Detección de sustancias psicoactivas ilegales en orinade madres y recién nacidos en un hospital público. Comparación de quinquenios 2009-2013 y 2014-2018 / Detection of illicit psychoactive substances in the urine of mothers and newborn infants at a public hospital. Comparison between the 2009­2013 and 2014­2018 five-year periods

Introducción. El consumo de sustancias psicoactivas ilegales en el embarazo constituye un problema creciente. En pocas maternidades latinoamericanas se aplica una estrategia de detección y los datos publicados son escasos. Objetivos. Comparar dos quinquenios de resultados de una estrategia de detección de sustancias psicoactivas ilegales implementada en el posparto. Población y métodos. Estudio de corte transversal. Detección por inmunoensayo en orinas de binomios madre-hijo/a, en un hospital público argentino entre 2009 y 2018. Resultados. En 76/191 binomios se detectaron sustancias en 10 años. El criterio de detección más frecuente fue la comunicación o antecedente de uso de drogas: 25/37 y 32/39 en cada quinquenio. Predominaron cannabis (21/37 y 26/39) y cocaína (19/37 y 16/39) en ambos períodos. No hubo diferencias en datos demográficos, ginecológicos, del embarazo ni neonatales en los quinquenios comparados. Conclusiones. No se encontraron diferencias en la frecuencia ni en el tipo de sustancias detectadas a lo largo de 10 años.

Introduction. The use of illicit psychoactive substances during pregnancy is a growing problem. Few Latin American maternity centers implement a screening strategy, and published data are scarce. Objectives. To compare the outcomes of 2 five-year periods of a postpartum strategy to screen for illicit psychoactive drugs. Population and methods. This was a cross-sectional study. Immunoassay detection in urine of mothernewborn infant dyads in an Argentine public hospital between 2009 and 2018. Results. Substances were detected in 76/191 dyads over 10 years. The most frequent detection criterion was reporting or history of drug use: 25/37 and 32/39 in each five-year period. Cannabis (21/37 and 26/39) and cocaine (19/37 and 16/39) predominated in both periods. No differences were observed in demographic, gynecological, pregnancy, or neonatal data between both five-year periods. Conclusions. No differences were found in the frequency or type of substances detected over 10 years

Elevada taxa de insegurança alimentar em unidades de triagem de resíduos no sul do Brasil: insegurança alimentar em recicladores / High food insecurity in recyclers from waste sorting units in southern Brazil: high food insecurity in recyclers

Introdução: No Brasil, existem poucos estudos com recicladores de Unidades de Triagem de Resíduos (UTRs). Vários fenômenos sociais têm sido associados ao aumento da Insegurança Alimentar (IA) em países menos desenvolvidos. O estudo tem como objetivo descrever a prevalência de insegurança alimentar em recicladores.Métodos: Estudo transversal realizado com adultos associados de duas UTRs na cidade de Porto Alegre, sul do Brasil, entre 2017 a 2018. Todas as coletas ocorreram nas UTRs. Os indivíduos tiveram seu estado nutricional avaliado por medidas antropométricas através da aferição de peso, altura e circunferência da cintura. A taxa de Insegurança Alimentar foi avaliada pela Escala Brasileira de Insegurança Alimentar (EBIA) e o risco para uso de substâncias foi avaliado pelo Alcohol, Smoking and Substance Involvement Screening Test (ASSIST).Resultados: Foram avaliados 123 sujeitos, com idade média de 35 ± 13,4 anos, sendo 66% do sexo feminino. Foi identificada uma taxa de IA de 74%, sendo que destes, 16% apresentaram Insegurança Alimentar Grave. Cerca de 57% dos participantes apresentaram sobrepeso ou obesidade e 48% circunferência da cintura aumentada. Em relação ao uso de substâncias, 60,5% relataram abuso de tabaco e 14% de álcool.Conclusão: São necessárias intervenções multidisciplinares para prevenir as situações encontradas e a implementação de políticas públicas voltadas para os atos de promoção da saúde na população de recicladores. É fundamental que tanto a sociedade, quanto o governo reconheçam a existência destes problemas para que medidas efetivas possam ser instituídas.

Introduction: In Brazil, there are few studies with recyclers of Waste Sorting Units (WSUs). Several social phenomena have been associated with increased food insecurity (FI) in less developed countries. The study aims to describe food insecurity prevalence in recyclers.Methods: Cross-sectional study conducted with adults from two WSUs in the city of Porto Alegre, southern Brazil, between 2017 and 2018. All data assessment occurred in WSUs. Anthropometric measurements were assessed by weight, height and waist circumference. Food insecurity was assessed with the Brazilian Food Insecurity Scale (EBIA) and substance use was evaluated by the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST).Results: 123 subjects were evaluated, with a mean age of 35 ± 13.4 years, 66% of which were female. A FI rate of 74% was identified, and of these, 16% had Severe Food Insecurity. About 57% of participants were overweight or obese and 48% presented high waist circumference. Regarding substance use, 60.5% were classified for tobacco abuse and 14% for alcohol abuse.Conclusion: Multidisciplinary interventions are needed to prevent all health issues encountered as well as implementation of public policies for the recyclers' health promotion. It is essential that both society and the government recognize the existence of these problems so that measures can be carried out by health institutions.

Construção simbólica frente à falha do recurso à droga na psicose / Construction symbolique face à l'échec de la consommation de drogue dans la psychose / Symbolic construction on the failure of drug use in psychosis

A inserção de psicanalistas em instituições da rede de saúde mental, em especial nos dispositivos de atenção a usuários de álcool e outras drogas, amplia a discussão sobre o diagnóstico estrutural frente ao uso de substâncias psicoativas. O recurso às drogas na psicose pode operar como uma tentativa de estabilização ao localizar no real da substância os efeitos da invasão do real dos sintomas psicóticos. O objetivo deste artigo é discutir, a partir de um caso clínico, a possibilidade de construção simbólica frente à falha deste recurso. O caso analisado pela teoria lacaniana demonstra que o uso de drogas pode ser capturado pelo processo de desorganização pulsional. Discute-se a função do sonho na psicose e sua relação com a construção delirante. O endereçamento transferencial ao analista, por outro lado, permite que o discurso sobre as drogas em sua dimensão significante opere como uma forma de construção simbólica para a amarração dos registros

L'insertion despsychanalystes dans les établissements du réseau d'assistance de la santé mentale, notamment dans les dispositifs de prise en charge des usagers d'alcool et d'autres drogues, élargit la réflexion sur le diagnostic structurel face à l'usage de substances psychoactives. L'usage de drogues dans la psychose peut opérer comme une tentative de stabilisation en situant dans le réel de la substance les effets de l'envahissement du réel des symptômes psychotiques. L'objectif de cet article est de discuter, a partir d'un cas clinique, de la possibilité d'une construction symbolique face à l'échec de cette ressource. Le cas, pour la théorie lacanienne, démontre que la consommation de drogues peut être capturée par le processus de désorganisation de la pulsion. Les rêves sont discutés a partir du délire et de sa fonction dans la psychose. L'adresse du transfert à l'analyste, au contraire, permet au discours sur la drogue dans sa dimension signifiante d'opérer comme une forme de construction symbolique pour nouer les registres.

The insertion of psychoanalysts in institutions of the mental health network, especially in spaces dedicated to the care of users of alcohol and other drugs, broadens the discussion on the structural diagnosis in the face of psychoactive substance use. The use of drugs in psychosis can operate as an attempt at stabbilization by locating in the real of the substance the effects of the invasion of the real of psychotic symptoms. The objective of this article is to discuss, based on a clinical case, the possibility of symbolic construction when facing the failure of this resource. The case demonstrates through lacan´s theory that drug use can be captured by the process of disorganization of the drive. The function of dream in psychosis is discussed through its relation to delusion. The transferential addre to the analyst, on the other hand, allows the discourse about drugs in its signifying dimension to operate as a form of symbolic construction for tying the registers

Análisis médico legal de la toxicomanía por MDMA: reporte de caso / Medical-legal relationship of MDMA drug addiction: case report

Resumen El análisis por toxicomanía representa un proceso común solicitado por la Autoridad Judicial para determinar si un usuario presenta hallazgos compatibles con el uso de una droga a nivel clínico, componentes histológicos, patológicos y toxicológicos que puedan generar su uso. Es necesario destacar las limitaciones del ambiente clínico donde se pueden generar múltiples hallazgos, y de la toxicología forense donde a pesar de la especificidad a la que se asocia; también se encuentra limitada por la capacidad de sus equipos tecnológicos. La resonancia magnética nuclear cuantitativa de hidrógeno representa grandes ventajas al demostrar la presencia de una droga ilegal, así como la posibilidad de disminuir costos y tiempo laboral. El uso del MDMA como tratamiento con una reciente aprobación para un estudio de fase III por la FDA, también requiere que se valore el motivo de su uso, por lo que para realizar un análisis médico legal se contemplaron diversos elementos de juicio a fin de satisfacer la evaluación sobre la toxicomanía por MDMA en un usuario que presentó un tejido granular blanco tipo polvo en la sección distal del tabique nasal y negó el consumo de metanfetaminas.

Abstract The analysis for drug addiction represents a common process requested by the Judicial Authority to determine if a user presents findings compatible with the use of a drug at a clinical level, histological, pathological and toxicological components that may generate its use. It is necessary to highlight the limitations of the clinical environment where multiple findings can be generated, and of forensic toxicology where despite the specificity to which it is associated; it is also limited by the capacity of its technological equipment. Quantitative hydrogen nuclear magnetic resonance represents great advantages when demonstrating the presence of an illegal drug, as well as the possibility of reducing costs and labor time. The use of MDMA as a treatment with a recent approval for a phase III study by the FDA, also requires that the reason for its use be assessed, therefore, in order to carry out a legal medical analysis, various elements of judgment were considered in order to satisfy evaluation of MDMA drug addiction in a user who presented with white powder-like granular tissue in the distal section of the nasal septum and denied the use of methamphetamine.

Sociodemographic and clinical profile of crack cocaine treatment-seeking individuals living in "Crackland", Brazil / Perfil sociodemográfico e clínico de indivíduos em busca de tratamento para o uso de crack que vivem na "Cracolândia"

OBJECTIVE: São Paulo's Crackland is the biggest and oldest open drug use scene in Brazil, yet little is known about the profile of crack cocaine treatment-seeking individuals living in this region. The aim of this crossectional study was to describe the demographics and clinical characteristics of treatment-seeking crack users living in the Crackland region. METHODS: A sample of nighty eight individuals were screened for DSM-V substance use disorders, including substance use, impulsiveness, and psychiatric symptoms. Recent crack cocaine use was also tested using biologic specimens. RESULTS: Results indicated severe social vulnerability, as participants experienced high rates of homelessness (46.9%), unstable housing (50%), unemployment (60.4%) and early school drop-out (27.5%). The average age of crack use onset was 20 years (SD = 6.9) and the mean duration of continuous crack use was 15 years (SD = 9.7). Most participants presented with concomitant mental health disorders, particularly alcohol use disorder (87.8%), as well high rates of psychiatric symptomatology and impulsiveness. More than half of the sample reported at least one previous inpatient (73.5%) and outpatient (65.3%) addiction treatment attempt. CONCLUSION: This population profile should inform mental healthcare services, promoting the provision of tailored assistance by targeting specific demands at all levels of treatment.

OBJETIVO: Localizada em São Paulo, a Cracolândia é o maior e mais antigo cenário aberto de uso de drogas do Brasil. Ainda assim, pouco se sabe sobre o perfil dos indivíduos que vivem nessa região e buscam tratamento para crack. O objetivo deste estudo transversal foi descrever características demográficas e clínicas de usuários de crack vivendo na região da Cracolândia que estão em busca de tratamento. MÉTODOS: Noventa e oito indivíduos foram avaliados para transtornos por uso de substâncias do DSM-V, padrão de uso de substâncias, impulsividade e sintomatologia psiquiátrica. O uso recente de crack também foi determinado por meio de coleta de amostras toxicológicas. RESULTADOS: Os resultados indicaram grave vulnerabilidade social, com significativas prevalências de falta de moradia (46,9%), moradia instável (50%), desemprego (60,4%) e abandono escolar precoce (27,5%). A idade média de início do uso de crack foi de 20 anos (DP = 6,9) e a duração média do uso contínuo do crack foi de 15 anos (DP = 9,7). A maioria dos participantes apresentou alguma comorbidade psiquiátrica, particularmente transtorno por uso de álcool (87,8%), bem como altas taxas de sintomatologia psiquiátrica e impulsividade. Mais da metade da amostra relatou pelo menos uma tentativa anterior de tratamento por internação (73,5%) e ambulatorial (65,3%). CONCLUSÃO: Os achados desse estudo permitem um maior entendimento do perfil e das necessidades de usuários de crack vivendo na região da Cracolândia e podem ajudar serviços de saúde especializados em dependência química a promoverem uma assistência mais direcionada às demandas específicas dessa população.

Psychometric properties of the Benzodiazepine Dependence Self-Report Questionnaire - Portuguese Version (BENDEP-SRQ-PV)

Abstract Objective To assess psychometric properties of the Benzodiazepine Dependence Self-Report Questionnaire - Portuguese Version (BENDEP-SRQ-PV) in a sample of Brazilian chronic hypnotic users. Methods One hundred and seventy-nine chronic hypnotic users (benzodiazepines and Z-drugs) were recruited, attended a psychiatric evaluation, and answered the BENDEP-SRQ-PV. Factor structure, reliability, and influence of covariates (dependence diagnosis and type of drug consumed) were assessed in a structural equation modelling environment. Discrimination was assessed with receiver operating characteristic (ROC) plots and stability with the test-retest method. Results Participants, mostly women (91.6%), aged 51 to 64 years old, had been using hypnotics for an average of 34.8 months, with a mean defined daily dose of 0.72. Psychometric analysis demonstrated construct and criterion validity, reliability, and response stability. The factor structure was maintained as originally proposed: problematic use (ω = 0.73), preoccupation (ω = 0.74), lack of compliance (ω = 0.74), and withdrawal (ω = 0.93). Conclusion The BENDEP-SRQ-PV is an adequate measure of hypnotic dependence in the Brazilian population of chronic users. Our results support using the scale for follow-up in clinical and research applications and in correlational studies.

Trastornos del ánimo y trastornos por uso de sustancias: una comorbilidad compleja y frecuente / Mood disorders and substance use disorders: a complex and frequent comorbidity

La comorbilidad entre trastornos del ánimo (TA) y trastornos por uso de sustancias (TUS) es frecuente, empeora el pronóstico de ambos cuadros y dificulta su tratamiento. El reconocimiento y manejo de síntomas anímicos en usuarios de sustancias significa un desafío en la práctica clínica. Si bien existen los trastornos anímicos secundarios a la patología por consumo, la evidencia muestra que la mayor parte de las veces en que ambas patologías coexisten, el trastorno anímico es primario, por lo tanto, el uso de sustancias activo no debiese impedir un tratamiento oportuno del TA, sin descuidar el manejo específico del uso de sustancias, ya que el tratamiento del cuadro afectivo por sí sólo no resuelve el TUS. Existe acuerdo en la necesidad de realizar un tratamiento integrado de ambos trastornos, que incorpore intervenciones farmacológicas y psicoterapéuticas ya validadas para el tratamiento de ambos trastornos por separado, y especialmente aquellas que han mostrado efectividad en la comorbilidad. El tratamiento debe tener un enfoque en la recuperación, que promueva la adherencia y reinserción social. Se requiere mayor investigación sobre el pronóstico y el tratamiento de la comorbilidad entre Trastorno anímicos y por uso de sustancias, y el fortalecimiento de la red de salud general y salud mental en la pesquisa y manejo de estos cuadros.

Comorbidity between Mood Disorders (MD) and Substance Use Disorders (SUD) are common and it worsens the prognosis of both conditions. The recognition and management of mood symptoms in SUD patients is a usual challenge in clinical practice. As opposed to the usual belief, most mood disorders in TUS patients are primary disorders and therefore the use of active substances should not prevent timely treatment of MD, without neglecting the specific management of substance use, since that the treatment of the affective condition alone does not resolve your SUD. There is agreement on the need to perform an integrated treatment of both disorders, which incorporates pharmacological and psychotherapeutic interventions already validated for the treatment of both disorders, and especially those that have shown effectiveness in comorbidity. Treatment should have a focus on recovery, which promotes adherence and social reintegration. More research is required on the prognosis and treatment of comorbidity between mood and substance use disorders, and the strengthening of the general health and mental health network in the research and management of these conditions.

Trastorno por deficit de atención/hiperactividad y uso de sustancias / Attention-deficit/hyperactivity disorder and substance abuse. Scientific evidence

El trastorno por déficit de atención con hiperactividad (TDAH) es una alteración del neurodesarrollo de base biológica que iniciado en la infancia puede persistir durante la adolescencia-juventud y, a pesar de lo que se pensaba hasta hace no muchos años, también en la edad adulta hasta en un 50-60% de los afectados, produciendo un notable deterioro clínico y psicosocial. A pesar de tratarse de un síndrome fácilmente identificable por la triada: desatención, hiperactividad e impulsividad que le caracteriza, en la práctica clínica existen diferentes circunstancias que dificultan y complican su diagnóstico y tratamiento. Una de las más significativas es la presencia, tanto en la infancia como en la edad adulta, de otros trastornos mentales comórbidos. Es a partir de la adolescencia-juventud cuando junto al TDAH podemos detectar la presencia de trastornos de la personalidad, trastornos del estado de ánimo, trastornos de ansiedad y muy especialmente trastornos por uso de sustancias. Las evidencias existentes hasta el presente muestran como la comorbilidad del TDAH y el trastorno por uso de sustancias influyen en el curso evolutivo de ambos, complicando el abordaje, el tratamiento y consecuentemente agravando el pronóstico final. Las dificultades en su abordaje y la escasez de opciones de tratamiento nos hacen subrayar la importancia del tratamiento preventivo en la etapa infantil a partir de programas de psicoeducación centrados en la vulnerabilidad de estos pacientes a las sustancias y las consecuencias asociadas al consumo.

Attention deficit hyperactivity disorder (ADHD) is a neurodevelopmental alteration of biological basis that started in childhood may persist during adolescence-youth and, despite what was believed until not many years ago, also in adulthood up to 50-60% of those affected, producing a significant clinical and psychosocial deterioration. In spite of being a syndrome easily identifiable by the triad: inattention, hyperactivity and impulsivity that characterizes it, in clinical practice there are different circumstances that hinder and complicate its diagnosis and treatment. One of the most significant is the presence, both in childhood and adulthood, of other comorbid mental disorders. It is from adolescence-youth when together with ADHD we can detect the presence of personality, mood and anxiety disorders and especially the use of several substances. The evidences existing until now show how the comorbidity of ADHD and substance use disorder influence the evolutionary course of both, complicating the approach, the treatment and, therefore, aggravating the final prognosis. The difficulties in their approach and the scarcity of treatment options make us underline the importance of preventive treatment in the infantile stage, starting from psychoeducation programs focused on the vulnerability of these patients to substances and the consequences associated with consumption.

Detección del nivel de riesgo de consumo de sustancias psicoactivas en estudiantes universitarios de psicología - Perú / Detection of the level of risk of consumption of psychoactive substances in university students of psychology - Perú

El presente estudio tuvo como objetivo detectar el nivel de riesgo por consumo de sustancias psicoactivas (SPA) en una muestra de 324 universitarios ingresantes a Psicología en Arequipa ­ Perú, siendo el 73.15% de sexo femenino y 26.85% masculino, con edades que fluctúan entre los 18 y 25 años. Se empleó para ello la prueba ASSIST elaborada por la Organización Mundial de la Salud (OMS), hallando que el 33.02%, 22.53% y 10.49% alcanza un nivel de riesgo moderado en el consumo de tabaco, bebidas alcohólicas y marihuana correspondientemente. Además, el 2.78% presentó un nivel de riesgo alto en el consumo de bebidas alcohólicas. Se concluye que las SPA más consumidas por dichos universitarios son bebidas alcohólicas y tabaco, y que aproximadamente 1 de cada 4 tiene un riesgo moderado a alto de tener problemas por el consumo de alcohol y tabaco

The objective of this study was to detect the level of risk due to consumption of psychoactive substances in a sample of 324 undergraduates entering Psychology in Arequipa - Peru, with 73.15% female and 26.85% male, and ages between 18 and 25 years. The ASSIST test prepared by the World Health Organization (WHO) detected that 33.02%, 22.53% and 10.49% reach a moderate level of risk in the consumption of tobacco, alcoholic beverages and marijuana correspondingly. Besides, 2.78% of a high level of risk in the consumption of alcoholic beverages, concluding that the SPA most consumed by these university students are alcoholic beverages and tobacco; that approximately 1 in 4 has a moderate to high risk of having problems with alcohol and tobacco consumption.

Twelve-month utilization rates and adequacy of treatment for mental health and substance use disorders in Argentina

Objective: To estimate the 12-month prevalence of mental health services utilization (overall and by type of service sector), the adequacy of treatment provided, and sociodemographic correlates in the Argentinean Study of Mental Health Epidemiology (ASMHE). Methods: The ASMHE is a multistage probability household sample representative of adults in urban areas of Argentina. The World Health Organization World Mental Health Composite International Diagnostic Interview (WMH-CIDI) was used to evaluate psychiatric diagnosis and service utilization. Results: Among those with a disorder, 27.6% received any treatment in the prior 12 months. Of these, 78.3% received minimally adequate treatment using a broad definition and only 43.6% using a stringent definition. For individuals with a disorder, more services were provided by mental health professionals (17.7%) than by general medical professionals (11.5%) or non-healthcare sectors (2.6%). Younger individuals with low education and income were less likely to receive treatment; those never married and those with an anxiety or mood disorder were more likely to receive treatment. Among those in treatment, treatment was least adequate among younger individuals with low education and low income. Conclusions: Policies to increase access to services for mental health disorders in Argentina are needed, as is training for primary care practitioners in the early detection and treatment of psychiatric disorders.

Síndrome de deprivación glucocorticoidea. A propósito de un caso / Glucocorticoid deprivation syndrome. Case presentation

RESUMEN El síndrome de deprivación glucocorticoidea es el cuadro clínico resultante de la suspensión de la administración exógena de esteroides, aplicados por tiempo prolongado, independientemente de la vía de administración. Provoca la frenación del eje hipotálamo-hipófisis-suprarrenal y por ende disminuye la producción y secreción de corticotropina. Paciente femenina de 54 años de edad, con esteroides como tratamiento prolongado. Al retirarlo comenzó con pérdida de peso y dificultad para caminar, además de hipotensión ortostática, sufrió caída brusca al piso con pérdida de conocimiento. Fue llevada al hospital y no se constató pulsos periféricos ni tensión arterial, que no resolvió totalmente con el uso enérgico de fluidos endovenosos. Se mantuvo sin regular parámetros normales, se reevaluó como un síndrome de depravación corticoidea y se le impuso tratamiento con prednisona, mejorando paulatinamente. Los síndromes asociados a la retirada de corticoidesaparecen por el empleo de dosis altas, o retirada brusca de la corticoterapia prolongada. Al conjunto de síntomas y signos que aparecen cuando no se consigue tolerar la retirada de glucocorticoides, ante la ausencia de enfermedad subyacente para la cual fueron indicados estos medicamentos, y con un eje hipotálamo-hipófisis-suprarenal (HHS) no suprimido se le considera un síndrome de retirada de corticoides. A pesar de la gravedad, la frecuencia e importancia de este efecto secundario, en ocasiones no se repara en él, por lo que es imprescindible valorar los tratamientos indicados y reevaluar periódicamente los tratamientos crónicos indicados.

ABSTRACT The glucocorticoide deprivation symptom is the clinical symptom resulting from stoping the exogenous administration of steroids that were used for a long time, in spite of the administration way. It restrains the hypothalamus-pituitary-adrenal axis and therefore reduces corticotropine production and secretion. This is the case of a female patient, aged 54 years, with a continued steroid treatment. When stoping it, she began to lose weight and presented difficulties for walking. Besides orthostatic hypotension, she abruptly fell to the ground losing conciousness. She was carried to the hospital and there were not found periferal pulses nor arterial tension, a problem that was not solved by the active use of endovenous fluids. She kept on without regulating normal parameters, and was re-evaluated as a corticoid deprivation symptom and treated with prenisone. She gradually got better. The syndromes asociated to corticod deprivation begin due to the usage of high doses, or due to the abrupt withdrawal of a long corticotherapy. The whole of the symptoms appearing when corticoid withdrawal is not tolerated, in the absence of the underlying disease against which these medicines were indicated, and with a non-suppressed hypothalamus-pituitary-adrenal axis, is considered as a syndrome of corticoide withdrawal. In spite of its seriousness, of the frequency and importance of this secundary effect, sometimes it is not noticed; therefore it is essential to evaluate the indicated treatments and periodically reevaluate the treatments ordered for chronic diseases.

Cuadernillo para equipos de salud: Educación y Promoción de la Salud, abordajes, propuestas y aprendizajes desde el hacer: Consumo problemático de sustancias / Booklet for health teams: Education and Health Promotion, approaches, proposals and learning from doing: Problematic substance use

Cuadernillo destinado a los equipos de salud producido por el equipo de comunicación de la Residencia Interdisciplinaria de Educación y Promoción de la Salud (RIEPS), del Ministerio de Salud del Gobierno de la Ciudad de Buenos Aires. Presenta como partes principales: Fundamentación, Perspectiva de Educación y Promoción de la Salud, Modelos Teóricos: Abstencionismo y Reducción de Riesgos y Daños, Marco Normativo, Medios de Comunicación, Dimensionando una Cuestión de Salud, y Consideraciones a la Hora de la Intervención. Incluye anexos y bibliografía.

Consumo, juego, palabra. "Cuestiones preliminares" y movilidad de los discursos en un espacio comunitario / Consumption, game, word, "Prelimininary questions" and discourses mobility in a communal space

Se exponen los resultados parciales de un proyecto de investigación y de intervención, que implicó el armado de un espacio de escucha para adolescentes con consumos problemáticos en un asentamiento en vías de urbanización de la ciudad de Corrientes. El objetivo central del Proyecto de investigación apuntó a indagar la relación entre los consumos problemáticos, la circulación discursiva y el lazo social, desde una opción teórica y clínica por el psicoanálisis. En la medida en que se significó el problema en relación con el sujeto que lo porta, se orientó el abordaje según una ética del decir

This article exposes the partials results of a Research and Intervention Project, that implied putting up a Listening Space for teenagers with problematic drugs 'consumption. This space was located in a slum, in Corrientes city (Argentine). The central goal of the Research Project was to drelate problematic consumption of drugs, discourses circulation and social bound, starting from a theoretical and clinic option for Psychoanalysis. As the problem was signified in relation to the subject that supports it, the Project pointed towards an "Ethic of saying"

Tratamiento de patología dual: depresión y trastorno por consumo de sustancias / Treatment of dual pathology: depression and disorder for consumption of substances

Se presenta el caso de un paciente de 53 años que padece dos cuadros clínicos, un trastorno por consumo de sustancia (TUS) y un cuadro de depresión mayor con riesgo suicida lo cual en la actualidad se denomina patología dual. Se dedican dos sesiones a la evaluación diagnóstica y funcional y el tratamiento se desarrolla de manera individual y grupal. Se utilizan técnicas de corte cognitivo-conductual: psicoeducación, mindfulness, técnicas cognitivas y de detección del pensamiento o también llamadas de bloqueo. Tras las sesiones de tratamiento los niveles de craving disminuyen, implementa técnicas de bloqueo y cesa el consumo de alcohol y tabaco. Se mantienen sesiones de seguimiento mensual, que tiene por finalidad objetivar el mantenimiento de los logros terapéuticos. Se observa a lo largo de estas sesiones de seguimiento la remisión de total del consumo de alcohol, tabaco y depresión. Se sigue trabajando actualmente en la búsqueda de actividades placenteras que llenen su tiempo libre (uso adecuado de su tiempo libre).

We present the case of a 53-year-old patient who suffers two clinical disorders, a disorder for consumption of substance and a major depression with suicidal risk, which at present is named a dual pathology. We dedicate two sessions to the diagnostic and functional evaluation and the treatment develops in an individual way and grupal. We use cognitive - behavioral technologies: psychoeducation, mindfulness, cognitive technologies and of thought detection or blockade. After the treatment sessions the levels of craving diminish, we implement technologies of blockade, and patient stops the consumption of alcohol and tobacco. There are kept meetings of monthly follow-up, which has for purpose the maintenance of the therapeutic achievements. Is observed along these meetings of follow-up the total remission of the consumption of alcohol, tobacco, and of depression. We continue working nowadays at the search of pleasant activities that fill his free time (suitable use of his free time).

Psicosis, Discapacidad intelectual y trastornos conductuales: enfoque biopsicosocial / Psychosis, intellectual disability and behavioral disorders: biopsychosocial approach

Caso Clínico: Mujer, 23 años. Discapacidad intelectual. Asiste a colegio especial (no lee ni escribe). Institucionalizada. Motivo de ingreso: Paciente ingresa en octubre del 2017 traída por carabineros por ser encontrada en la calle bajo el efecto de múltiples sustancias, con ideación suicida. Días antes fue expulsada del hogar por agresión a cuidadoras. Diagnósticos de ingreso: Discapacidad intelectual moderado. Síndrome suicidal, Trastorno por dependencia a drogas. ¿Esquizofrenia hebefrénica? Evolución: Mantiene desajustes conductuales severos fluctuantes, con serias dificultades para manejar la rabia, lo que la lleva a tener conductas hetero y autoagresivas. Plan de tratamiento: Farmacológico (clozapina), Psicológico (TCC), Social (dispositivo adecuado post-alta). Clozapina para trastornos psicóticos en adultos con discapacidad intelectual. El principal riesgo de atribuir alguno de estos comportamientos a una supuesta "psicosis", es el de "medicalizar" y tratar de forma poco acertada. Es importante descartar factores ambientales y del aprendizaje (hábitos y conductas aprendidas, institucionalización, reacciones ante el estrés agudo.) La prevalencia de abuso y dependencia de sustancias en población con DI va desde el 0,5% al 2,6%. Lo cual es menor que la población general. Pacientes con DI y dependencia a drogas se asocia a otras enfermedades psiquiátricas (42-54%). Se ha informado que las personas con discapacidad intelectual en América Latina a menudo están institucionalizadas y escondidas de la sociedad en instalaciones deficientes y superpobladas.

Clinical Case: Female, 23 years old. Intellectual disability. He attends a special school (she does not read or write). Institutionalized. Reason for admission: Patient enters in October 2017 brought by police officers to be found in the street under the effect of multiple substances, with suicidal ideation. Days before she was expelled from the home because of assaulting caregivers. Admission diagnoses: Moderate intellectual disability. Suicidal syndrome, Disorder due to drug dependence. Hebephrenic schizophrenia? Evolution: Maintains fluctuating severe behavioral imbalances, with serious difficulties in managing rage, which leads to hetero and self-aggressive behaviors. Treatment plan: pharmacological (clozapine), Psychological (CBT), Social (adequate post-hospitalization discharge device). Clozapine for psychotic disorders in adults with intellectual disabilities. The main risk of attributing some of these behaviors to a supposed "psychosis" is that of "medicalizing" and dealing inappropriately. It is important to rule out environmental and learning factors (habits and behaviors learned, institutionalization, reactions to acute stress. The prevalence of substance abuse and dependence in the population with ID ranges from 0.5% to 2.6%. Which is less than the general population. Patients with ID and drug dependence are associated with other psychiatric illnesses (42-54%). It is reported that people with intellectual disabilty in Latin America are often institutionalized and hidden from society in poor and overcrowded facilities.

Consideraciones sobre las adicciones en la formación del profesional de Ciencias Médicas / Considerations on addictions in the training of medical sciences professional

En la actualidad se acepta como adicción, cualquier actividad que el individuo no sea capaz de controlar, que lo lleve a conductas compulsivas y perjudique su calidad de vida. La drogodependencia, también llamada drogadicción o farmacodependencia, es un problema de salud causado por el frecuente uso de sustancias adictivas llamadas drogas. No nos resulta nuevo que gran cantidad de estudiantes universitarios consuman drogas controladas para supuestamente potenciar su desempeño académico. Cuba no escapa a esta realidad a pesar de ser un baluarte mundial en la lucha antidroga. La imitación o aprendizaje de esta conducta es un elemento clave en adolescentes y estudiantes universitarios, la dificultad estriba en el acceso al fármaco lo cual para estudiantes de determinadas carreras, por ejemplo las carreras de Ciencias Médicas, no constituye un gran obstáculo. Exponemos de forma breve las consideraciones sobre el tema (AU).

Currently, any activity the individual is not able to control, that lead him to compulsive behavior damaging his life quality is accepted as addiction. Drug-dependence, also called drug addiction of pharmacodependence, is a health problem caused by the frequent use of addictive substances called drugs. It is not a news that a big quantity of university students consume controlled drugs to supposedly potentiate their academic competence. Cuba is not free of this reality in spite of being a world bulwark in the antidrug fight. This behavior imitation or learning is a key element among teenagers and university students, the difficulty rests in the drug access for the students of several specialties, what is not a trouble for the Medicine students. We briefly expose several considerations on the them (AU).

Borderline personality disorder: an adaptation of the Taiwan short version of the screening inventory into Brazilian Portuguese / Transtorno de personalidade borderline: uma adaptação para o português brasileiro do inventário de rastreamento de Taiwan em sua forma reduzida

Abstract Objective The current study presents the translation and adaptation of the 20-item Taiwan version of the Borderline Personality Inventory (BPI) into Brazilian Portuguese (BPI-P). Methods After translation and back-translation, the Brazilian Portuguese version was administered to three samples: patients with borderline personality disorder, psychiatric patients with comorbid substance use disorder and volunteers with no reported mental disorders. Results Significant differences between groups for borderline scores (analysis of variance [ANOVA], F = 52.923, p = 0.01) were found but there were no significant correlations between scores for borderline personality disorder and alcohol or nicotine dependence. The BPI-P had satisfactory validity for borderline personality disorder, even when anxiety and depression were present, with an area under the receiver operating characteristic curve of 0.931 at a cutoff point of 14. Conclusion This study provides support for the potential utility of the BPI-P as a screening instrument for clinical practice in Portuguese speaking countries, including outpatients with alcohol and nicotine use disorders in early or sustained remission.

Resumo Objetivo Este estudo apresenta a tradução e adaptação do Inventário de Taiwan para Transtorno de Personalidade Borderline (IPB) de 20 itens, para o português brasileiro (IPB-P). Métodos Após tradução e retrotradução, a versão em português brasileiro foi aplicada em três amostras: pacientes com transtorno de personalidade borderline, pacientes psiquiátricos com comorbidade de transtorno de uso de substâncias e voluntários sem transtornos mentais relatados. Resultados Diferenças significantes entre os grupos em relação aos graus para borderline (análise de variância [ANOVA], F = 52,923, p = 0,01) foram encontradas mas não houve correlações significantes entre as pontuações para transtorno de personalidade borderline e dependência de álcool ou nicotina. O IPB-P teve uma validade satisfatória para transtorno de personalidade borderline mesmo quando ansiedade e depressão estavam presentes, com uma área sob a ROC (receiver operating characteristic curve) de 0,931 no ponto de corte de 14. Conclusão Este estudo dá suporte para a utilidade potencial do IPB-P como um instrumento de rastreamento para a prática clínica em países de língua portuguesa, incluindo pacientes ambulatoriais com transtorno de uso de álcool e nicotina em remissão precoce ou sustentada.

Screening and Brief Intervention for the use of alcohol and other drugs / Rastreo e intervención breve para uso de alcohol y otras drogas / Rastreamento e Intervenção Breve para uso de álcool e outras drogas

ABSTRACT Objective: to identify the lifetime use of alcohol and other drugs among users of the Family Health Strategy and apply Brief Intervention to problems related to the use of these substances. Method: a descriptive cross-sectional study where 1,031 users of the Family Health Strategy of the city of Rio de Janeiro answered a form with socio-demographic information and the Alcohol, Smoking and Substance Involvement Screening Test. Statistical analysis with simple frequency distribution was performed. Results: the most commonly used drugs in lifetime were alcohol and tobacco; among the illegal drugs, marijuana, hypnotics and cocaine/crack stood out. Those who received most Brief Intervention were users of tobacco, hypnotics, marijuana, cocaine/crack and alcohol. Conclusion: it is important to detect early problems associated with the use of alcohol and other drugs in Primary Care, since it has the promotion/protection of health and the prevention of diseases as priority health practices.

RESUMEN Objetivo: identificar el uso en la vida de alcohol y otras drogas entre usuarios de la Estrategia Salud de la Familia y aplicar una intervención breve para problemas relacionados al uso de esas sustancias. Método: el estudio descriptivo del tipo transversal donde 1031 usuarios de la Estrategia Salud de la Familia de la ciudad de Rio de Janeiro respondieron a un formulario con informaciones sociodemográficas y a el Alcohol, Smoking and Substance Involvement Screening Test. Se realizó un análisis estadístico con distribución de frecuencias simple. Resultados: las drogas más usadas en la vida fueron el alcohol y el tabaco; entre las drogas ilícitas, se destacaron marihuana, hipnóticos y cocaína/crack. Los que más recibieron intervención breve fueron los usuarios de tabaco, hipnóticos, marihuana, cocaína/crack y alcohol. Conclusión: es importante detectar precozmente problemas asociados al uso de alcohol y otras drogas en la atención básica, pues ella tiene la promoción/protección de la salud y la prevención de agravios como prácticas sanitarias prioritarias.

RESUMO Objetivo: identificar o uso, na vida, de álcool e outras drogas entre usuários da Estratégia Saúde da Família e aplicar Intervenção Breve para problemas relacionados ao uso dessas substâncias. Método: estudo descritivo do tipo transversal onde 1031 usuários da Estratégia Saúde da Família da cidade do Rio de Janeiro responderam um formulário com informações sociodemográficas e o Alcohol, Smoking and Substance Involvement Screening Test. Análise estatística com distribuição de frequências simples foi realizada. Resultados: as drogas mais usadas na vida foram álcool e tabaco; entre as drogas ilícitas, destacaram-se maconha, hipnóticos e cocaína/crack. Os que mais receberam Intervenção Breve foram os usuários de tabaco, hipnóticos, maconha, cocaína/crack e álcool. Conclusão: é importante detectar precocemente problemas associados ao uso de álcool e outras drogas na Atenção Básica, pois ela tem a promoção/proteção da saúde e a prevenção de agravos como práticas sanitárias prioritárias.