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

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

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

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

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

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

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

Relación entre psicólogos y estudiantes usuarios en el 2014: factor determinante en los servicios de prevención de adicciones de la Universidad de Antioquia / Relationship between psychologist and student users in 2014: a determining factor in Universidad de Antioquia's Addiction Prevention Services / Relação entre psicólogos e estudantes utentes no 2014: fator determinante nos serviços de prevenção de adições da Universidade de Antioquia

Resumen Objetivo: Describir la relación entre psicólogos y estudiantes usuarios que accedieron a los servicios del Programa Educativo de Prevención de Adicciones, servido por la Universidad de Antioquia, sede Medellín, en el 2014, y su influencia en la percepción de la calidad del mismo. Metodología: Se realizó una investigación cualitativa, utilizando herramientas del método conocido como teoría fundada. Se contó con fuentes primarias de información, constituidas por los discursos resultantes de entrevistas aplicadas a estudiantes que hubieran accedido al programa. Las herramientas de recolección fueron entrevista semiestructurada y entrevista a profundidad. Resultados: La calidad percibida del programa está condicionada significativamente por la relación entre los psicólogos y los estudiantes usuarios, teniendo en cuenta, por parte de los últimos, aspectos como la percepción positiva de los servicios y el cumplimiento de sus necesidades y expectativas. Conclusión: El buen trato, la amabilidad y la confianza que los psicólogos generen en los estudiantes usuarios se reconocen como elementos determinantes en la adhesión al proceso y la percepción de calidad de los servicios.

Abstract Objective: To describe the relationship between psychologists and student users who attended the addiction prevention program offered by Universidad de Antioquia, at the Medellin campus, in 2014, and its influence on the perception of the quality of the program. Methodology: A qualitative research was conducted using tools of the method known as Grounded Theory. The primary information sources of this study were discourses resulting from interviews with students who had accessed the program. The Collection tools were a semi-structured interview and an in-depth interview. Results: Perceived program qualityis conditioned significantly by the relationship between psychologists and student users, taking into account, on the part of the latter, aspects as a positive perception of services and the fulfillment of their needs and expectations. Conclusion: Good treatment, kindness and the trust that psychologists build with student users are recognized as determining elements in continuing the process and in service quality perception.

Resumo Objetivo: Descrever a relação entre psicólogos e estudantes utentes que acessaram aos serviços do Programa Educativo de Prevenção das Adições, oferecido pela Universidade de Antioquia, na Sé do Medellín, no 2014, e a sua influência na percepção da qualidade do mesmo. Metodologia: Se realizou uma investigação qualitativa, utilizando ferramentas do método conhecido como teoria fundada. Se contou com fontes primarias de informação, constituídas pelos discursos resultantes de entrevistas aplicadas a esses estudantes que tiveram acedido ao programa. As ferramentas de coleta foram a entrevista semiestruturada e entrevista aprofundada. Resultantes: A qualidade percebida do programa está condicionada significativamente pela relação entre os psicólogos e os estudantes utentes, levando a sério, por parte dos últimos, aspectos como a percepção positiva dos serviços e a adimplência na frente dessas, as suas necessidades e expectativas. Conclusão: O bom atendimento, a amabilidade e a confiança que os psicólogos gerem nos estudantes utentes sejam reconhecidos como elementos determinantes na aderência ao processo e a percepção de qualidade dos serviços.

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

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

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

Female depression and substance dependence in the Mexico City penitentiary system / Depresión en mujeres y la dependencia a sustancias en el sistema penitenciario de la Ciudad de México

Summary: The prevalence of mental disorders in people deprived of freedom has been estimated at between 10 and 15%. Acute or chronic mental illnesses provoke a major breakdown and maladjustment to prison conditions. The more frequent diagnose of mental disorders have been substance consumption, major depression, bipolar disorder, post-traumatic stress disorder and psychotic disorders. Objective To identify the frequency of major depressive episode in women in prison in Mexico City, its frequency of association with alcohol and substance dependence, and to describe the symptomatic and socio-demographic characteristics. Material and method A transversal, non-experimental, descriptive, ex post facto field study, in two prisons of Mexico City (Centro Preventivo Femenil Oriente [Preventivo Oriente] and the Feminine Center for Social Readaptation Tepepan CERESO), in a non- probabilistic sample of 213 women, selected by convenience. The instrument was designed ex profeso. For the evaluation of the major depressive episode, the Mini International Neuropsychiatric Interview (MINI) and DSM-IV criteria were used for substance dependence. Field work lasted from August 2001 to March 2004. Interviews were carried out under previous informed consent; confidentiality and anonymity were guaranteed. In collaboration with the Center of Orientation and Classification (COC), each center elaborated a list of inmates with a history of substance abuse who met the inclusion criteria to take part in the research. Results The mean age of the interviewed population was 30.6 ± 7.9 years; 45.5% belonged to the age group between 28 to 40 years; the school attainment more frequent was elementary school (41.3%), followed by secondary school. Single women represented 48.6% of the population and 50.2% referred having, at the moment of the interview, a partner relationship. The type of offense reported with major frequency was robbery (51.6%, in different modalities: unspecific, simple, aggravated, not-aggravated, unspecific, burglary, tentative of robbery and car theft). The researched population referred that 43.7% had previously done time in some penal institution. The frequency of depressive episodes was 62% (n=132) in the interviewed population. The group between 18 to 27 years, with lower years of schooling, single mothers with children under 18 years presented the highest frequency of depression and substance abuse. Alcohol dependence and depression were more frequent in women with less than six months in prison. For depression and substance dependence, the more affected group was the one between one to four years of imprisonment. As to the length of the sentence, women with three to seven years were the most affected by the two diagnoses. Conclusions The interviewed population showed that the longer the imprisonment or the sentence, the higher the frequency of the depressive disorder. A possible explanation is that being imprisoned for a long time may have severe consequences in women's well-being due in part to the fact that in most of the cases women are abandoned by their relatives and loved ones, which intern increases their loss of social support networks. The problem of mental disorders becomes more evident when it is estimated that only 40% of the people who have a disorder had received treatment. Nearly half of the depressed women had not received support and care for their mental health problem. In the group of women with alcohol dependence, less than a quarter had asked for help, in contrast with the group with substance dependence where half of the women had asked for help. On the other hand, prison by itself generates depression and it is a normal reaction in the face of the new situation. There is also the erroneous belief that symptoms will fade away by themselves. In other studies it has been observed that being deprived of freedom causes the lose of emotional relationships, solitude and boredom, lack of services, heterosexual relationships, autonomy, security, a problematic cohabitation with other unpredictable prisoners, all of which cause fear and anxiety. All these deprivations may constitute serious threats to the personality and self-esteem.

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Utilización intrahospitalaria de benzodiacepinas y desarrollo posterior de abuso o dependencia / Hospital-acquired use of benzodiazepines and subsequent development of abuse or dependence

La utilización de benzodiacepinas (BZs) en el tratamiento intrahospitalario de pacientes psiquiátricos brinda ventajas que han hecho que su prescripción aumente. Sin embargo no se han reportado suficientes estudios que permitan establecer sus riesgos, específicamente en lo relacionado con abuso y dependencia. En la presente investigación se evaluaron 161 historias clínicas de pacientes admitidos para tratamiento psiquiátrico en una unidad de salud mental. El 70.8% de los pacientes (n= 114) recibió BZs. A 76 se les pudo efectuar seguimiento. Se encontró que solamente uno (1.3%) desarrolló dependencia y que 8 (10.5%) presentaron insomnio transitorio ante la suspensión o reducción de la BZs. Con base en las características de los casos detectados y en los reportes de la literatura se plantean recomendaciones para evitar complicaciones en el manejo de estos fármacos...

The use of benzodiazepines (BZs) for the treatmentofpsychiatric inpatients has many advantages that resultin its increased prescríption. Yet, there are not enough studies that allow knowing its rísks, particularly those related with abuse and dependence. This study has evalúated 161 clinical records of patients admitted for psychiatric treatmentin an acute treatment unit. 70.8% (n=114) rece/ved BZs. Of them 76 patients could be followed. Only one patient (1.3%) had dependence and 8 (10.5%) transient insomnia following the reduction or cessation of BZs. Consideríng the characterístics of this cases and literature reports we propose recommendations to avoid complications with the use of BZs...