Phytochemical interventions for post-traumatic stress disorder: A cluster co-occurrence network analysis using CiteSpace / 中西医结合学报

OBJECTIVE@#This study investigated trends in the study of phytochemical treatment of post-traumatic stress disorder (PTSD).@*METHODS@#The Web of Science database (2007-2022) was searched using the search terms "phytochemicals" and "PTSD," and relevant literature was compiled. Network clustering co-occurrence analysis and qualitative narrative review were conducted.@*RESULTS@#Three hundred and one articles were included in the analysis of published research, which has surged since 2015 with nearly half of all relevant articles coming from North America. The category is dominated by neuroscience and neurology, with two journals, Addictive Behaviors and Drug and Alcohol Dependence, publishing the greatest number of papers on these topics. Most studies focused on psychedelic intervention for PTSD. Three timelines show an "ebb and flow" phenomenon between "substance use/marijuana abuse" and "psychedelic medicine/medicinal cannabis." Other phytochemicals account for a small proportion of the research and focus on topics like neurosteroid turnover, serotonin levels, and brain-derived neurotrophic factor expression.@*CONCLUSION@#Research on phytochemicals and PTSD is unevenly distributed across countries/regions, disciplines, and journals. Since 2015, the research paradigm shifted to constitute the mainstream of psychedelic research thus far, leading to the exploration of botanical active ingredients and molecular mechanisms. Other studies focus on anti-oxidative stress and anti-inflammation. Please cite this article as: Gao B, Qu YC, Cai MY, Zhang YY, Lu HT, Li HX, Tang YX, Shen H. Phytochemical interventions for post-traumatic stress disorder: A cluster co-occurrence network analysis using CiteSpace. J Integr Med. 2023; 21(4):385-396.

Pharmacotherapy used for alcohol and cocaine use disorders in a CAPS-AD of Minas Gerais

Abstract Substance use disorder is one of the major social and public health problems in the world. The present study analyzed the pharmacoepidemiological profile of patients treated at the Psychosocial Treatment Center for Alcohol and Substance Use Disorders (CAPS-AD) for treatment of alcohol use disorders (AUD), cocaine use disorders (CUD) and concomitant alcohol and cocaine use disorders (A-CUD) in the city of Betim-MG. The study used quantitative and descriptive data and was based on the evaluation of medical records of patients attended from January to December 2016. After analyzing 295 medical records, the majority of study participants were male (83.7 %) with an average age of 46.26 for AUD, 28.88 for CUD and 34.29 for A-CUD. The most prescribed drugs for AUD were diazepam (54.1 %), thiamine (37 %), complex B vitamins (29.5 %), and disulfiram (2.7 %); for CUD, diazepam (26.9 %) and haloperidol (23.1 %). It should be noticed that although contraindicated by the guidelines, chlorpromazine (42.3 %, 25.3 %, 20.3 %) was prescribed for CUD, AUD, and A-CUD respectively. Knowing the pharmacoepidemiological profile of CAPS-AD patients is extremely important for making decisions regarding which medicines to make available to the population.

Internações compulsórias por processos judiciais para usuários de um Centro de Atenção Psicossocial álcool e drogas / Compulsory hospitalization by legal proceedings for users of a psychosocial Care Center - alcohol and drugs

O estudo teve por objetivo avaliar as características sociodemográficos e clínicas de 218 usuários de substâncias psicoativas, em um Centro de Atenção Psicossocial para Álcool e Drogas (CAPS-ad), de Ribeirão Preto, que chegaram por mandado judicial para avaliação médica e internação compulsória. Trata-se de um estudo retrospectivo, baseado em dados secundários do tipo transversal da abordagem quantitativa. O período avaliado se deu entre os anos de 2008 e 2019. Foram avaliadas as informações sociodemográficas, tipos de internações, diagnósticos, tipos de substâncias psicoativas usadas, requerentes no processo judicial e motivações para a abertura do processo judicial. Os resultados demonstraram que os usuários encaminhados por demanda judicial se caracterizam por serem adultos, com média de idade de 30,5 anos, variando entre 15 e 69 anos, do sexo masculino 182 (83,5%), raça/ etnia branca 146 (67,0%), viviam sem um companheiro 177 (81,2%), possuíam baixo nível de escolaridade 146 (66,1%), desempregados 140 (64,2%) e eram residentes de Ribeirão Preto 215 (98,6%). Quanto aos tipos de internações: 126 (58%) foram Internações Compulsórias, 66 (30,3%) internações voluntárias em Comunidades Terapêuticas, 69 (31,7%) internações voluntárias em hospital e 36 (16,6%) internações involuntárias. Considerando que o estudo se deu a partir da análise dos prontuários ao longo de um período de tempo, o mesmo paciente pode ter tido mais de uma internação em qualquer uma das modalidades. Em relação aos tipos de substâncias psicoativas as mais usadas foram: crack 104 (48,4%), cocaína 59 (27,4%), álcool 33 (15,3%) e a maconha 19 (8,8%). Um pouco mais da metade, 113 (54,6%) dos usuários, possuía outro transtorno mental associado ao uso de substâncias, dentre eles, a Esquizofrenia 40 (18,1%) e o Transtorno de Personalidade 25 (11,5%) foram os mais prevalecentes, seguidos de Outros Transtornos Psicóticos 20 (9,2%) e Transtorno Afetivo Bipolar 18 (8,3%). Não apresentaram outro transtorno mental associado ao uso de substâncias 99 (45,4%). O estudo aponta principalmente a dificuldade das famílias dos usuários de álcool ou de outras drogas para lidar com situações de conflito, bem como a necessidade de políticas públicas de saúde que entendam a realidade na qual esses indivíduos estão inseridos

The study aimed to evaluate the sociodemographic and clinical characteristics of 218 users of psychoactive substances, in a Psychosocial Care Center for Alcohol and Drugs (CAPS-ad) in Ribeirão Preto who arrived by court order for medical evaluation and compulsory hospitalization. This is a retrospective study based on secondary data of the transversal type of the quantitative approach. The evaluated period took place between the years 2008 to 2019. Sociodemographic information, type of hospitalizations, diagnosis, type of psychoactive substances used; applicant in the judicial process and reasons for opening the judicial process. The results showed that the users referred by judicial demand were characterized by being adults, with an average age of 30.5 years, ranging from 15 to 69 years old, male 182 (83.5%), white race / ethnicity 146 (67.0%), lived without a partner 177 (81.2%), had a low level of education 146 (66.1%), unemployed 140 (64.2%) and were residents of Ribeirão Preto 215 (98, 6%). Regarding the types of hospitalizations: 126 (58%) were Compulsory Hospitalizations, 66 (30.3%) voluntary hospitalizations in Therapeutic Communities, 69 (31.7%) voluntary hospitalizations and 36 (16.6%) involuntary hospitalizations. Considering that the study was based on the analysis of medical records over a period of time, the same patient may have had more than one hospitalization in any of the modalities. Regarding the type of psychoactive substance most used were: crack 104 (48.4%), cocaine 59 (27.4%), alcohol 33 (15.3%) and marijuana 19 (8.8%). A little more than half, 113 (54.6%) of users had another mental disorder associated with substance use; among them, Schizophrenia 40 (18.1%) and Personality Disorder 25 (11.5%) were the most prevalent, followed by Other Psychotic Disorders 20 (9.2%) and Bipolar Affective Disorder 18 (8.3%). There was no other mental disorder associated with substance use 99 (45.4%). The study mainly points out the difficulty of the family of users of alcohol or other drugs to deal with conflict situations, as well as the need for public health policies that understand the reality in which these individuals are inserted

O consumidor de crack: a influência das crenças familiares no tratamento / Crack consumer: family beliefs influence in treatment / Consumo de crack: la influencia de creencias de la familia en el tratamiento

A literatura considera que existe um conjunto de valores, crenças e práticas familiares que constituem o referencial cultural da família e que interfere na participação dos familiares no tratamento dos consumidores de crack e outras drogas. O objetivo deste estudo foi investigar as crenças familiares sobre consumo de crack e sua relação com a participação familiar no tratamento de seus membros. Participaram desta pesquisa qualitativa 10 familiares de consumidores de crack que estavam em tratamento em uma Comunidade Terapêutica (CT) e um representante da instituição. Foram aplicados os seguintes instrumentos: uma escala para avaliar o nível socioeconômico; uma versão resumida do questionário Cebrid/Samsha, para avaliar a percepção de risco sobre o consumo de substâncias psicoativas; e dois roteiros de entrevista semiestruturada - versões família e representante da CT. Na avaliação de risco, os familiares consideraram que o consumo de crack, desde a primeira vez na vida, já apresentava um risco grave, em comparação com as outras substâncias. Foram investigadas crenças relacionadas ao consumo do crack, principalmente com relação à influência dos amigos, dependência química, influência do consumidor com o tráfico, entre outras. Os familiares acreditam na importância da participação familiar e consideram que contribuem nesse sentido. Os resultados puderam fornecer subsídios para uma melhor compreensão das crenças familiares sobre o consumo de crack, contribuindo para fomentar uma intervenção que favoreça a participação familiar no tratamento.

According to the literature, there is a set of values, beliefs, and family practices that form a family's cultural frame of reference and may even interfere in the participation of the family in the treatment of crack users - and users of other types of substances. The goal study is to explore family beliefs regarding the use of crack and its correlation with the family's involvement in the treatment of its members. Ten family members of crack users, all of whom were receiving treatment at one of the recovery centers known as Therapeutic Communities, and a representative of this institution took part in the study. The following tools were used: a scale to evaluate the socioeconomic status, a shortened version of the questionnaire developed by Cebrid (the "Brazilian Center of Information on Psychotropic Drugs") and Samsha (the Substance Abuse and Mental Health Services Administration), in order to evaluate the perception of the risks involved in the use of psychoactive substances, and two semi-structured interview scripts. Two versions of the script were elaborated: one for the family and another for the Therapeutic Community representative. The family members stated that using crack is dangerous from the very beginning, particularly when compared to using other substances. Beliefs related to the use of the drug were analyzed, especially concerning the influence of friends, substance abuse, the relationship between the drug user and the traffic, and other factors. The family members believe in the importance of their participation. The results provided a better understanding of family beliefs regarding the use of crack, which helped to create an intervention that may emphasize more the family's participation in the treatment.

La literatura tiene en cuenta que hay un conjunto de valores, creencias y prácticas familiares que constituyen el referencial cultural de la familia y que interfieren en su participación en el tratamiento de los consumidores del crack y de otras drogas. Esta investigación tuvo el objetivo de buscar las creencias familiares acerca del consumo del crack y su relación con la participación de la familia en tratamiento de sus miembros. Participaron de esta investigación cualitativa 10 familiares de consumidores del crack que recibían tratamiento en uno de los centros de recuperación conocidos como Comunidades Terapéuticas y un representante de la institución. Las siguientes herramientas fueron utilizadas: una escala para que se evaluara el nivel socioeconómico, una versión resumida del cuestionario desarrollado por Cebrid (el "Centro Brasileño de Informaciones sobre Drogas Psicotrópicas") y Samsha (la "Administración de Salud Mental y de Abuso de Sustancias", en los EE.UU.), para que se evaluara la percepción de riesgo acerca del consumo de sustancias psicoactivas, y dos guiones de entrevistas semiestructuradas - en las versiones "familia" y "representante de la Comunidad Terapéutica". En la evaluación de riesgos, los miembros de la familia afirmaron que el consumo del crack, desde el principio, representa un grave riesgo en comparación con otras sustancias. Se investigaron las creencias relacionadas al consumo del crack, sobre todo con respecto a la influencia de los amigos, a la dependencia química, a la relación del consumidor con el tráfico y otros factores. La familia cree en la importancia de su participación y en su contribución. Los resultados colaboraron con una mejor comprensión de las creencias de la familia acerca del consumo del crack, lo que ayudó a desarrollar un tipo de intervención que favoreciera la participación de la familia en el tratamiento.

Postural Control of People in treatment for substance use disorder

Abstract Aims: One of the common sequelae of chronic abuse of alcohol and/or illicit drugs is the impairment of body balance control, caused by long-term neurological damage. This study aimed to investigate the postural control of individuals hospitalized for the treatment of substance use disorder (initial phase) and to compare the results obtained by a control group. Method: For this, One-hundred fourteen individuals hospitalized for the treatment of substance use disorder and eighty-eight healthy controls, all males, were analyzed. Body mass, height, and waist circumference were measured. Were performed a balance test in a static upright position with feet side by side using a plantar pressure platform. Results: Individuals with substance use disorder have shown significantly lower results on body balance compared with controls. Individuals with chemical dependence showed balance results open-eyes, similar/lower than control subjects with close-eyes. Still, those who used only alcohol or alcohol combined with other illicit drugs presented worse results. Finally, impairments in body balance variables showed a significant correlation with age and substance time of use. Conclusion: Even in the early stage of treatment, substance use disorder considerably impairs the balance of the investigated men. The worst results were found in alcohol-dependents (alcohol alone or alcohol combined with other drugs).

GAM, apoio e cuidado em CAPS AD / GAM, care support in álcohol and other drugs / GAM, cuidado y apoyo em álcohol y otras drogas

Discute-se um processo de capilarização da estratégia GAM - Gestão Autônoma da Medicação - em São Paulo entre 2017 e 2018, em que trabalhadores e usuários foram convidados à investigação e experimentação do dispositivo GAM na atenção especializada no campo de álcool e outras drogas. Este processo resultou na construção de práticas de apoio distribuído entre trabalhadores e usuários e de um coletivo com potencial de ampliação de possibilidades de redução de danos. Ao longo do processo, os trabalhadores realizaram oficinas de apoio e moderaram os grupos GAM com usuários. Dois analisadores do trabalho e da clínica emergiram nesse processo compartilhado: as experiências de violência nos modos de existência dos usuários e o dia-a-dia dos trabalhadores em serviço; e a expectativa de abstinência e a frustração das "recaídas" que incidem nas relações de cuidado.

A process of capillarization of the GAM strategy - Autonomous Management of Medication - is discussed. In São Paulo, between 2017 and 2018, workers and users were invited to the investigation and experimentation of the GAM proposal in the specialized attention to the suffering in the field of alcohol and other drugs. This process resulted in the construction of a device that generates support practices distributed among workers and users and of a collective with potential to increase possibilities of harm reduction. Throughout the process, workers held "support workshops" and moderated "GAM groups" with users. Two analyzer's themes emerged in this collective process: the experiences of violence that happens in the existence of the users and the day-to-day of the workers in the institution; and the expectation of abstinence and the frustration of "relapses" that affect care relationships in the service and clinic.

Se discute un proceso de capilarización de la estrategia GAM (Gestión autónoma de medicamentos) en São Paulo entre 2017 y 2018, en el que se invitó a trabajadores y usuarios a investigar y experimentar el dispositivo GAM en atención especializada en el campo del alcohol y otras drogas. Este proceso resultó en la construcción de prácticas de apoyo distribuidas entre los trabajadores y usuarios y de un colectivo con el potencial de ampliar las posibilidades de reducción de daños. A lo largo del proceso, los trabajadores realizaron talleres de apoyo y moderaron los grupos GAM con los usuarios. Dos analizadores de trabajo y clínica surgieron en este proceso compartido: las experiencias de violencia en los modos de existencia de los usuarios y la vida cotidiana de los trabajadores en servicio; y la expectativa de abstinencia y la frustración de las "recaídas" que afectan las relaciones de atención.

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.

Use of psychoactive substances in women in outpatient treatment / Uso de sustancias en mujeres en tratamiento ambulatorio / Uso de substâncias psicoativas em mulheres em tratamento ambulatorial

ABSTRACT Objective: to characterize the sociodemographic and psychiatric profile of women users of psychoactive substances in treatment for drug addiction. Method: descriptive study of quantitative approach performed with women attended at a Psychosocial Care Center for Users of Alcohol and Other Drugs (CAPS ad) from the interior of São Paulo State. Results: the sample consisted of 349 adult women, single, low educational level and unemployed, users of alcohol, cocaine, crack and tranquillizers. Among the consequences of use include withdrawal syndrome, overdose, depressive and suicidal symptoms. Most were referred for treatment by the family or health services. Almost 20% of these women had previously started treatments. Conclusion: The results suggest marked morbidity and high levels of psychosocial vulnerability, which require thorough investigation at the patient's admission, as well as damage associated with use, withdrawal symptoms and depressive symptoms.

RESUMEN Objetivo: caracterizar el perfil sociodemográfico y psiquiátrico de mujeres usuarias de sustancias psicoactivas en tratamiento para la dependencia química. Método: estudio descriptivo de abordaje cuantitativo realizado con mujeres atendidas en un Centro de Atención Psicosocial para Usuarios de Alcohol y otras Drogas (CAPS ad) del interior paulista. Resultados: la muestra fue de 349 mujeres adultas, solteras, baja escolaridad y desempleadas, usuarias de alcohol, cocaína, crack y tranquilizantes. Entre las consecuencias del uso incluyen el síndrome de abstinencia, sobredosis, síntomas depresivos y suicidas. La mayoría fueron encaminadas para el tratamiento por la familia o los servicios de salud. Casi el 20% de estas mujeres ya habían iniciado tratamientos anteriormente. Conclusión: Los resultados sugieren acentuada morbilidad y altos niveles de vulnerabilidad psicosocial, que requieren una investigación minuciosa en la admisión de la usuaria, además de daños asociados al uso, síntomas de abstinencia y síntomas depressivos.

RESUMO Objetivo: caracterizar o perfil sociodemográficos e psiquiátrico de mulheres usuárias de substâncias psicoativas em tratamento para dependência química. Método: estudo descritivo de abordagem quantitativa realizado com mulheres atendidas em um Centro de Atenção Psicossocial para Usuários de Álcool e outras Drogas (CAPS ad) do interior paulista. Resultados: a amostra foi de 349 mulheres adultas, solteiras, baixa escolaridade e desempregadas, usuárias de álcool, cocaína, crack e tranquilizantes. Entre as consequências do uso incluem a síndrome de abstinência, overdose, sintomas depressivos e suicidas. A maioria foi encaminhada para o tratamento pela família ou serviços de saúde. Quase 20% dessas mulheres já havia iniciado tratamentos anteriormente. Conclusão: Os resultados sugerem acentuada morbidade e elevados níveis de vulnerabilidade psicossocial, que requerem investigação minuciosa na admissão da usuária, além de danos associados ao uso, sintomas de abstinência e sintomas depressivos.

Ayahuasca no tratamento da farmacodependência à cocaína: possíveis intervenções terapêuticas? / Ayahuasca in the treatment of cocaine addiction: possible therapeutic interventions?

Alucinógenos (ALU) são substâncias psicoativas que não induzem o indivíduo à dependência, possuem perfil de segurança de uso mais alto quando comparado a outras drogas e baixa capacidade de causar tolerância ao uso. Estudos recentes propõem o uso de ALU como tratamento a algumas doenças e transtornos relacionados ao sistema nervoso central, como a depressão, ansiedade e dependência. Dentre os ALU, a ayahuasca (AYA), cujo princípio ativo é a dimetiltriptamina (DMT), é uma bebida psicoativa amplamente utilizada pelas populações indígenas em rituais religiosos. Existem evidências de que pode ser eficaz no tratamento de dependência relacionada ao álcool e nicotina. No entanto, para a cocaína, a segunda droga ilícita mais utilizada no Brasil e na Europa, não existem muitos estudos. O objetivo deste trabalho foi avaliar o potencial da AYA em prevenir a expressão da sensibilização comportamental (SC) induzida pela cocaína e as repercussões neuroquímicas do tratamento em camundongos C57Bl/6. Para tanto, foi avaliada a influência da administração aguda de AYA (1,76; 3,0; 17,6; 30,0 mg/kg de DMT v.o.) na atividade locomotora dos animais em campo aberto (CA). Como não houve diferença estatística na distância percorrida durante a análise, as duas menores doses (1,76 e 3,0 mg/kg de DMT v.o.) foram escolhidas como doses iniciais para a realização do protocolo de prevenção à expressão da SC induzida pela cocaína. Inicialmente, os animais foram habituados no CA durante 3 dias consecutivos após a administração de solução salina 0,9% i.p. No 4o dia experimental, os animais receberam, durante 10 dias alternados, cocaína 10 mg/kg ou salina 0,9% i.p. e foram submetidos diretamente à avaliação da atividade locomotora no CA por 30 minutos. Vinte e quatro horas depois, receberam, durante 8 dias consecutivos, água ou AYA (1,76 ou 3,0 mg/kg de DMT v.o.) e após 30 minutos da administração, foram colocados no CA por 30 minutos para análise da atividade locomotora. No dia seguinte, os camundongos foram desafiados com uma administração de salina. E, no último dia experimental, foi realizado um desafio com cocaína, sempre colocando o animal no CA por 30 minutos. Nessas doses, a AYA não foi eficaz em prevenir a expressão da SC induzida pela cocaína. Dessa forma, avaliamos doses superiores de AYA (15, 30 e 45 mg/kg de DMT v.o.), as quais foram capazes de prevenir a expressão da SC à cocaína. Assim, o protocolo experimental foi novamente realizado com a menor dose (15 mg/kg de DMT v.o.), ao término do protocolo experimental, os animais foram eutanasiados e tiveram seu córtex pré-frontal, estriado e hipocampo dissecados para análise por immunoblotting dos receptores serotoninérgicos 5-HT1A e 5-HT2A. No entanto, não foram não observadas diferenças significativas ao comparar o nível proteico dos receptores nos grupos experimentais. Dessa forma, esses resultados sugerem que a AYA pode ser uma boa estratégia terapêutica para a dependência em cocaína, abrindo caminho para novos estudos

Psychedelics (PSY) are psychoactive substances that do not induce the individual to addiction, have a higher use safety profile when compared to other drugs and low ability to cause tolerance to use. Recent studies propose the use of PSY as a treatment for some diseases and disorders related to the central nervous system, such as depression, anxiety and addiction. Among the PSY, ayahuasca (AYA), whose active component is dimethyltryptamine (DMT), is a psychoactive drink widely used by indigenous populations in religious rituals. There is evidence that it may be effective in treating alcohol and nicotine addiction. However, for cocaine, the second most widely used illicit drug in Brazil and Europe, there are not many studies. The aim of this study was to evaluate the potential of AYA in preventing cocaine-induced behavioral sensitization (BS) expression and the neurochemical repercussions of this treatment in C57Bl/6 mice. Thus, we evaluated the influence of acute administration of AYA (1.76; 3.0; 17.6; 30.0 mg/kg of DMT, orally) on the locomotor activity of animals in the open field (OF). As there was no statistical difference in the distance travelled during the analysis, the two lowest doses (1.76 and 3.0 mg/kg of DMT, orally) were chosen as initial doses to perform the cocaine-induced expression prevention protocol. First, animals were habituated to OF for 3 consecutive days following administration of saline 0.9% i.p. On the fourth experimental day, the animals received for 10 alternate days cocaine 10 mg/kg or saline 0,9% i.p. and were directly submitted to the evaluation of locomotor activity in OF for 30 minutes. Twenty-four hours later they received, for 8 consecutive days, water or AYA (1.76 or 3.0 mg/kg of DMT, orally), and 30 minutes after administration, they were placed in the OF for 30 minutes for analysis of locomotor activity. The next day, the mice were challenged with saline administration. On the last experimental day, a cocaine challenge was performed, always placing the animal in the OF for 30 minutes. At these doses, AYA was not effective in preventing cocaine-induced expression of BS. Thus, we evaluated higher doses of AYA (15, 30 and 45 mg/kg of DMT, orally), which were able to prevent the expression of cocaine-induced BS. Thus, the experimental protocol was again performed with the lowest dose (15 mg/kg of DMT, orally). At the end of the experimental protocol, the animals were euthanized and their prefrontal cortex, striatum and hippocampus were dissected for serotonergic receptor 5-HT1A and 5-HT2A by immunoblotting. However, no significant differences were observed when comparing receptor protein level in the experimental groups. Thus, these results suggest that AYA may be a good therapeutic strategy for cocaine addiction, paving the way for further studies

Avaliação toxicológica da exposição à Cannabis e cocaína na gravidez em cordão umbilical humano: validação de método analítico e prospecção de biomarcadores proteicos de toxicidade / Toxicological assessment of Cannabis and cocaine exposure during pregnancy in human umbilical cord tissue: analytical method validation and prospection of protein biomarkers related to fetotoxicity

O abuso de drogas atinge aproximadamente 35 milhões de pessoas em todo planeta, sendo um problema alarmante em decorrência de graves danos à saúde, como a dependência química e intoxicações fatais. No Brasil, o número de usuários tem crescido principalmente para o consumo de produtos da Cannabis e cocaína, drogas amplamente consumidas, inclusive entre mulheres em período gestacional, trazendo à tona um novo grupo de risco. A exposição gestacional a drogas de abuso está diretamente relacionada a malformações fetais e complicações de saúde para mãe e bebê nos períodos pré- e pós-natal. Tradicionalmente, a avaliação toxicológica da exposição é realizada pela detecção da droga parental e de seus produtos de biotransformação em matrizes materno-fetais por meio de métodos bioanalíticos. Entretanto, estes ensaios não fornecem informações acerca dos impactos fisiológicos ocasionados pela exposição, deixando uma lacuna no que tange às informações sobre os mecanismos e moléculas subjacentes envolvidos em processos de toxicidade. Desse modo, o desenvolvimento de análises toxicológicas mais robustas utilizando tecnologia de ponta, que possam comprovar o uso drogas e também elucidar aspectos de toxicidade é de suma importância, pois auxiliam na compreensão do impacto biológico relativo à exposição humana a xenobióticos. Neste trabalho foram desenvolvidos ensaios bioanalíticos, utilizando o tecido do cordão umbilical para a avaliação da exposição in utero à canabinoides. Foi desenvolvido e validado método QuECheRS adaptado como preparo de amostra, no qual etapas simultâneas de extração e hidrólise alcalina de canabinoides são alcançadas, utilizando cromatografia em fase gasosa acoplada a espectrômetro de massas para detecção de delta-9-tetraidrocanabinol (THC), canabinol (CBN), 11-hidroxi-delta-9-tetraidrocanabinol (11-OHTHC) e 11-nor-9-carboxi-tetrahidrocanabinol (THC-COOH). Também foram desenvolvidas metodologias utilizando LC-MS/MS e Trapped Ion Mobility Mass Spectrometry para análise de proteoma de cordão umbilical humano em diferentes regiões, no intuito de identificar biomarcadores proteicos relativos à fetotoxicidade do uso de drogas na gravidez. Até o presente momento, QuECheRS é utilizado pela primeira vez como abordagem bioanalítica para avaliação de drogas ilícitas em matrizes teciduais materno-fetais e mostrou-se satisfatório para detecção de produtos da Cannabis. Nos ensaios proteômicos, foram identificados potenciais biomarcadores de fetotoxicidade, como as moléculas ACTA 2, Collagen alpha-1 (XVIII), SMC1A, KNL1, KMT2A, em tecidos expostos à Cannabis e/ou cocaína. Tais macromoléculas estão correlacionadas a malformações embriogênicas e complicações de saúde na vida intra-uterina. As metodologias desenvolvidas neste trabalho podem ser úteis para uma melhor avaliação da toxicidade do uso de drogas na gravidez, fornecendo novas pistas sobre a exposição e/ou efeitos tóxicos significativos considerados na avaliação de risco

Drug abuse affects approximately 35 million people worldwide and can be considered a significant burden on society due to severe health problems, e.g. drug addiction and fatal poisonings. In Brazil, the number of users has been growing related to Cannabis and cocaine products, drugs widely used, including among women in gestational period, bringing up a new risk group. Gestational exposure to drugs of abuse is directly related to fetal malformations and health complications for mother and babies in the pre- and postnatal periods. Traditionally, toxicological assessment of exposure is performed by detecting the parent drug and its biotransformation products in maternal-fetal matrices using bioanalytical methods. However, these assays do not provide information about the physiological impacts caused by exposure, leaving a lack of information about the pathways and molecules involved in toxicity processes. Thus, the development of robust toxicological analyzes using cutting-edge technologies in order to prove drug use and also elucidate aspects of toxicity is very important, as they help in understanding the biological impact of human exposure to xenobiotics. Herein, bioanalytical methods using umbilical cord tissue to assess in utero exposure to cannabinoids were developed. A QuECheRS method was developed fully validated as a sample preparation technique for simultaneous extraction and alkaline hydrolysis of cannabinoids, using gas chromatography coupled to mass spectrometry to detect the analytes delta-9-tetrahydrocannabinol (THC), cannabinol (CBN), 11-hydroxydelta-9-tetrahydrocannabinol (11-OH-THC) and 11-nor-9-carboxy-tetrahydrocannabinol (THC-COOH). LC-MS/MS based proteomics and Trapped Ion Mobility Mass Spectrometry were also developed in order to identify protein biomarkers related to fetotoxicity of drug use in pregnancy. Our works represents the first use of QuECheRS for evaluation of illicit drugs in maternal-fetal tissue and was suitable for detection of Cannabis products. In the proteomic assays, potential biomarkers of fetotoxicity were identified in the exposed tissues, such as ACTA 2, Collagen alpha-1 (XVIII), SMC1A, KNL1, KMT2A. These proteins are related to embryogenic malformations and health complications in intrauterine life. The methodologies developed in this project may be useful for a better assessment of the toxicity of drug use in pregnancy, providing new clues about exposure and/or significant toxic effects that should be considered in the risk assessment

O tratamento da dependência na perspectiva das pessoas que fazem uso de crack / El tratamiento de la dependencia desde la perspectiva de las personas que usan crack / Treatment for dependency from the perspective of people who use crack

O artigo pretende compreender, a partir da fala dos usuários, quais os aspectos fundamentais para o sucesso no tratamento da dependência do crack. Trata-se de um estudo descritivo, com abordagem qualitativa, onde foram entrevistadas 39 pessoas que fazem uso de crack, atendidas num programa de proteção social para usuários de drogas. Para a compreensão das narrativas, foi utilizada a técnica de análise de conteúdo, com referencial teórico baseado em Bardin. Foram mencionados, como importantes aspectos, realizar tratamento voluntário e espiritualidade, categorias que podemos agrupar como aspectos individuais; como, também, ampliação do cardápio de atividades, oferta de espaço protegido da droga e qualificação profissional com inclusão socioprodutiva, como aspectos institucionais. Essas demandas precisam ser consideradas para um melhor entendimento das necessidades para o sucesso no tratamento, assim como serem contempladas pelas políticas públicas voltadas para o problema.(AU)

El artículo pretende comprender, a partir de las palabras de los usuarios, cuáles son los aspectos fundamentales para el éxito en el tratamiento de la dependencia del crack. Se trata de un estudio descriptivo, con abordaje cualitativo, en donde fueron entrevistadas 39 personas que utilizan crack, atendidas en un programa de protección social para usuarios de drogas. Para la comprensión de las narrativas se utilizó la técnica de análisis de contenido con referencial teórico basado en Bardin. Se mencionaron como aspectos importantes la realización de tratamiento voluntario y la espiritualidad, categorías que podemos agrupar como aspectos individuales, como también la ampliación del menú de actividad, oferta de espacio protegido de la droga y calificación profesional con inclusión socio-productiva, como aspectos institucionales. Esas demandas deben considerarse para un mejor entendimiento de las necesidades para el éxito en el tratamiento, así como su inclusión por las políticas públicas enfocadas en el problema.(AU)

The aim of this study is to understand the essential aspects for a successful treatment for crack dependency, based on the speech of users. This is a descriptive study, using a qualitative approach. Interviews were conducted with 39 crack users who were assisted in a social protection program for drug users. In order to understand the narratives, the content analysis technique was used and the theoretical framework was based on Bardin. Aspects that were mentioned as important were undergoing voluntary treatment and spirituality, categories that can be grouped as individual aspects, as well as increasing the list of activities, supply of settings protected from drugs and professional qualification with socio-productive inclusion, as institutional aspects. These demands must be considered for a better understanding of what is needed for a successful treatment, and contemplated by public policies targeted at this issue.(AU)

Conceptions and practices of an integrative treatment for substance use disorders involving Amazonian medicine: traditional healers' perspectives

Objective: The harmful use of psychoactive substances represents one of today's largest public health problems. Yet, in spite of its global relevance, current treatment for substance use disorders (SUDs) is still not entirely successful. The purpose of this study was to investigate alternative treatments and conceptions from traditional Amazonian medicine adapted to SUDs. Methods: We conducted semi-structured interviews with 13 practicing experts at a well-established addiction treatment center in the Peruvian Amazon and performed qualitative content analysis on the collected data. Main categories were deductively defined and corresponding subcategories inductively developed. Results: Our findings revealed characteristic features and consequences, causes and antecedents, and treatment methods of SUDs as the main categories. Overall, concepts of disease etiology bore resemblance with contemporary biopsychosocial models of SUDs. The Amazonian therapeutic means however differed markedly from current Western ones. The main methods involved dietary retreats, healing ceremonies, and purging rituals. The integral application of Amazonian methods, as well as their traditional implementation according to prescribed ritual protocols, were emphasized by the experts as crucial for efficacy and safety of treatment delivery. Conclusion: We suggest further scientific attention to these therapies, including clinical studies, for which our results provide conceptual underpinnings. Findings from this research expand the cross-cultural understanding of SUDs and, in the long run, may enhance its treatment options.

Opioid analgesic administration in patients with suspected drug use / Administración de analgésicos opioides en pacientes con sospecha de uso de drogas / Administração de analgésicos opioides em pacientes com suspeita de uso de drogas

ABSTRACT Objective: To identify the prevalence of patients suspected of drug use according to the nursing professionals' judgement, and compare the behavior of these professionals in opioid administration when there is or there is no suspicion that patient is a drug user. Method: A cross-sectional study with 507 patients and 199 nursing professionals responsible for administering drugs to these patients. The Chi-Square test, Fisher's Exact and a significance level of 5% were used for the analyzes. Results: The prevalence of suspected patients was 6.7%. The prevalence ratio of administration of opioid analgesics 'if necessary' is twice higher among patients suspected of drug use compared to patients not suspected of drug use (p = 0.037). Conclusion: The prevalence of patients suspected of drug use was similar to that of studies performed in emergency departments. Patients suspected of drug use receive more opioids than patients not suspected of drug use.

RESUMEN Objetivo: Identificar la prevalencia de pacientes con sospecha de uso de drogas de acuerdo con la opinión de los profesionales de enfermería y comparar el comportamiento de estos profesionales en la administración de opioides cuando hay o no hay sospecha de que el paciente sea un consumidor de drogas. Método: Estudio transversal con 507 pacientes y 199 enfermeras responsables de la administración de medicamentos a estos pacientes. Para el análisis se utilizó la prueba de Chi-cuadrado, la prueba exacta de Fisher y un nivel de significación del 5%. Resultados: La prevalencia de pacientes con sospecha de uso de drogas fue del 6,7%. La razón de prevalencia de la administración de analgésicos opioides 'si es necesario' es dos veces mayor entre los pacientes con sospecha de uso de drogas en comparación a las personas sin sospecha de uso de drogas (p = 0,037). Conclusión: La prevalencia de los sospechosos fue similar a los estudios llevados a cabo en los servicios de urgencias. Los pacientes sospechosos de uso de drogas reciben más opioides que los no sospechosos.

RESUMO Objetivo: Identificar a prevalência de pacientes com suspeita de uso de drogas conforme opinião de profissionais de enfermagem e comparar a conduta desses profissionais na administração de opioides quando há ou não suspeita de que o paciente seja usuário de drogas. Método: Estudo transversal com 507 pacientes e 199 profissionais de enfermagem responsáveis pela administração de medicamentos a esses pacientes. Para as análises foram utilizados os testes de Qui-Quadrado, Exato de Fisher e um nível de significância de 5%. Resultados: A prevalência de pacientes suspeitos foi 6,7%. A razão de prevalência de administração de analgésicos opioides "se necessário" é duas vezes maior entre os pacientes suspeitos em relação aos não suspeitos (p=0,037). Conclusão: A prevalência de suspeitos foi semelhante à de estudos realizados em departamentos de emergência. Os suspeitos de serem usuários de drogas recebem mais opioides do que os não suspeitos.

[ effects of Boswellia serrata and Lavandula angustifolia extracts administration on improving erection dysfunction following opioid dependence]

Background: Erection dysfunction, weakness, the inability to achieve an erection or hold the erection long enough to reach sexual relationship is said. Prevalence studies indicate that 20 to 22 percent of men around the world suffer from erectile dysfunction. Several methods have been proposed to improve this process but those have been unsuccessful mainly due to multiple complications

Objective: The aim of this study was assessing the effects of administration of Boswellia serrata and Lavandula angustifolia extracts in improving erection dysfunction following opioid dependence

Methods: Both plants were extracted and formulized for administration. Choosing patients was based on medical standards, questionnaire of International Index of Erection Function and standard criteria test. The proper cases were categorized randomly in one of three groups under study regarding DSM5 criteria. The investigation continued for two month for all groups: oral extract administered group, placebo treatment group and no premature treatment as a control group. The scores gained form fast ejaculating questionnaire were assessed in early stages of treatment [pretest], one month after treatment [posttests], and two month after treatment [fallow]

Results: The results showed with regarding inter group causes; the F value calculated for assessing drug effect in recovery of premature ejaculation in various stages would be meaningful in the level of 0.05 [F=3.601, P<0.05]

Conclusion: It seems that, administration of Boswellia serrata and Lavandula angustifolia extracts compounds can be effective in recovery of erection function in opioid addicted patients

Acerca de las nominaciones del consumo de drogas en tiempos de medicalización / Nominations about drug use in times of medicalization

El trabajo que aquí se presenta, forma parte de la construcción de las categorías teóricas de la tesis doctoral de la autora. La Estrategia metodológica utilizada adhiere a las dimensiones básicas de la Investigación en Políticas, Sistemas y Servicios de salud (Almeida, 2000): abordaje de distintos niveles de análisis y articulación entre academia y servicios de salud (Stolkiner, 1999, 2001,2005). El objetivo del trabajo es reflexionar sobre las formas de nominación del consumo de drogas en un contexto de exacerbación del consumo en general y analizar la existencia de una tolerancia social diferencial en el caso del consumo de medicamentos que convive con procesos de estigmatización sobre determinados grupos de personas con problemas de drogadependencia.

This paper is part of the theoretical categories constructed for the doctoral thesis of the author. The methodological strategy used adheres to the basic dimensions of Health Policies, Systems and Services Research (Almeida, 2000): it combines different levels of analysis and aims to coordinate between academic research and health services practices (Stolkiner, 1999, 2001,2005). The aim of this work is to reflect on the nomination forms of drug use in a context of exacerbation of consumption in general and analyze the existence of a differential social tolerance in the case of consumption of drugs that coexists with processes of stigmatization of certain groups' people with drug addiction problems.

Tratamiento del consumo de alcohol y drogas en adolescentes / Treatment of alcohol and drug use among adolescents

El consumo problemático de sustancias entre los adolescentes, presenta tasas de prevalencia considerable a nivel mundial y se constituye en un problema de salud pública, indispensable de ser abordado, considerando la etapa del ciclo vital de esta población. El presente artículo tiene por objetivo, realizar un revisión del estado actual de los tratamientos indicados para los trastornos por abuso o dependencia de sustancias en adolescentes y de los resultados y evidencia que respaldan su efectividad, con el objetivo de orientar tanto a profesionales de la salud, como a los principales actores sociales que se relacionan con estos jóvenes (familiares, escuelas, centros comunitarios), en la posibilidad de optar por intervenciones que se ajusten a las necesidades específicas del joven, según su etapa evolutiva, nivel de desarrollo y su contexto natural más cercano.

Problematic substance use among adolescents presents significant rates worldwide prevalence and constitutes a public health problem, which is essential to be addressed, considering the stage of the life cycle of this population. This article aims, conduct a review of the current state of the indicated treatments for substance use disorders in adolescents, and the results and evidence supporting its effectiveness, with the aim of assisting both professionals health, as major social actors that relate to these young people (family, schools, community centers), the possibility of opting for interventions that meet the specific needs of the young, by evolutionary stage, level of development, and its closest natural context.

Systematic review of N-acetylcysteine in the treatment of addictions

Objective: To conduct the first systematic literature review of clinical trials of N-acetylcysteine (NAC) for the treatment of substance abuse disorders and addictive behaviors. Methods: A search of the MEDLINE, Embase and PsycINFO databases was conducted. The inclusion criteria for the review were clinical trials that used NAC in the treatment of a disorder related to substance use and/or addictive behaviors, limited to texts in English, Spanish, or French. The selected studies were evaluated with respect to type of trial, sample size, diagnostic input, intervention, length of follow-up, outcome variables, and results. Results: Nine studies analyzing a total of 165 patients met the eligibility criteria and were included in qualitative analysis. These studies evaluated the role of NAC in cocaine dependence (three studies), cannabis dependence (two studies), nicotine dependence (two studies), methamphetamine addiction (one study), and pathological gambling (one study). Five of these trials were double-blind, randomized, and placebo-controlled. Conclusions: The studies analyzed suggest a potential role for NAC in the treatment of addiction, especially of cocaine and cannabis dependence. These results are concordant with the hypothesis of the involvement of glutamatergic pathways in the pathophysiology of addiction. .

Substance Dependence in a Tribal District.

Introduction: Retrospective study was carried out with an aim to understand the status of substance dependence in Adilabad which is a tribal district of Telangana region and to know the possible reasons behind it. Material and Methods: Records from September 2009 to August 2010 was collected and analysed from patients of RIMS Adilabad. Cases of single substance dependence or polysubstance dependence and associated disorders were included in the study. Parameters were incidence, socio-demographics, age, sex, polysubstance dependence, alcohol dependence, comorbidity, management of substance dependence and hospital stay. Results: A total of 157 patients included in the study. Significant (p<0.05) seasonal variations were observed. Villagers 57.32%, Hindus 92.36%, Muslims 6.37% with mean age of 37 years was observed. Female to male ratio was 0.05:1. 86% females were from tribal villages, chronic beedi smokers and all had family history. Polysubstance dependence (3.18%) included alcohol 100% and cannabis 2.55%. Chronic alcoholics 44.59%, moderate quantity in 76%, consciousness in 53%, handmade liquor in 18% and alcohol without food in 7.64% observed. Associated comorbidity seen in 70.70% cases. Death occurred in 3.18% cases. Ranitidine and ampicillin were mainly given. Mean hospital stay was 2.26 days. Conclusion: Productive age group and handmade liquor is common but polysubstance dependence is negligible. Comprehensive strategy involving education, counselling, treatment and rehabilitation programs are needed to fight against substance dependence in the region.

Dual addictions, parallel treatments: nicotine replacement therapy for patients receiving methadone treatment in the Islamic Republic of Iran

This parallel, randomized, open-ended clinical trial tested the impact of nicotine replacement pharmacotherapy during the course of methadone treatment among opiate abusers. A total of 424 men entered the study at 4 drug treatment centres in Tehran, Islamic Republic of Iran. The intervention group received a 6-week regimen of nicotine replacement pharmacotherapy at no charge. After 6 months, 211 persons [99.5%] in the control group continued to smoke and 1 person [0.5%] had quit. In the intervention group, 117 [55.1%] persons smoked, 15 [7.1%] persons had quit and 80 [37.7%] had reduced by more than 50% the number of cigarettes they smoked at the start of the study [P < 0.0001]. The findings suggest that the use of nicotine replacement pharmacology in tandem with methadone maintenance treatment can lead to dramatically improved efficacy for treatment of dual addictions

Suppressive effects of Rosa damascena essential oil on naloxone-precipitated morphine withdrawal signs in male mice

This research was done to test the effect of Rosa damascena essential oil on withdrawal signs of naloxone-precipitated morphine in male mice. Morphine dependence was induced by injection [IP] three times daily at doses of 50, 50 and 75 mg/kg, respectively, for 3 days. On day 4, after the last administration of morphine, Rosa damascena essential oil was administered at different concentrations [5, 2 and 40%, IP] 30 min before administration of naloxone [5 mg/kg, IP]. The following actions were taken as signs of withdrawal and records taken for jumping as a number and scores of 0 to 3 were given for incidences of grooming, teeth chattering, rearing, writing, diarrhea, wet dog shakes and climbing during a 30 min period. Results showed that different concentrations of Rosa damascena essential oil significantly reduced signs of morphine withdrawal compared to the control group in terms of number of jumps [p < 0.05 and p < 0.01], grooming, teeth chattering, rearing, climbing, wet dog shakes and writhing, but not for diarrhea [p < 0.05]. In conclusion it seems that GABAergic activity induced by flavonoids from Rosa damascena essential oil can alleviate signs of morphine withdrawal, but further studies need to be done to better understand this mechanism