Dental treatment before surgery in a patient with cleft lip and palate: case report / Efeito do Cissus quadrangularis na cicatrização de fraturas em animais de laboratório

Introduction: orofacial clefts are common congenital malformations with an important social, psychological, and economic impact. The treatment of this condition may include different surgical procedures that previously require an adequate oral condition. Case report: we report a case of dental treatment before palatoplasty in a male patient of 17 years-old with bilateral cleft lip and palate and lesion in the jugal mucosa. Final considerations: the adequacy of the oral environment is a fundamental step in the treatment of patients with orofacial clefts and aims to restore oral health regardless of the degree of complexity of the dental treatment through the reduction of the pathogenic microbiota, elimination of retentive niches, instructions on diet and adequate oral hygiene and constant patient motivation.

Objetivos: as fissuras orofaciais são malformações congênitas comuns, com importante impacto social, psicológico e econômico. O tratamento dessa condição pode incluir vários procedimentos cirúrgicos que requerem previamente uma adequada condição bucal. Relato de caso: Relatamos o caso de tratamento odontológico prévio a palatoplastia em um paciente do gênero masculino de 17 anos de idade, com fissura transforame incisivo bilateral e lesão em mucosa jugal. Considerações finais: A adequação do meio bucal é uma etapa fundamental no tratamento de pacientes com fissuras orofaciais e visa restabelecer a saúde bucal independente do grau de complexidade do tratamento odontológico por meio da redução da microbiota patogênica, eliminação de nichos retentivos, orientações sobre dieta e higiene bucal adequada e motivação constante do paciente.

Macrostomia congênita associada à microtia unilateral: um Relato de Caso / Congenital macrostomia associated with unilateral microtia: a case report

A macrostomia congênita, também denominada fissura facial transversa, horizontal ou lateral, constitui 1,5% de todas as fissuras. A expressão clínica variável envolve desde uma forma discreta até casos graves com malformações desfigurantes. Deformidades da orelha externa podem estar presentes, desde excesso de pele até ausência do pavilhão. A macrostomia congênita deve ser submetida a uma investigação sistemática clínica e de imagem para definir o âmbito das anomalias, uma vez que a doença é rara, complexa e manifesta-se fenotipicamente de maneiras distintas. Este presente artigo relata um caso de macrostomia congênita associada à microtia unilateral.

Congenital macrostomia, also called transverse, horizontal, or lateral facial cleft, constitutes 1.5% of all clefts. The variable clinical expression ranges from mild to severe cases with disfiguring malformations. External ear deformities can be present, from excess skin to the absence of the pinna. Congenital macrostomia must be submitted to a systematic clinical and imaging investigation to define the scope of the anomalies, since the disease is rare, complex and manifests itself phenotypically in different ways. This article reports a case of congenital macrostomia associated with unilateral microtia.

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.

Cognitive restraint directed at carbohydrates in individuals on low-carb diet with binge eating: the role of guilt about food cravings / Restrição cognitiva direcionada aos carboidratos em indivíduos praticantes de dieta low carb com compulsão alimentar: o envolvimento da culpa pelos desejos por comida

ABSTRACT Objective To evaluate whether the carbohydrate-restricted diet leads to higher levels of food cravings in individuals with binge eating. Methods A total of 146 individuals with binge eating participated in the Low-Carb Diet Group (n=48) and Control Group (n=98). The Binge Eating Scale, Hay's questionnaire, Food Cravings Questionnaire - Trait and State, Cognitive restraint subscale and its adapted version for the cognitive restraint toward carbohydrates, were used as measures. Parametric tests were used for comparison between groups (Student's t test), and Pearson's correlation test to verify correlations between variables of interest. Results No differences were found between groups with and without diet concerning the level of binge eating or food craving total score. The differences found were the higher levels of cognitive restraint (p=0.01), cognitive restraint for carbohydrates (p=0.01) and subscales of 'guilt about food craving' (p=0.04) in the Low-Carb Diet Group. Conclusion Individuals with binge eating and a history of low-carb diet have greater cognitive restraint toward carbohydrates and association with altered eating attitudes (guilt about food craving).

RESUMO Objetivo Avaliar se a dieta com restrição de carboidratos acarreta níveis elevados de desejos intenso por comida em indivíduos com compulsão alimentar. Métodos Participaram 146 indivíduos com compulsão alimentar divididos nos Grupos Dieta Low Carb (n=48) e Grupo Controle (n=98). Foram utilizados como medidas: Escala de Compulsão Alimentar Periódica, Questionário de Hay, Questionário de Desejos Intensos por Comida - Traço e Estado, Subescala de restrição cognitiva e sua versão adaptada para a restrição cognitiva direcionada aos carboidratos. Foram utilizados testes paramétricos para comparação entre grupos (teste t de Student) e o teste de correlação de Pearson para verificar correlações entre variáveis de interesse. Resultados Não foram encontradas diferenças entre grupos com e sem prática de dieta em relação ao nível de compulsão alimentar ou ao escore total para desejos intensos por comida. As diferenças encontradas foram os maiores níveis de restrição cognitiva (p=0,01), restrição cognitiva para carboidratos (p=0,01) e subescalas de 'culpa por causa dos desejos' (p=0,04) no Grupo Dieta Low Carb. Conclusão Indivíduos com compulsão alimentar e histórico de dieta com restrição de carboidratos (low carb) possuem maior restrição cognitiva direcionada aos carboidratos e associação com atitudes alimentares alteradas (culpa pelos desejos).

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.

Fissuras Labiopalatais Congênitas: uma análise dos comportamentos e enfrentamentos paternos / Congenital Cleft lip and Palate: an analysis of paternal behaviors and confrontations

Introdução: Fissuras labiopalatais são as mais comuns entre as malformações congênitas craniofaciais e, no Brasil, segundo o Ministério da Saúde, há uma incidência estimada de um para cada 650 nascimentos. O diagnóstico inicial de fissuras causa um grande impacto familiar, resultando em um desequilibrio emocional tanto dos familiares quanto da própria criança, revelando, assim, diferentes formas de reações e enfrentamento dos progenitores, dentre as quais se destacam: choque, luto, negação, culpa, esperança, vergonha, rejeição e até aceitação. Objetivos: Avaliar os indicadores de qualidade de vida dos familiares de crianças com fissuras labiopalatais e analisar seus comportamentos e enfrentamentos frente a essa problemática, bem como, seus primeiros sentimentos, reações e planos de cuidados para uma criança com essa anomalia. Método: Foi realizado um estudo transversal retrospectivo, descritivo e analítico com pais de crianças com fissuras labiopalatais que estavam em tratamento para correção de anomalias craniofaciais no Hospital de Reabilitação de Anomalias Craniofaciais (HRAC), em Bauru, a fim de identificar os padrões de comportamento e a qualidade de vida a partir do questionário The World Health Organization Quality of Life ­ Bref (WHOQOL ­ bref), elaborado pela Organização Mundial de Saúde (OMS). Resultados: Foram avaliados 11 pais de crianças com fissuras labiopalatais, sendo que a maioria era do sexo feminino. Os participantes demonstraram diferentes posicionamentos frente à problemática e foram observadas variações de domínios nas respostas do questionário WHOQOL ­ bref, resultando em uma grande modificação no bem estar dos familiares envolvidos. Considerações finais: As famílias passam por uma lenta adaptação com uma criança fissurada, mas apesar das modificações da qualidade de vida, a maioria consegue superar os sentimentos negativos.

Introduction: Cleft lip and palate are the most common among the congenital craniofacial malformations, and, according to the Brazilian Health Ministry, in Brazil, it has an estimated incidence of 1 to every 650 children born. Its initial diagnostic causes a considerable impact on the family and results in an emotional imbalance both in the family and in the children themselves, revealing different ways of reactions and confrontation of the progenitors, which are: chock, mourning, denial, guilt, hope, shame, rejection, and even acceptance. Goals: This study aimed to evaluate the quality of life indicators of the relatives of kids with cleft lip and palate and analyze their behavior and how they face these issues such as their first feelings, reactions, and care plans created for a child with this anomaly. Method: A retrospective, descriptive, and analytical crosssectional study was conducted with the parents of children with cleft lip and palate, who were undergoing treatment for the correction of craniofacial anomalies at the Hospital de Reabilitação de Anomalias Craniofaciais (HRAC) in Bauru to identify patterns of behavior and the quality of life from the questionnaire The World Health Organization Quality of Life ­ Bref (WHOQOL ­ bref), created by the World Health Organization (WHO). Results: Eleven parents of children with cleft lip and palate, mostly female, were evaluated. The participants demonstrated different positions regarding the problem and domain variations observed in the answers to the WHOQOL - bref questionnaire, resulting in a considerable change in the well-being of the family members involved. Final considerations: Families go through a slow adaptation with a fissured child, but despite the alterations in quality of life, most manage to overcome negative feelings.

Colgajo lingual de base anterior para cierre de fistula palatina anterior / Retalho lingual de base anterior para fechamento de fístula palatina anterior / Closure of anterior palatal fistula by anterior base lingual flap

Introdução: Fístulas oro-nasais são as sequelas mais comuns após o reparo falho da fissura palatina primária, gerando problemas funcionais e emocionais para as pessoas que sofrem desta complicação. Fístulas grandes são difíceis de fechar e podem exigir retalhos de grande comprimento, largura e profundidade, sendo o retalho lingual de base anterior uma das opções de retalho mais bem sucedidas para fechamento devido às semelhanças com tecidos locais. e sua vascularização abundante, havendo taxas significativamente menores de recorrência da fístula após a cirurgia. Relato de caso: O objetivo deste artigo é apresentar o caso de um paciente previamente diagnosticado com fissura labiopalatina que tem história de seis procedimentos cirúrgicos malsucedidos que apresentaram resultados satisfatórios após a realização deste procedimento. Considerações finais: Ao longo dos anos, foi demonstrado que o retalho de língua é confiável e fácil de obter, devido à vascularização abundante e à grande quantidade de tecido que este órgão fornece para o reparo de fístulas maiores que 5 mm, formadas por complicações pós-cirurgia para fechamento de fenda palatina ou tentativas anteriores de fechamento de fístula com diferentes tipos de técnicas. A flexibilidade do retalho, juntamente com a técnica, a qualidade e a quantidade de tecido, tornam este procedimento de escolha para o fechamento das fístulas palatinas anteriores... (AU)

Introduction: Oro-nasal fistulas are the most common complication after the failed repair of the primary cleft palate, creating functional and emotional problems to people with this issue. Large fistulas are difficult to close and may require flaps with great length, width and depth, the anterior base lingual flap is one of the most successful options for fistula closure due to the similarities with local tissues, great vascularization and significantly lower fistula recurrence rates of the after surgery. Case Report: The objective of this article is to present the case of a patient previously diagnosed patient with cleft lip and palate with six previous unsuccessful surgical procedures on the palate, this patient presented satisfactory results after undergoing tongue flap surgery. Final Considerations: Over the years it has been shown that the lingual flap is reliable and easy to obtain, due to the abundant vascularization and large amount of tissue that this organ provides for the repair of fistulas larger than 5mm that are formed by complications post surgery either for cleft palate closure or previous attempts at fistula closure with different types of techniques. The flexibility of the flap, together with the technique, quality and quantity of tissue make this procedure of choice for the closure of anterior palatine fistulas... (AU)

Introduccioón: Las fístulas oro-nasales son las secuelas más comunes posteriores a la reparación fallida de paladar hendido primario, generando problemas funcionales y emocionales a las personas que padecen esta complicación. Las fístulas de gran tamaño son difíciles de cerrar y pueden requerir de tejido adyacente de gran longitud, ancho y profundidad para su cierre, siendo el colgajo lingual de base anterior una de las opciones más exitosas para cierre de la misma debido a sus similitudes con los tejidos locales y su abundante vascularización, existiendo tasas significativamente menores de recidiva de la fístula después de la cirugía. Descripción del Caso: El objetivo de este artículo es presentar el caso de un paciente previamente diagnosticado con labio y paladar hendido que presenta antecedente de seis intervenciones quirúrgicas en paladar sin éxito que presentó resultados satisfactorios tras someterse a este procedimiento. Consideraciones Finales: Con el paso de los años se ha demostrado que el colgajo lingual es confiable y fácil de obtener, debido a la abundante vascularización y gran cantidad de tejido que este órgano proporciona para la reparación de fístulas mayores a 5mm que se forman por complicaciones posteriores a cirugía ya sea para cierre de paladar hendido o intentos previos de cierre de fístula con diferentes tipos de técnicas. La flexibilidad del colgajo, junto con la técnica, calidad y cantidad de tejido hacen que este procedimiento sea de elección para el cierre de fistulas palatinas anteriores... (AU)

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.

Consumo de Canábis: craving e a relação com ansiedade, stresse e depressão / Cannabis use: craving and the relationship with anxiety, stress and depression

Resumo. A canábis é a substância ilícita mais consumida em Portugal com um início de consumo muito precoce. O craving é considerado um dos factores fundamentais ligados ao consumo de canábis, associando-se à depressão, a ansiedade e ao stresse. Espera-se que nível de craving e sexo se relacionem com a depressão, ansiedade e stresse numa amostra de consumidores portugueses. A amostra foi constituída por 143 consumidores da zona Norte do país e os dados recolhidos através de questionários online (DASS-21 e o MCQ-SF). Os resultados permitem concluir que a emocionalidade, a intencionalidade e a compulsividade relacionaram-se positivamente com o nível do craving, bem como, com o stresse e a depressão. Quanto ao número de anos de consumo, constatou-se um efeito significativo, de dimensão média, na ansiedade.

Abstract. Cannabis is the most used illicit substance in Portugal and is the one, which presents, on average, na earlier onset of consumption. Craving is considered one of the fundamental factors linked to the cannabis use, associating anxiety, stress and depression. The sample consisted of 143 individuals from the northern area of the country and the data was gathered through two online questionnaires (DASS-21 and the MCQ-SF). The obtained results allow us to conclude that emotionality, purposefulness and compulsivity are positively associated with the level of craving and, combined, as well to stress and depression. The number of years of consumption presents a significant effect in anxiety, with a medium effect size.

Do food intake and food cravings change during the menstrual cycle of young women? / A ingestão de alimentos e os desejos por comida mudam durante o ciclo menstrual das mulheres jovens?

Abstract Objective The aim of the present study was to assess the anthropometric measures, food intake and food cravings during the menstrual cycle of undergraduate students of the faculty of nutrition. Methods A cross-sectional study was performed with 27 students from a public university in the state of Mato Grosso do Sul, Brazil, who had their food intake evaluated through a 24-hour food recall, their nutritional status evaluated based on anthropometric measures, and food cravings evaluated using the Food Desire Questionnaire. Data were collected during an evaluation in the follicular phase (between the 5th and the 9th day of the menstrual cycle) and another in the luteal phase (LP) (between the 20th and the 25th day of the menstrual cycle). For food intake variables, the analysis of variance (ANOVA) test was used, followed by the Tukey test. The Mann-Whitney test was used for the analysis of food cravings, considering a significance level of 5% (p< 0.05). Results The desire for foods rich in sugar, salt, and fat, such as chocolate, pastries, snacks and desserts were higher (p< 0.05) during the premenstrual period, although it did not reflect neither a higher energy intake nor an alteration in the distribution of macronutrients. A higher intake of carbohydrates, proteins, fibers, and calcium was observed during the LP; however, without statistical difference between the groups. There were no differences either in the intake of any food group or in the anthropometric measurements (p> 0.05). Conclusion Food cravings of nutrition students differed between the phases of the menstrual cycle; however, with no difference in food intake and in anthropometric measures.

Resumo Objetivo Verificar alterações de medidas corporais, consumo e desejos alimentares durante o ciclo menstrual de acadêmicas de nutrição. Métodos Estudo transversal com 27 estudantes de uma universidade pública do Mato Grosso do Sul, as quais tiveram seu consumo alimentar avaliado por meio de recordatório alimentar de 24 horas, estado nutricional avaliado com base em medidas antropométricas, e desejos alimentares avaliados utilizando-se o Questionário de Desejo Alimentar. Os dados foram coletados durante uma avaliação na fase folicular (entre o 5° e o 9° dia do ciclo menstrual) e outra na fase lútea (entre o 20° e o 25° dia do ciclo menstrual). Para as variáveis de consumo alimentar, utilizou-se o teste análise de variância (ANOVA, na sigla em inglês), seguido pelo teste de Tukey. Já para a análise dos desejos alimentares, utilizou-se o teste de Mann-Whitney. Foi considerado o nível de significância de 5% (p< 0,05). Resultados Os desejos por alimentos ricos em açúcar, sal e gordura, como chocolates, produtos de pastelaria, lanches e sobremesas foram maiores (p< 0,05) no momento pré-menstrual, apesar de não refletirem em maior consumo energético e tampouco em alteração na distribuição de macronutrientes. Observou-se maior consumo de carboidratos, proteínas, fibras e cálcio na fase lútea; no entanto, sem diferença estatística entre os grupos. Não foram encontradas diferenças no consumo de nenhum grupo alimentar, tampouco nas medidas antropométricas (p> 0,05). Conclusão Os desejos alimentares das acadêmicas de nutrição diferiram entre as fases; no entanto, sem diferença no consumo alimentar e nas medidas corporais.

A vontade em Vygotski: contribuições para a compreensão da "fissura" na dependência de drogas / Le volonté chez Vygotski: contributions à la compréhension d'avidité dans la dépendance des drogues / La voluntad en Vygotski: contribuciones a la comprensión del craving en la drogadicción / The will in Vygotsky: contributions to the understanding of the "craving" in drug addiction

Resumo A fissura (craving) é questão central no cuidado a pessoas com problemas decorrentes do uso de álcool e outras drogas, sendo considerada uma incapacidade de controlar o desejo pelo consumo. Contudo, não há definição unívoca desse fenômeno. Investigou-se o conceito de vontade em Lev S. Vygotski (1896-1934), considerando-se que sua abordagem poderia contribuir para a compreensão da fissura. Realizou-se uma revisão da literatura acerca do craving e uma análise focal do conceito de vontade em textos selecionados de Vygotski. Não obstante as controvérsias sobre a definição do fenômeno da fissura, a proposição de Vygotski acerca da vontade como função psicológica superior mediada por motivos auxiliares possibilita ampliar a compreensão do craving. O manejo da fissura, assim, depende não somente de uma iniciativa individual, mas também de questionamentos sobre a lógica social, política e histórica que preside os significados sobre o uso de drogas.

Resumé L'avidité (craving) est un point central pour le soin des personnes ayant problèmes issus de l'utilisation de l'alcool et d'autres drogues envisagée comme l'incapacité de contrôler le désir de consommation. Cependant, il n'y a pas de définition univoque sur ce phénomène. On a recherché le concept de volonté chez Lev S. Vygotski (1896-1934) en envisageant que son approche pourrait contribuer à la compréhension de l'avidité. On a effectué une révision de littérature autour du craving et une analyse focale du concept de volonté dans des textes sélectionnés de Vygotski. Malgré les controverses sur la définition du phénomène d'avidité, la proposition de Vygotski autour de la volonté comme fonction psychologique supérieure médiate par motifs auxiliaires permet d'enrichir la compréhension du craving. Le maniement de l'avidité ne dépend pas seulement d'une initiative individuelle, mais aussi des interrogations sur la logique sociale, politique et historique qui oriente les sens de l'utilisation des drogues.

Resúmen La fisura (craving) es un tema central en la atención de personas con problemas derivados del uso de drogas, considerada una incapacidad para controlar el deseo de consumo. Sin embargo, no existe una definición única de este fenómeno. Se investigó el concepto de voluntad de Lev S. Vygotsky (1896-1934) teniendo en cuenta que podría contribuir a la comprensión de la fisura. Se realizó una revisión bibliográfica sobre el deseo, y un análisis focal del concepto de voluntad en textos seleccionados de Vygotski. A pesar de las controversias en la definición del fenómeno de la fisura, la proposición de Vygotsky sobre la voluntad como función psicológica superior mediada por motivos auxiliares hace posible ampliar la comprensión del craving. El tratamiento de la fisura no sólo depende de una iniciativa individual, sino también de preguntarnos acerca de la lógica social, política e histórica que preside los significados del consumo de drogas.

Abstract Craving is a central issue in the care of people with problems due to the use of alcohol and other drugs, and is considered an inability to control the desire for consumption. However, there is no clear definition of this phenomenon. We investigated the concept of will in the works of Lev S. Vygotsky (1896-1934), considering that his approach could contribute to understanding the craving. We reviewed the literature on craving and performed a focal analysis of the concept of will in selected texts by Vygotsky. Despite the controversies over the definition of the craving phenomenon, Vygotsky's proposition that the will is a superior psychological function mediated by auxiliary motives makes it possible to deepen the understanding of the craving. Craving management thus depends not only on individual initiative, but also on questions about the social, political, and historical logic that presides over the meanings of drug use.

Craving en adicciones conductuales: propuesta de un modelo teórico explicativo en la adicción a facebook y mensajería instantánea / Craving in behavioral addictions: proposal of an explicative theoretical model in addiction to facebook and Instant messaging

El craving se define como el deseo o ansias por introducir una sustancia en el cuerpo. La American Psychiatric Association ha propuesto que para adicciones conductuales, que implican el realizar algún tipo de acción, se consideren los mismos criterios que para una adicción a sustancias. Las naturalezas de los objetos son diferentes por lo que surge el desafío de analizar si el abordaje de las adicciones conductuales debe realizarse bajo los criterios de una adicción a sustancias. Se seleccionaron 23 artículos sobre la materia los que permitieron elaborar un modelo teórico explicativo de craving hacia Facebook y Mensajería instantánea. El modelo consta de tres dimensiones: intensidad del deseo, grado de control y expectativas de calma. Se propone estudiar la forma en que estas dimensiones se presentan en adicciones conductuales para reconstruir el concepto en este campo, y generar un instrumento que permita su evaluación.

Craving is defined as the desire to introduce a substance in the body. The American Psychiatric Association proposed to research if behavioral addictions can be assessed with the substance addictions criteria. Nature of both objects are different so the challenge of analyze if assessment of behavioral addictions can be done with the same criteria of substance addictions. 23 articles about substance addictions were selected to elaborate a theoretical explicative model of craving to start research craving to Facebook and Instant Messaging. The model consists of three dimensions: desire intensity, degree of control and calm expectations. It is proposed to study how these dimensions are in behavioral addictions to rebuild the concept in this area, and generate an instrument to asses it.

Development and Evaluation of Group Counseling Program using Neurolinguistic Programming for Alcoholics / 정신간호학회지

PURPOSE: The aim of this study was to develop and evaluate the effectiveness of a group counseling program using neurolinguistic programming (NLP) for individuals abusing alcohol. METHODS: In a quasi-experimental study, 48 participants were recruited from five alcohol medical centers. The NLP group counseling program was provided to the experimental group for 90 minute sessions twice a week for 5 weeks. Pre-post data were collected from November, 2014 to April, 2015. Data were analyzed using descriptive statistics, chi-squared tests, and independent t-tests. RESULTS: Compared with the control group, participants in the experimental group showed significantly decreasing scores for depression (t=−2.19, p=.033) and alcohol craving (t=−3.59, p=.001). Participants in the experimental group also showed improved self-efficacy related to drinking refusal (t=3.05, p=.004). CONCLUSION: Study findings support using the NLP group counseling program with patients abusing alcohol as it is effective in improving depression, drinking refusal self-efficacy, and craving. Therefore, the NLP group counseling program is a useful nursing intervention to prevent relapse in alcoholics.

Double-blind evaluation of homeopathy on cocaine craving: a randomized controlled pilot study / 中西医结合学报

<p><b>BACKGROUND</b>Brazil is among the nations with the greatest rates of annual cocaine usage. Pharmacological treatment of cocaine addiction is still limited, opening space for nonconventional interventions. Homeopathic Q-potencies of opium and Erythroxylum coca have been tested in the integrative treatment of cocaine craving among homeless addicts, but this setting had not proven feasible, due to insufficient recruitment.</p><p><b>OBJECTIVE</b>This study investigates the effectiveness and tolerability of homeopathic Q-potencies of opium and E. coca in the integrative treatment of cocaine craving in a community-based psychosocial rehabilitation setting.</p><p><b>DESIGN, SETTING, PARTICIPANTS, AND INTERVENTIONS</b>A randomized, double-blind, placebo-controlled, parallel-group, eight-week pilot trial was performed at the Psychosocial Attention Center for Alcohol and Other Drugs (CAPS-AD), Sao Carlos/SP, Brazil. Eligible subjects included CAPS-AD patients between 18 and 65 years of age, with an International Classification of Diseases-10 diagnosis of cocaine dependence (F14.2). The patients were randomly assigned to two treatment groups: psychosocial rehabilitation plus homeopathic Q-potencies of opium and E. coca (homeopathy group), and psychosocial rehabilitation plus indistinguishable placebo (placebo group).</p><p><b>MAIN OUTCOME MEASURES</b>The main outcome measure was the percentage of cocaine-using days. Secondary measures were the Minnesota Cocaine Craving Scale and 12-Item Short-Form Health Survey scores. Adverse events were reported in both groups.</p><p><b>RESULTS</b>The study population comprised 54 patients who attended at least one post-baseline assessment, out of the 104 subjects initially enrolled. The mean percentage of cocaine-using days in the homeopathy group was 18.1% (standard deviation (SD): 22.3%), compared to 29.8% (SD: 30.6%) in the placebo group (P < 0.01). Analysis of the Minnesota Cocaine Craving Scale scores showed no between-group differences in the intensity of cravings, but results significantly favored homeopathy over placebo in the proportion of weeks without craving episodes and the patients' appraisal of treatment efficacy for reduction of cravings. Analysis of 12-Item Short-Form Health Survey scores found no significant differences. Few adverse events were reported: 0.57 adverse events/patient in the homeopathy group compared to 0.69 adverse events/patient in the placebo group (P = 0.41).</p><p><b>CONCLUSIONS</b>A psychosocial rehabilitation setting improved recruitment but was not sufficient to decrease dropout frequency among Brazilian cocaine treatment seekers. Psychosocial rehabilitation plus homeopathic Q-potencies of opium and E. coca were more effective than psychosocial rehabilitation alone in reducing cocaine cravings. Due to high dropout rate and risk of bias, further research is required to confirm our findings, with specific focus on strategies to increase patient retention.</p><p><b>TRIAL REGISTRATION</b>RBR-2xzcwz (http://www.ensaiosclinicos.gov.br).</p>