitación de adicciones en el Municipio de Chía, Cundinamarca / Structure and Family Type in Patients With Substance Abuse or Dependence Psychoactive Rehabilitation Center of Addiction in the Municipality of Chia Cundinamarca

Objetivo: Determinar la estructura y la tipología familiar de un grupo de pacientes con dependencia o abuso de sustancias que se encontraban en un centro de rehabilitación de adicciones durante el periodo comprendido entre agosto y octubre de 2009. Métodos: A través de una metodología descriptiva cualitativa-interpretativa, se estudió a 10 pacientes y sus familias que cumplían los criterios de inclusión por dependencia o abuso de sustancias; el trabajo de campo y las transcripciones se realizaron durante 3 meses mediante observación no participante, entrevista no estructurada y revisión de la historia clínica del paciente. Resultados: De las familias entrevistadas, siete eran monoparentales, con una organización no convencional respecto a «roles de género¼. La familia monoparental favorece la soledad, la dificultad para poner reglas, la desidealización del lugar del padre en la estructura familiar y la búsqueda de una complicidad constante. En el análisis por categorías, se concluyó que en las 10 familias del estudio de personas con adicciones son frecuentes características de la estructura familiar como la comunicación inadecuada, la ausencia de autoridad, reglas y límites, la presencia de triangulaciones, la falta de cohesión dada por la existencia de un patrón de relación desligado y el cambio de roles convencionales con respecto a género. La búsqueda del afecto de la madre ante su ausencia emocional por la sobrecarga en los roles y la falta del padre, suscitada por la separación de la pareja, se encontró como un aspecto esencial subyacente al comportamiento adictivo. Se configura un patrón de abandono parental. Conclusiones: Se confirma lo mencionado por diversos autores acerca de las características de la tipología y la estructura familiar encontradas en pacientes con adicciones, además de su necesidad de afecto junto con la premura por una figura maternal. La tipología familiar no determina por sí misma el abuso de sustancias psicoactivas, sino la influencia de otros factores como la estructura familiar, especialmente las interacciones afectivas deficientes, lo cual debe considerarse en el desarrollo de las estrategias terapéuticas.

Objective: To determine the family type, family structure in a group of patients with a diagnosis of substance abuse or dependence who were at a rehabilitation center for addiction during the period between August and October 2009. Methods: Through a descriptive qualitative-interpretative methodology 10 patients who met inclusion criteria for substance dependence or abuse were studied. The fieldwork and transcripts were made for three months by non-participant observation, non-structured interviews and examination of patients' clinical history. Results: Seven of the families interviewed were single-parent families with an unconventional organization on "gender roles". Single-parent families favored loneliness, difficulty in rule-setting, de-idealization of the place of the father in the family structure and a constant search for complicity. In the analysis by categories, we found that in 10 families in the study of individuals with addictions it is common to find family structure characteristics such as inadequate communication, lack of authority rules and limits, presence of triangulations, the lack of cohesion due to the existence of a disconnected relationship pattern and changed roles compared to conventional gender. The search for the affection of the mother at her emotional overload absence of roles and lack of father, raised by the separation of the couple, was found as an essential aspect underlying the addictive behavior. A pattern of parental abandonment is configured. Conclusion: The findings confirmed what has been mentioned by various authors regarding the characteristics of the family typology structure and personal factors in patients with addictions, in addition to their need for affection combined with the desire for the mother's presence. The family typology does not determine for itself the abuse of psychoactive substances, but the influence of other factors such as family structure, especially deficient affective interactions, which should be considered in the development of therapeutic strategies.

Sudarshan Kriya For Male Patients With Psycho Active Substance Dependence: A Randomized Control Trial

Objectives: The aims of the study were to investigate whether Sudarshan Kriya (SK), a form of Yoga and related practices can lead to increased Global Assessment of Functioning (GAF) and increased feeling of wellness in patients with substance dependence. Method: This was a 3-month single blind parallel randomized controlled study with sample size of 111 patients which were allocated by simple randomization to two groups. Study subjects were involved in an intensive program of Sudarshan Kriya and practices (SK&P) which they practised daily for 6 weeks. The control subjects were instructed to sit in an armchair with their eyes closed and pay gentle attention to their breath. A period sample of three months consisting of all patients admitted in De-addiction (DAC) ward fulfilling study criteria was taken. Only male patients diagnosed to be suffering from Substance Dependence by ICD-10 (DCR) criteria, aged between 18-65 years were included in this study. The assessment tools were the Basic Socio-demographic Performa, Mini Mental State Examination (MMSE), Severity of Dependence Scale (SDS), Schedule for Clinical Assessment in Neuropsychiatry (SCAN) based clinical interview, Global Assessment of Functioning (GAF) and Psychological General Well Being (PGWB). These assessments were conducted before starting the intervention and six weeks thereafter. Results: In the final analysis, number of participants analyzed in the study group was 55 and in the control group was 56. Majority of subjects were unemployed, married individuals who did not have occupational skills of more than skilled labour level. After six weeks of SK&P, statistically significant improvement in study subject dimensional scores of GAF (48.43+/- 0.08 to 66.77+/-0.14), Anxiety (ANX) (9.64+/-0.52 to 15.66+/-0.38), Depressed Mood (DEP)(7.19+/-0.2 to 9.18+/-0.37), Positive Well Being (PWB)(10.28+/-0.61 to 12.92+/-0.73), General Health (GH)(7.74+/-0.18 to 9.75+/-0.22) and Total PGWB(41.46+/-0.35 to 59.28+/-0.63) were noticed. However, when compared with control subjects, improvement was statistically significant in the case of GAF (p=0.000158), Anxiety (ANX)(p=0.011), Positive Well Being (PWB)(p=0.02), General Health (GH)(p=0.02) and Total PGWB(p=0.05); but not in the case of Depressed Mood (DEP), Self Control (SC) and Vitality. Conclusion: Practicing SK&P helps in improving Global Assessment of Functioning, Psychological General Well Being, General Health (GH) and positive well being of an individual. SK&P also causes significant reduction in anxiety levels of an individual.

Family burden with substance dependence: a study from India.

Background & objectives: A substance dependent person in the family affects almost all aspects of family life. This leads to problems, difficulties or adverse events which impact the lives of family members and causes enormous burden on family caregivers. The present study aimed to assess the pattern of burden borne by the family caregivers of men with alcohol and opioid dependence. Methods: A cross-sectional study was conducted with ICD-10 diagnosed substance dependence subjects and their family caregivers attending a de-addiction centre at a multispecialty teaching hospital in north India. Family Burden Interview Schedule was used to assess the pattern of burden borne by the family caregivers of 120 men with alcohol and/or opioid dependence. Results: Compared to opioid and alcohol+opioid dependence groups, more often the alcohol dependence group was older, married, currently working, having a higher income and with the wife as a caregiver. Family burden was moderate or severe in 95-100 per cent cases in all three groups and more for ‘disruption of family routine’, ‘financial burden’, ‘disruption of family interactions’ and ‘disruption of family leisure’. Family burden was associated with low income and rural location. It was associated neither with age, education or duration of dependence of the patients, nor with family size, type of caregiver or caregiver’s education and occupation. Interpretation & conclusions: Almost all (95-100%) caregivers reported a moderate or severe burden, which indicates the gravity of the situation and the need for further work in this area.

Impact of Substance Dependence on Primary Caretaker in Rural Punjab.

Objectives: The study was planned to assess the impact of substance dependence and factors affecting it on PCT (Primary Care Taker) in rural area of Punjab. Methods: This is a systematic, randomized,cross sectional study which involves 83 PCT of patients with ICD-10 diagnosis of substance dependence in village Chhajli of Punjab. Details of substance useand sociodemographic attributes of dependence patients were taken on semi-structured proforma. All PCT underwent detailed assessment using Family Burden Interview Schedule. Results: Majority of PCT (77.5 percent) was found to have moderate burden especially in financial areas, disruption of routine activities, family leisure and family interaction. Higher proportion of burden was seen in PCT of illiterate patients of reproductive age group, of lower socioeconomic status, having multiple and longer duration of substance dependence and had relapsed many times. Conclusion:Burden on PCT was observed more in temporal association to the number of substance, type and duration of dependence. The impact of substance dependence on family members must be assessed at every stage of patient treatment for better quality of life.

Prevalence & correlates of metabolic syndrome in alcohol & opioid dependent inpatients.

Background & objectives: The research on the association of metabolic syndrome (MS) and substance abuse is scanty. The present research aimed to study the prevalence and correlates of MS among the inpatients at a Drug De-addiction Centre in north India. Methods: Consecutive male subjects (N=110) admitted to a drug de-addiction centre during July to December 2009 with a primary diagnosis of alcohol or opioid dependence were evaluated for the presence of MS as per the International Diabetes Federation (IDF) criteria. Results: The prevalence of MS was 24.6 and 29.3 per cent in alcohol and opioid dependent groups, respectively. MS showed a significant association with the age and body mass index (BMI) in the opioid dependent group. Co-morbid tobacco use was not associated with MS in either group. Interpretation & conclusions: The prevalence of MS in our sample of alcohol and opioid dependent male inpatients was greater than the prevalence of MS in general population, however it was comparable to that reported in physical and other psychiatric disorder populations. Even though the absence of any comparative study limits the generalizability of our findings, results indicate towards a need for screening of the patients with substance dependence especially for those aged above 30 years and/or having a high BMI for MS.

Distância social dos profissionais de saúde em relação à dependência de substâncias psicoativas / Social distance among health professionals toward the substance dependence

A atribuição de características indesejáveis a alguém pode conduzir à rejeição da pessoa rotulada, ocasionando o distanciamento social. O presente estudo teve como objetivos, avaliar as diferenças entre o desejo de distanciamento social dos profissionais de saúde da cidade de Juiz de Fora-MG, Brasil, em relação aos dependentes de álcool, maconha e cocaína, e possíveis relações entre o desejo de distanciamento social em cada um dos casos e variáveis sociodemográficas desses profissionais. Os resultados demonstraram que o distanciamento social foi maior para o dependente de cocaína, não havendo diferença significativa entre os escores das escalas para dependentes de álcool e maconha. Os julgamentos de distância social foram independentes de qualquer característica sociodemográfica da amostra, com exceção do aspecto "nível profissional" em relação ao dependente de álcool. O estudo do desejo de distância social dos profissionais de saúde pode contribuir para a implementação de estratégias de melhora dos serviços.

The attribution of undesirable characteristics to a person may lead to rejection and social distance. This study aims to evaluate differences on desire for social distance related to dependents of marijuana, alcohol and cocaine, among health professionals from Juiz de Fora, Minas Gerais, Brazil. Relation between desire for social distance and the professionals socio-demographics characteristics was also availed. The results demonstrated greater social distance related to cocaine dependents and no significant difference between the scores for marijuana and alcohol dependents. Social distance judgements were not significantly correlated to any socio-demographics characteristics but "professional level", that correlated with "dependent of alcohol" scores. Studying social distances may contribute to the implementation of strategies that may lead to services improvement.

Brain hypoperfusion in adolescents dependent of multiple drugs / Hipoperfusão cerebral em adolescentes dependentes de múltiplas drogas

Brain SPECT imaging (BSI) with statistical parametric mapping (SPM) offers a clear and accurate vision of perfusion changes. OBJECTIVE: To study brain perfusion abnormalities in adolescents' dependent of multiple drugs. METHOD: Sixteen male patients (15.1±2.1 years) were submitted to 99mTc-HMPAO BSI with SPM. RESULTS: Cortical hypoperfusion occurred in 7/16 patients (44 percent). There was a significant inverse correlation between the number of hypoperfused regions and the patient's age (p= -0.6737; p=0.004) and with the age when the drug dependence began (p= -0.5616; p=0.023). There was also a tendency towards an inverse correlation between regions of hypoperfusion and the duration of the drug dependence. CONCLUSION: BSI with SPM can help detect hypoperfusion in adolescents dependent on multiple drugs. The younger the patients, the more regions of hypoperfusion are noted. Probably, the neuronal plasticity has an important role in this phenomenon because the highest neural activity occurs in childhood.

SPECT cerebral (SC) com statistical parametric mapping (SPM) oferece uma visão clara e acurada de alterações perfusionais. OBJETIVO: Avaliar anormalidades perfusionais cerebrais em adolescentes usuários de múltiplas drogas. MÉTODO: Dezesseis pacientes masculinos (15,1±2,1 anos) foram submetidos a SC com SPM utilizando-se HMPAO-99mTc. RESULTADOS: Hipoperfusão cortical ocorreu em 7/16 pacientes (44 por cento). Houve uma significativa correlação inversa entre o número de áreas hipoperfundidas e a idade dos pacientes (p= -0,6737; p=0,004) e com a idade quando iniciaram o abuso das drogas (p= -0,5616; p=0,023). Também houve uma tendência para uma correlação inversa entre as áreas de hipoperfusão e a duração do abuso de drogas. CONCLUSÃO: SC com SPM pode auxiliar na detecção de hipoperfusão cortical em adolescentes dependentes de múltiplas drogas. Quanto menor a idade, mais áreas de hipoperfusão são identificadas. Provavelmente a plasticidade neuronal tem importante papel neste fenômeno, pois a maior atividade neuronal ocorre na infância.

Dopamine transporter SPECT imaging of the peroral addictors of compound codeine phosphate solution / 中华核医学杂志

Objective To study the damage to striatum in patients perorally addicted to compound codeine phosphate solution by using the brain dopamine transporter SPECT imaging. Methods Patients p erorally addicted to compound codeine phosphate solution ( n = 29 ) and addicted to heroin ( n = 27 ), as well as healthy volunteers (n = 31 ) were included in the study. Each of them underwent dopamine transporter (DAT) SPECT imaging with 99Tcm-2β-[N, N'-bis-( 2- mercaptoethyl ) ethylenediamino] methyl, 3β-(4-chlorophenyl)tropane (99Tcm-TRODAT-1). The striatum volume (V, cm3), mass (m, g) and radiactivity ratio (Ra) of striatum to whole brain were calculated using physio-mathematical modeling method.R esults Bilateral striatum of healthy volunteers showed typical "panda eyes" pattern and the distribution of DAT was uniform and symmetrical. Bilateral striatum of patients addicted to compound codeine phosphate showed impaired tracer uptake, similar to those addicted to heroin. The V, m and Ra of bilateral striatum of patients addicted to compound codeine phosphate were (23.68 ±4.94) cm3, (24.87 ±5.19) g and (5.01 ±0. 88 ) %, respectively, which were significantly lower than those of healthy controls: ( 35.39 ± 4.42 ) cm3,(37.16 ±4.64) g and (7.93 ±0.86)% (t = -9.69, -9.69, - 13.01, all P =0.000), but significantly higher than those addicted to heroin: ( 18.87 ± 4.66 ) cm3, ( 19.81 ± 4.90 ) g and (4.26 ± 1.02 ) % ( t =3.74, 3.74, 2.96, P = 0.000, 0.000, 0.005 ). Conclusion Long-term peroral intake of compound codeine phosphate solution may damage the function of cerebral striatum, which is someway similar to though less severe than, the impairment caused by heroin.

Psychosocial factors associated with relapse in men with alcohol or opioid dependence.

Background & objectives: Relapse is a common and distressing aspect of substance dependence mediated by several biological and psychosocial factors. This study examined the association between demographic variables, clinical parameters and certain psychosocial factors and relapse among patients with either alcohol or opioid dependence. Methods: Structured assessments of clinical/demographic parameters, relapse precipitants, coping strategies, self-efficacy, stressful life events and perceived social support were carried out among patients with alcohol/opoid dependence (n=30) who had relapsed and compared with those (n=30) who had managed to remain abstinent. Similar comparisons were also carried out between relapsed and abstinent patients in the individual subgroups of alcohol and opioid dependence. Results: Patients who had relapsed were significantly more likely (i) to have a positive family history of substance use and higher number of previous relapses; (ii) to be using maladaptive coping strategies; (iii) to have been exposed to a higher total number of ‘high risk’ situations; and (iv) have experienced a higher number of undesirable life events. Those who had remained abstinent tended to use significantly more number of coping strategies, principally adaptive ones and scored significantly higher on all measures of self-efficacy. Factors influencing relapse appeared to be largely similar among patients with alcohol and opioid dependence. Interpretation & conclusions: This study provided further evidence in support of the importance of certain clinical/psychosocial factors in relapse in substance dependence. It extended these results to substances other than alcohol and provides the basis for investigating correlates of relapse in a wide range of behavioural and substance use problems.

Inicio del consumo de cocaína en edades tardías: a propósito de un caso / Initiation cocaine use in elderly patients: a case report

Introducción: El consumo de cocaína es infrecuente en los ancianos. Sin embargo el consumo puede estar siendo infraestimado. Se han descrito casos de pacientes que inician el consumo a edades tardías, o que han estado en contacto con ellas durante la juventud y vuelvan 'a recaer en el consumo durante esta época de la vida. Caso clínico: Se presenta el caso clínico de una paciente de 61 años ingresada para realizar tratamiento de desintoxicación de cocaína (1-l'5g/día), que inicio, por primera vez, el consumo de cocaína intranasal a los 60 años de edad. Factores como la jubilación, dolor crónico o la presencia de sintomatología afectiva pueden facilitar el aislamiento de las personas mayores precipitando el consumo de cocaína y contribuir al subdiagnóstico del abuso o dependencia. Los ancianos tienden a sufrir más complicaciones médicas que los jóvenes y su uso puede empeorar de forma importante su estado físico. Discusión: El consumo de cocaína debe ser evaluado sistemáticamente, en todos los pacientes independientemente de la edad y especialmente en ancianos cuando se presenten condiciones médicas o psiquiátricas que resulten inusuales o extrañas.

Introduction: Cocaine use is an uncommon condition in older people, a population in which cocaine use is probably overlooked. Cases initiation of use in late adulthood as well as elderly relapsing to use from youth drug use have been reported. Clinical case: We report a woman of 61 years of age hospitalized in the detoxification unit for cocaine dependence treatment (used 1-1'5 g/day). She did not begin cocaine use until she was 60 years old. Some risk factors include retiref11ent, chronic pain, and affective symptoms are related with loneliness and increased cocaine use in elderly, and account for the unnderreporting of abuse or dependence. Old people have more medical conditions related to cocaine use and have greater health deterioration than young people. Discussion: Cocaine use should be evaluated in every patient, and elderly patients should be checked particularly when presenting atypical medical or psychiatric conditions.