Gender differences in progression to crack-cocaine use and the role of sexual and physical violence

Objective: This study aimed to evaluate whether progression from first drug use to crack-cocaine use differs according to gender, and whether the report of sexual or physical violence impacts the time of progression. Methods: We interviewed 896 crack-cocaine users (548 men; 348 women) from addiction treatment units. Cox regression models evaluated the time of progression from first drug use to crack use. We analyzed gender differences according to the absence or presence of sexual or physical violence, also considering whether violence, when present, had occurred before or after the onset of crack use. Results: Women presented a faster progression to crack use regardless of exposure to sexual or physical violence (p < 0.05). Compared to unexposed men, there was a similar progression for men exposed to sexual or physical violence before the first use of crack (p = 0.167 and p = 0.393, respectively). In both genders, we observed a faster progression among individuals exposed to these types of violence after the onset of crack use (p < 0.01). Conclusions: We found a faster progression to crack use among women and among individuals exposed to sexual and physical violence after the onset of crack use. These results encourage differentiated treatment strategies, focused on gender and individual characteristics.

Decision-making under risk and theory of mind in adolescent offenders in provisional deprivation of liberty

Abstract Introduction Delinquent behaviors are risky behaviors that increase during puberty and reach their highest peak in late adolescence. It has been proposed that poor decision-making and theory of mind (ToM) are key cognitive processes implicated with delinquency during adolescence, affecting evaluation of risks and impairing appreciation of social norms. Nevertheless, it is not yet clear whether adolescent offenders who are subjected to provisional deprivation of liberty due to conflict with the law (adolescents in conflict with the law [ACL]) might, in fact, present a specific profile with regard to these cognitive processes. Objectives To assess deliberative decision-making and ToM among adolescents in conflict with the law and adolescents not in conflict with the law. Methods The sample comprised 62 participants: ACL (n = 29) and a control group (CG) (n = 33). ToM was assessed with the Reading the Mind in the Eyes Test (RMET) and decision-making was assessed with the Columbia Card Task (CCT). Substance use, callous-unemotional traits, childhood maltreatment, and intelligence quotient (IQ) were also assessed. Results ACL had more ToM errors for negative mental states in comparison to CG, but not for error rates concerning neutral and positive mental states. With regards to decision-making, our results suggest that ACL group members did not vary their behavior based on the available information and that the risk information had an opposite effect on the number of cards chosen (risk-taking behavior) when compared to CG. Conclusion These findings have important implications for development of interventions for these adolescents, suggesting that they tend to learn little from negative outcomes and have reduced capacity to process negative emotions.

Instruments for measuring perceived and experienced mental illness Stigma: a systematic review / Instrumentos de avaliação do estigma percebido e estigma experienciado na doença mental: uma revisão sistemática / Instrumentos de evaluación del estigma percibido y el estigma experimentado en enfermedades mentales: una revisión sistemática

In order to investigate which instruments are most utilized when measuring perceived and experienced mental illness stigma (MIS) in adults, and some of the variables that may moderate or interfere in measured outcomes, 101 published empirical and peer-reviewed studies were systematically extracted from electronic databases (PubMed, Scopus, EBSCO, Web of Science, and PsycINFO). The results revealed that MIS is commonly evaluated by five scales. When considering the most tested and reported associative effects, age, and symptoms’ severity were identified as potentially intervening variables. Other variables, such as sex, diagnostic, and treatment regimen (inpatient/outpatient) were evaluated by a few studies and presented inconsistent results. These findings suggest that future studies should use well-established instruments in the literature to assess MIS, as well as to aim for the cross-cultural adaptation of instruments that evaluate MIS since no instruments presented in this review are validated to the Brazilian population.

Objetivando investigar quais instrumentos são mais utilizados na mensuração do estigma da doença mental (EDM) percebido e experienciado por adultos, e quais variáveis podem moderar ou interferir nos resultados da mensuração, 101 artigos foram sistematicamente selecionados nas bases de dados eletrônicas (MEDLINE/PubMed, Scopus, EBSCO, Web of Science e PsycINFO). Os resultados revelaram que existem cinco instrumentos comumente utilizados para medir o EDM. Ao considerar os efeitos associativos mais testados e reportados sobre o estigma, a idade e a severidade dos sintomas foram apontadas como variáveis potencialmente intervenientes. Outras variáveis, como sexo, diagnóstico e regime de tratamento (internamento/ambulatório) foram avaliadas por poucos estudos e apresentaram resultados inconsistentes. Essas descobertas sugerem que trabalhos futuros devem utilizar instrumentos bem estabelecidos na literatura para avaliar o EDM, assim como visar à adaptação transcultural de instrumentos que avaliem o EDM, uma vez que nenhum dos instrumentos apresentados nesta revisão é validado para a população brasileira.

Con el objetivo de investigar qué instrumentos son más utilizados en la medición del estigma de la enfermedad mental (EEM) percibido y experimentado en adultos, así como las variables que pueden moderar o interferir en los resultados de la evaluación, 101 artículos fueron sistemáticamente extraídos en las bases de datos electrónicas (MEDLINE/PubMed, Scopus, EBSCO, Web of Science y PsycINFO). Los resultados revelaron que existen cinco instrumentos comúnmente utilizados para medir el EEM. Al considerar los efectos asociativos más comprobados y reportados sobre el estigma, la edad y la severidad de los síntomas fueron identificadas como variables potencialmente intervinientes. Otras variables, como el sexo, diagnóstico y condición de tratamiento (internación/ambulatorio) fueron evaluadas en pocos estudios y presentaron resultados inconsistentes. Estos hallazgos sugieren que trabajos futuros deben utilizar instrumentos consolidados en la literatura para evaluar el EEM, así como para la adaptación transcultural de instrumentos que evalúen el EEM, ya que ninguno de los instrumentos presentados en esta revisión ha sido validado para la población brasileña.

Crack-cocaine dependence and aging: effects on working memory

Objective: To compare the working memory (WM) performance of young adult crack-cocaine dependent users, healthy older adults, and a control group of healthy young adults. Methods: A total of 77 female participants took part in this study: 26 young adult crack-cocaine dependent users (CRK), 19 healthy older adults (HO), and 32 healthy younger adults (HC). All participants completed the N-back verbal task. Results: A multivariate analysis of covariance was performed. The model included education, income, and medication use as covariates. A group effect (F6,140 = 7.192, p < 0.001) was found. Post-hoc analyses showed that the performance of the CRK and HO groups was reduced compared to the HC group in two N-back conditions. No differences between the HO and CRK groups on WM performance were found. Conclusions: CRK participants perform similar to HO participants on a WM task, despite the well-known effects of age on WM and the young age of CRK. These data point to a possible parallel between cognitive declines associated with crack use and developmental aging.

Propriedades psicométricas da Cocaine Selective Severity Assessment (CSSA) em mulheres usuárias de crack / Psychometric properties of Cocaine Selective Severity Assessment (CSSA) in crack users

Objetivo Este estudo teve como objetivo adaptar a Cocaine Selective Severity Assessment (CSSA) para o português do Brasil e verificar as propriedades psicométricas do instrumento em uma amostra de usuárias de crack. Métodos Após as etapas de tradução e adaptação, 125 mulheres usuárias de crack, internadas em uma unidade pública de desintoxicação, foram avaliadas. Para caracterização da amostra e análise das validades concorrente, de construto e preditiva, foram utilizados os seguintes instrumentos: SCID-I, ASI-6, BDI-II e CCQ-B. Resultados A análise fatorial exploratória identificou cinco fatores, com níveis adequados de consistência interna tanto para os fatores quanto para o escore geral da CSSA. Quanto à validade concorrente, a CSSA vai ao encontro de instrumentos já utilizados na clínica e em pesquisas. Em relação à validade de construto e preditiva, a CSSA pode ser sensível ao declínio dos sintomas de abstinência durante o processo de desintoxicação do crack. Conclusões Nossos achados foram além da tradução e adaptação da CSSA, proporcionando testes de validade e sugerindo que a CSSA é um instrumento confiável na avaliação dos sintomas de abstinência do crack. .

Objective This study aimed to describe the translation and adaptation of Cocaine Selective Severity Assessment (CSSA) into Brazilian Portuguese and verify the psychometric properties in a sample of crack cocaine users. Methods After the translation and adaptation steps, 125 female crack cocaine-dependent inpatients who were enrolled in an inpatient detoxification unit were evaluated. To characterize the sample and realize the analysis of concurrent validity, construct validity and predictive validity the following instruments were used: SCID-I, ASI-6, BDI-II e CCQ-B. Results The exploratory factorial analysis identified five factors and revealed appropriate levels of internal consistency, as well as the total score of the CSSA. The concurrent validity showed that CSSA was in line with instruments used in clinical practice and in researches. Further, both construct and predictive validity indicated adequate sensitivity to decline of withdrawal symptoms during the detoxification processes. Conclusions Our findings were beyond the translation and adaptation, providing the reliability and validity of CSSA regarding the evaluation of withdrawal symptoms in crack cocaine abstinence. .

Influence of personality traits in coping skills in individuals with bipolar disorder / A influência dos traços de personalidade nas habilidades de coping de indivíduos com transtorno de humor bipolar

Background: Bipolar disorder is marked by alterations in coping skills which in turn impacts the disease course. Personality traits are associated with coping skills and for this reason it has been suggested that personality traits of patients with BD may have influence over their coping skills. Objective: To investigate possible associations between coping skills and personality in individuals with bipolar disorder (BD). Methods: Thirty-five euthymic subjects with BD were compared with 40 healthy controls. Coping skills were evaluated using Ways of Coping Checklist Revised and Brief-COPE. Personality traits were assessed by Neo Personality Inventory. MANCOVA was used for between groups comparison. Results: Regarding coping, individuals with BD reported more frequent use of emotion-focused strategies than problem-focused strategies, and high levels of neuroticism and low levels of extroversion and conscientiousness on personality measures. Neuroticism influenced negatively the use of problem-focused strategies, and positively emotion-focused coping. Conscientiousness influenced the use of problem-focused strategies in both groups. There was a significant difference between emotion focused coping and personality traits between BD and control groups. Discussion: Personality traits seem to modulate coping skills and strategies in BD which may be took into account for further interventions...

Contexto: O transtorno de humor bipolar (THB) é marcado por estratégias de enfrentamento, ou coping, que determinam comportamentos que podem influenciar negativamente o curso da doença. Traços de personalidade são altamente associados com estratégias de coping, portanto se faz a hipótese de que traços de personalidade influenciem as estratégias de coping de portadores de THB. Objetivo: Este estudo buscou investigar associações entre traços de personalidade e estratégias de coping em pacientes com THB. Métodos: Trinta e cinco participantes eutímicos diagnosticados com THB e 40 controles saudáveis participaram deste estudo. Estratégias de coping foram avaliadas com a Ways of Coping Checklist Revised and Brief – COPE – e traços de personalidade foram avaliados com o Neo Personality Inventory. Resultados: Participantes com THB possuíram padrão de estratégias de coping significativamente mais baseados na emoção. Em termos de traços de personalidade, participantes com THB tiveram significativamente mais características de neuroticismo e reduzidas características de extroversão e consciência. Foram encontradas associações positivas entre índices de neuroticismo e estratégias de coping baseadas em emoções e associações negativas com estratégias baseadas no problema. Conclusão: Traços de personalidade são fundamentais para as estratégias de coping de pacientes com THB, portanto traços de personalidade devem ser considerados alvos terapêuticos para a psicopatologia...

Revised Reading the Mind in the Eyes Test (RMET) - Brazilian version

Objective: To translate and adapt to Brazilian Portuguese the Revised Reading the Mind in the Eyes Test (RMET), in both paper-and-pencil and computerized versions. The RMET is a well-accepted instrument for assessment of Theory of Mind (ToM), an important component of social cognition. Methods: Following a guideline for translation of material for clinical populations, this study had three main phases: 1) formal translation and semantic adaptation to Brazilian Portuguese; 2) an acceptability trial with health professionals as judges evaluating picture-word matching; and 3) a trial using the paper-and-pencil and computerized versions (experiments built in E-Prime 2.0.10 software) with healthy participants to test whether the instrument has similar outputs to those expected in versions in other languages. Results: RMET was adequately adapted to Brazilian Portuguese. This version showed acceptability and outputs similar to versions of the instrument in other languages, including the original one. We kept the same number of images as the original English version. Conclusions: Considering the scarcity of cognitive assessment instruments adequately adapted to Portuguese and the importance of social cognition in many psychiatric disorders, this work adds an important resource to Brazilian research and is administrable in both paper-and-pencil and computerized versions. .

Brazilian version of the Structured Interview for Disorders of Extreme Stress - Revised (SIDES-R): adaptation and validation process / Versão brasileira da Structured Interview for Disorders of Extreme Stress - Revised (SIDES-R): processo de adaptação e validação

BACKGROUND: Posttraumatic stress disorder (PTSD) contemplates the impact of acute traumatic events, but the literature indicates that this is not true for chronic exposure to stress. In this sense, the category disorders of extreme stress not otherwise specified (DESNOS) has been proposed to characterize the behavior and cognitive alterations derived from exposure to continuous early life stress. The Structured Interview for Disorders of Extreme Stress - Revised (SIDES-R) was developed to investigate and measure DESNOS. Considering the lack of instruments designed to assess DESNOS, especially in Brazil, the aim of this study was to translate, adapt, and validate the contents of SIDES-R to Brazilian Portuguese (SIDES-R-BR). METHOD: The original interview was subjected to translation, back-translation, semantic equivalence and conceptual correspondence analyses by naive and specialized judges, respectively, an acceptability trial, and inter-rater validity analysis. RESULTS: The interview underwent semantic and structural adaptations considering the Brazilian culture. The final version, SIDES-R-BR, showed a mean understanding score of 4.98 on a 5-point verbal rating scale, in addition to a kappa coefficient of 0.853. CONCLUSION: SIDES-R-BR may be a useful tool in the investigation of DESNOS and contributes a valuable input to clinical research in Brazil. The availability of the instrument allows to test symptoms with adequate reliability, as verified by the kappa coefficient and translation steps (AU)

INTRODUÇÃO: O transtorno do estresse pós-traumático (posttraumatic stress disorder, PTSD) contempla o impacto de eventos traumáticos agudos, mas a literatura indica que o mesmo não se aplica a exposição crônica ao estresse. Nesse sentido, foi proposta a categoria transtornos de estresse extremo não especificados (disorders of extreme stress not otherwise specified, DESNOS). Com o objetivo de investigar e medir as alterações comportamentais e cognitivas relacionadas ao diagnóstico de DESNOS, foi desenvolvida a Structured Interview for Disorders of Extreme Stress - Revised (SIDES-R). Considerando a falta de instrumentos construídos para avaliar DESNOS, especialmente no Brasil, o objetivo deste estudo foi traduzir, adaptar e validar os conteúdos da SIDES-R para português brasileiro (SIDES-R-BR). MÉTODO: A entrevista original foi submetida a tradução, retrotradução, análise de equivalência semântica e correspondência conceitual por avaliadores leigos e especializados, respectivamente. Foi realizado teste de aceitabilidade e análise de validade interavaliadores. RESULTADOS: A entrevista passou por adaptações semânticas e estruturais considerando a cultura brasileira. A versão final, SIDES-R-BR, demonstrou um escore médio de compreensão de 4,98 em uma escala de avaliação verbal de 5 pontos, além de um coeficiente de kappa de 0,853. CONCLUSÃO: O SIDES-R-BR pode ser uma ferramenta útil na investigação de DESNOS e contribui com um input valioso para a pesquisa clínica no Brasil. A disponibilidade do instrumento permite testar sintomas com confiabilidade adequada, conforme verificado por meio do coeficiente de kappa e etapas de tradução (AU)

Déficits na memória de trabalho em idosos com depressão maior: uma revisão sistemática / Impairment of working memory during a depression of the elderly: a systematic review

A depressão em idosos é associada com prejuízos cognitivos, entretanto a extensão destes à Memória de Trabalho (MT) ainda não é consensual. Portanto, o objetivo deste estudo é revisar sistematicamente as associações encontradas entre MT e depressão em idosos. Para tanto conduzimos uma revisão sistemática dos artigos publicados entre 2000 e 2011 nas principais bases de dados internacionais. Posteriormente a aplicação dos critérios de exclusão, 17 artigos foram revisados integralmente. Os resultados apresentam evidências da associação entre depressão geriátrica e prejuízos da MT, que em alguns trabalhos ainda foram mantidos mesmo após a remissão da sintomatologia de humor.

Geriatric depression is related with cognitive impairments, but how this is connected to specific Working Memory deficits is still unknown. Hence, the aim of this study is to systematically review the literature about the associations between Working Memory impairments and major depression in the elderly. Thus we performed a systematic review, considering published articles in major international databases between 2000 and 2011. After exclusion criteria, 17 articles were fully reviewed. There is evidence that there is indeed an association between depression in elderly and Working Memory impairments. In addition, some articles found that such deficits are sustained even after mood symptoms remission.

Tarefa N-back auditiva: desempenho entre diferentes grupos etários / Auditory N-back task: different age groups performance

Um dos instrumentos mais utilizados internacionalmente para avaliação da Memória de Trabalho (MT) é a Tarefa N-back Auditiva. Recursos para avaliação desse sistema são escassos no Brasil. O presente estudo objetiva observar o desempenho da Tarefa N-back Auditiva em indivíduos de diferentes faixas etárias: 27 crianças, 22 pré-adolescentes, 26 adultos e 27 idosos. Os resultados mostram que o grupo etário influencia no desempenho da Tarefa N-back Auditiva. A acurácia foi aumentando na transição da infância para a pré-adolescência e seguiu em crescimento até a adultez. Observou-se um declínio no desempenho de idosos. Os dados da Tarefa N-back Auditiva corrobora a trajetória desenvolvimental, sugerindo que essa tarefa possa ser utilizada no contexto experimental. Pesquisas de normatização contribuirão para melhor compreensão dessa tarefa.

One of the most internationally used instruments for evaluation of Working Memory (WM) is the Auditory N-Back Task. In Brazil, resources to evaluate this system are scarce. The aim of this study is to investigate the performance of different age subjects in auditory n-back tasks. We divided the 102 subjects in four groups: 27 children, 22 adolescents, 26 young adults and 27 older adults. The results demonstrate an age-related difference in the n-back task performance. The accuracy increased in the transition from childhood to adolescence and kept growing from adolescence to adulthood. We also found a decrease in the performance of aged subjects. The Auditory N-Back Task results are in agreement with WM development trajectory, and so, it demonstrates to be an adjusted instrument to evaluate this system in experimental setting.

Translation and adaptation of Theory of Mind tasks into Brazilian portuguese / Tradução e adaptação de tarefas de Teoria da Mente para o português brasileiro

BACKGROUND: Theory of mind (ToM) is a field of social cognition that deals with the individual’s cognitive ability to interpret or infer the mental states of others based on previous knowledge. Recently, research has shown that this ability is compromised in patients with some psychopathologies, e.g., schizophrenia and autistic disorder. Investigators have also shown that deficits in ToM have impacts on social functioning and, consequently, on quality of life. Even though ToM studies have recently grown in number, some problems still remain (e.g., the difficulty of standardized tools to assess ToM in different languages). OBJECTIVES: To describe the translation and adaptation into Brazilian Portuguese of two of the most important and widely used ToM tasks, namely, the Theory of Mind Stories and the Hinting Task. METHOD: The process included the following steps: 1) translation; 2) production of a single translated version and review by specialists; 3) back-translation into English; 4) review by an English-speaking specialist; 5) adaptation of marked corrections; and 6) pilot application in a group representative of the target population (people with schizophrenia). RESULTS: A final translated version was obtained for each of the tasks. Both instruments were well understood by participants and can now be used in the Brazilian experimental setting. CONCLUSION: The availability of two major ToM tasks in Brazilian Portuguese facilitates the conduction of research on the topic in Brazil. In the future, this could help design clinical interventions aimed at people with social and cognitive difficulties (AU)

INTRODUÇÃO: A teoria da mente (theory of mind, ToM) é um domínio da cognição social que se refere à habilidade cognitiva de interpretar ou inferir estados mentais de outras pessoas através de conhecimentos prévios. Recentemente, pesquisas têm mostrado que essa capacidade está comprometida em algumas psicopatologias, como esquizofrenia e autismo. Além disso, pesquisadores têm mostrado que déficits na ToM impactam a funcionalidade social e, consequentemente, a qualidade de vida. Apesar do aumento recente de estudos na área, alguns problemas (por exemplo a dificuldade de instrumentos estandardizados para avaliar essa habilidade em diferentes idiomas). OBJETIVOS: Descrever a tradução e a adaptação para o português brasileiro de duas das mais importantes e amplamente utilizadas tarefas de ToM - o Theory of Mind Stories e o Hinting Task. MÉTODO: O processo incluiu as seguintes etapas: 1) tradução; 2) produção de uma versão unificada e avaliada por especialistas; 3) retrotradução para o inglês; 4) revisão da versão em inglês por especialista; 5) adaptação das correções indicadas; e 6) aplicação de estudo piloto em um grupo representativo da população para qual as tarefas foram originalmente desenvolvidas (portadores de esquizofrenia). RESULTADOS: Uma versão final em português foi obtida para cada uma das tarefas. Ambos os instrumentos demonstraram boa compreensão por parte dos participantes e podem agora ser utilizados no contexto experimental brasileiro. CONCLUSÕES: A disponibilização de duas das mais consagradas tarefas de ToM em português brasileiro favorece o desenvolvimento de pesquisas sobre o assunto no Brasil. No futuro, isso pode auxiliar no planejamento de intervenções clínicas direcionadas a indivíduos com dificuldades sociocognitivas (AU)

Social cognition and Theory of Mind: controversies and promises for understanding major psychiatric disorders

The term "social cognition" generally refers to the mental operations that underlie social interactions including the perception and interpretation of the intentions, dispositions, and behaviors of others and the generation of a response to these behaviors. Social cognition has been considered a valuable and promising field that strives to understand the nature and outcome of major mental disorders. This article discusses the concept of social cognition and its relationship to Theory of Mind (ToM). Theory of Mind in autistic spectrum disorders has been studied since the 1980s, and cognitive impairments in these disorders may be restricted to ToM deficits because other cognitive domains and nonsocial intelligence are preserved. This article addresses the issues of human ontogeny, reviews the main findings from research on schizophrenia and bipolar disorder, and summarizes the tools commonly used in the assessment of these illnesses.