Síndrome amotivacional en consumidores crónicos de marihuana. Una revisión narrativa para la aproximación al concepto / Amotivational syndrome in chronic marijuana users. A narrative review to approach the concept

Introducción: Durante los últimos sesenta años se ha construido evidencia sobre los efectos adversos relacionados con el consumo crónico de cannabis. Los problemas de memoria y concentración, el riesgo de esquizofrenia en sujetos predispuestos y el síndrome amotivacional han sido referenciados. Con los primeros al parecer no hay muchas dudas, pero en relación con el último, existe controversia. Objetivo: revisar la evidencia científica existente sobre el síndrome amotivacional. Material y Métodos: La revisión se realizó mediante una búsqueda en bases de datos académicas, se tomaron en cuenta las publicaciones que estuvieran relacionadas con trastornos mentales relacionados con el consumo crónico de marihuana en los que se hacía referencia al síndrome amotivacional que cumplieran con criterios de calidad de los artículos apegados a estándares internacionales. Desarrollo: Se incluyó un total de 31 artículos, de los cuales 16 incluían la definición de síndrome amotivacional. Una vez integradas todas las fuentes, se determinó organizar la evidencia encontrada en 15 factores: apatía; desinterés; pasividad; indiferencia; demora en la realización de tareas; pereza; presentismo; desgano para actividades prolongadas que requieran atención o tenacidad; abandono del cuidado personal; desinterés sexual; disminución de los reflejos; autoeficacia disminuida; deterioro de las habilidades comunicativas; retraimiento social y afecto no alterado. Conclusiones: A partir de los hallazgos, se sugiere que el síndrome amotivacional es una constelación de síntomas y/o signos relacionados, lo que podría constituir una morbilidad propia del consumo crónico de cannabis, se espera que en el futuro se desarrollen investigaciones que prueben o rechacen su existencia(AU)

Introduction: Over the past sixty years, evidence for the adverse effects of chronic cannabis use has been demonstrated. Memory and concentration problems, the risk of schizophrenia in predisposed subjects, and amotivational syndrome have been referenced. There is not much doubt in relation to the first effect mentioned, but there is controversy around the last. Objective: To review the existing scientific evidence for the amotivational syndrome. Material and Methods: The review was conducted through academic database searching. The publications related to mental disorders associated with the chronic marijuana use, which referred to amotivational syndrome that fulfilled the criteria for articles attached to international standards, were taken into account. Results: A total of 31 articles were included. Of them, 16 presented the definition of amotivational syndrome. Once all the sources were integrated, the evidence found in 15 factors was organized. These factors included: apathy; disinterest; passivity; indifference; delay to perform tasks; sloth; presentism; reluctance to do prolonged activities that require attention or tenacity; abandonment of personal care; sexual disinterest; decreased reflexes; decreased self-efficacy; impairment in communication skills; social withdrawal, and unaltered affection. Conclusions: Based on these findings, we suggest that the amotivational syndrome is a constellation of symptoms and / or related signs which could constitute a typical morbidity caused by chronic cannabis use, so we expect that future research will be developed to demonstrate or discard their existence(AU)

Road traffic injuries and substance use among emergency department patients in the Dominican Republic and Peru / Traumatismos causados por el tránsito y consumo de sustancias psicoactivas en pacientes del departamento de urgencias en Perú y República Dominicana / Lesões por acidentes de trânsito e uso de substâncias químicas em pacientes que deram entrada no setor de emergência na República Dominicana e Peru

ABSTRACT Objective. To report demographic and substance use characteristics and risk of road traffic injury (RTI) from alcohol use, cannabis use, and combined use in a sample of emergency department patients from two countries in Latin America and the Caribbean. Methods. A cross-sectional study in which patients 18 years and older admitted within six hours of suffering an RTI to one emergency department in Santa Domingo, Dominican Republic (n = 501) and in Lima, Peru (n = 431) were interviewed. Case-crossover analysis, based on self-reported use prior to the RTI, was used to analyze risk from alcohol, cannabis, and co-use. Results. Overall, 15.3% reported alcohol use prior to the event and 2.5% cannabis use. Drivers using alcohol only were over twice as likely to have an RTI (OR = 2.46, p < 0.001), and nearly eight times more likely if using both alcohol and cannabis (OR = 6.89, p < 0.01), but risk was not elevated for cannabis alone. Significant differences were not found for passengers or pedestrians. Conclusions. Risk of RTI for drivers in these two samples is significantly elevated from alcohol use, and more so for co-use with cannabis. Differences between the two countries underscore the need for similar data from the region to determine risk of RTI from substance use, including risk for passengers and pedestrians. Data suggest that alcohol contributes significantly to the burden of RTI, which calls for more stringent enforcement of alcohol control policy related to drink driving in the region.

RESUMEN Objetivo. Presentar las características demográficas y de consumo de sustancias psicoactivas y el riesgo de traumatismos causados por el tránsito debidos al consumo de alcohol, cannabis y su consumo combinado en una muestra de pacientes del departamento de urgencias de dos países de América Latina y el Caribe. Métodos. Se realizó un estudio transversal en que se entrevistaron pacientes de 18 años o más ingresados en las siguientes seis horas de haber recibido traumatismos causados por el tránsito en un departamento de urgencias en Lima (Perú) (n = 431) y en Santo Domingo (República Dominicana) (n = 501). Se empleó el análisis de cruce de casos, basado en el consumo autoinformado con anterioridad a los traumatismos causados por el tránsito, para evaluar el riesgo por consumo de alcohol, cannabis y consumo combinado. Resultados. En términos generales, 15,3% notificó consumo de alcohol con anterioridad al evento y 2,5%, consumo de cannabis. Los conductores que consumieron alcohol únicamente tuvieron más del doble de probabilidades de sufrir traumatismos causados por el tránsito (OR = 2,46, p < 0,001) y casi ocho veces más probabilidades si consumieron tanto alcohol como cannabis (OR = 6,89, p < 0,01), si bien el riesgo no fue tan elevado para el consumo único de cannabis. No se encontraron diferencias significativas en pasajeros o peatones. Conclusiones. El riesgo de sufrir traumatismos causados por el tránsito para los conductores en estas dos muestras es significativamente más elevado por el consumo de alcohol y más aún por el consumo combinado con cannabis. Las diferencias entre ambos países ponen de manifiesto la necesidad de obtener datos similares sobre la región para determinar el riesgo de sufrir traumatismos causados por el tránsito debidos al consumo de sustancias psicoactivas, así como el riesgo para pasajeros y peatones. Los datos indican que el alcohol agrava significativamente la carga de los traumatismos causados por el tránsito, lo que exige un cumplimiento más estricto de las políticas de control del alcohol relacionadas con la conducción bajo los efectos del alcohol en la región.

RESUMO Objetivo. Descrever as características demográficas e uso de substâncias químicas e o risco de lesões por acidentes de trânsito associados ao consumo de álcool, uso de cannabis (maconha) e uso combinado de álcool e cannabis em uma amostra de pacientes que deram entrada no setor de emergência em dois países da América Latina e no Caribe. Métodos. Estudo transversal em que foram entrevistados pacientes maiores de 18 anos que deram entrada no setor de emergência no espaço de seis horas após sofrerem lesões por acidentes de trânsito em Santo Domingo, na República Dominicana (n = 501), e em Lima, Peru (n = 431). Foi realizada uma análise cruzada de casos com dados obtidos do autorrelato do uso de substâncias químicas anterior ao acidente de trânsito para avaliar o risco associado ao consumo de álcool, uso de cannabis e uso combinado. Resultados. Dos pacientes entrevistados, 15,3% relataram consumo de álcool e 2,5% referiram uso de cannabis antes do acidente. Os condutores que fizeram uso de álcool tiveram uma chance duas vezes maior de ter lesões por acidente de trânsito (OR = 2,46, p < 0,001) e uma chance de cerca de oito vezes maior com o uso combinado de álcool e cannabis (OR = 6,89, p < 0,01). Porém, o risco não foi elevado com o uso somente de cannabis. Não foram observadas diferenças significativas no risco para passageiros ou pedestres. Conclusões. Verificou-se que o risco de lesões por acidentes de trânsito para os condutores nas duas amostras estudadas foi significativamente elevado com o consumo de álcool e foi ainda maior com o uso combinado de álcool e cannabis. As diferenças entre os dois países reforçam a necessidade de dados semelhantes da Região para determinar o risco de lesões por acidentes de trânsito com o uso de substâncias químicas, inclusive para determinar o risco para passageiros e pedestres. Os dados indicam que o álcool contribui significativamente à carga de lesões por acidentes de trânsito requerendo o cumprimento mais rigoroso da política de controle do consumo de álcool associado à condução de veículos na Região.

Introducing the evidence-based population health tool of the Lower-Risk Cannabis Use Guidelines to Brazil

Cannabis is the most commonly used illegal drug, and is associated with well-documented adverse health outcomes, both acute and chronic. Cannabis use prevalence in Brazil is lower than in high-use regions in the Americas (e.g., North America), but concentrated among young people. Frameworks for cannabis control are increasingly shifting towards public health-oriented principles, with some countries undertaking respective policy reforms. These frameworks require a continuum of population-level interventions (e.g., prevention and treatment) including targeted prevention of adverse health outcomes among users. In this context, and based on examples from other health fields, an international expert group developed the evidence-based Lower-Risk Cannabis Use Guidelines (LRCUG), originally for Canada, including a set of 10 recommendations based on systematic data reviews and expert consensus methods. The LRCUG form a scientific population-health prevention tool to reduce adverse public health impacts for broad application among cannabis users. In Canada, the LRCUG have been formally endorsed and are supported by leading national health organizations and government authorities within the continuum of cannabis interventions. As the LRCUG are being internationalized, this paper introduces the LRCUG's concept and content - including their original recommendations translated into Portuguese - to the Brazilian context as an evidence-based population-level intervention tool for uptake, dissemination, and discussion. Sociocultural adaptation may be required for meaningful implementation.

Arteriopatía periférica asociada a marihuana / Marijuana-associated peripheral arteriopathy

La arteriopatía por marihuana debe ser considerada en pacientes jóvenes con arteriopatía periférica sin factores de riesgo para ateroesclerosis. Se ha descrito por primera vez en 1960 y existen más de 100 casos en la literatura. Si bien se tiende a considerar como una entidad independiente de la tromboangeítis obliterante o enfermedad de Leo Buerger, debido a los hallazgos la consideramos dentro del espectro de esta última. Presentamos dos casos de pacientes jóvenes con enfermedad vascular periférica asociada al consumo de marihuana, luego de excluir otras enfermedades. El tratamiento es el cese del consumo. Es indispensable valorar el uso de drogas en pacientes jóvenes que se presentan con arteriopatía periférica.

The marijuana arteriopathy should be considered in young patients with peripheral arterial disease with no risk factors for atherosclerosis. It was described for the first time in 1960 and since then there have been about 100 cases published in the literature. Although it tends to be considered as an independent entity of thromboangiitis obliterans or Leo Buerger´s disease, in the light of the last findings it is possible to consider it within the spectrum of the latter. We present two cases of young patients with peripheral vascular disease associated with marijuana use where other associated illnesses had been excluded and where the mainstay of treatment has been the cessation of marijuana consumption. It is essential to assess drug use in young patients presenting with peripheral arterial disease.

Síndrome de hiperémesis por cannabinoides: caso clínico / Cannabinoid hyperemesis syndrome: clinical case

Background. The cannabinoid hyperemesis syndrome (CHS) was first described in 2004. It is considered as a functional gastrointestinal syndrome characterized by the presence of nausea, severe and cyclic morning vomiting, epigastric abdominal pain, hot water bathing for symptom relief, in patients that use cannabis regularly and has a resolution of the syndrome after cessation of cannabis consumption. Clinical Case. Report of a 29 year old male, with daily consumption of cannabis, with history of intense epigastric abdominal pain and recurrent vomiting that partially responded to the use of antispasmodics. After 4 visits to the emergency department he was hospitalized for study and treatment. Laboratory and image exploration are carried out without positive results for organic disease. Therefore, a functional gastrointestinal syndrome is thought, and a cannabinoid hyperemesis syndrome was suspected. A psychiatric evaluation is carried out, diagnosing a cannabis use disorder. Discussion and conclusion. CHS is a syndrome that has been described recently and is not usually considered as a differential diagnosis for patients with hyperemesis. However, the current high prevalence of cannabis consumption, will probably lead to a more frequent presentation of the syndrome at different health providers. Therefore, it is important to diffuse and update the knowledge about this syndrome to recognize it and develop a timely treatment, avoiding medical complications from invasive exploratory methods and the use of unnecessary resources. (AU)

Oral health assessment for users of marijuana and cocaine/crack substances

Abstract: The objective of this study was to assess the oral health status of users of illicit drugs such as marijuana and cocaine/crack and compare it with individuals not using these chemical substances. Questionnaires were applied to 35 illicit drugs users to gather information on demographic status, general health, and use of drugs. Then, a clinical assessment of the oral health condition was performed to collect data on decayed, missing and filled teeth (DMFT) index, salivary flow rate (SFR), and mucosal lesions. The control group was composed of 35 non-illicit drug users. In the experimental group, 91.43% were males, 80% were smokers, and 42.85% were alcoholics. Cocaine was the most common drug used (77.15%), followed by marijuana (68.6%), and crack (51.4%). The average DMFT index was 9.8 and the SFR was reduced in 60% of subjects. Mucosal alterations were detected, but no potentially malignant disorders or oral cancer were diagnosed. Compared to control group, significantly higher values for gender (40%, p = 0.0001), smoking (22.86%) and heavy drinking (5.7%) habits (p = 0.0001), SFR (31.4%; p = 0.0308), and oral lesions (p = 0.0488) were found for the experimental group, although significantly higher values were found in the control group for DMFT index (p = 0.0148). It can be concluded that the use of illicit drugs contributed to an increased prevalence of oral mucosa lesions. In addition, a decline on SFR and a reduced DMFT index was observed for illicit drug users.

Consideraciones perioperatorias en pacientes consumidores de drogas ilícitas de uso frecuente / Perioperative considerations in patients consumers of illicit drugs frequently used

Debido al importante aumento del consumo de drogas ilícitas o recreativas en nuestra sociedad, es cada vez más probable que nos encontremos con pacientes usuarios de ellas en el contexto quirúrgico. Es importante conocer los principales efectos de las sustancias ilícitas más frecuentemente usadas por los pacientes sometidos a cirugía, como cocaína, marihuana, pasta base de cocaína y psicoestimulantes, como también los efectos más significativos que pueden producirse al combinar estas sustancias recreativas con fármacos relacionados a la cirugía y anestesia. Asimismo, es relevante tener en cuenta las principales consideraciones perioperatorias en el proceso quirúrgico y anestésico de los pacientes consumidores de estas drogas ilícitas. La cocaína altera principalmente los sistemas cardiovascular, respiratorio, nervioso central, gastrointestinal y renal, teniendo los pacientes adictos mayor riesgo de infarto agudo al miocardio, arritmias y crisis hipertensivas arteriales. La marihuana inhibe los receptores muscarínicos de acetilcolina, afectando principalmente los sistemas cardiovascular, respiratorio y neuropsiquiátrico, teniendo un rol importante en el manejo analgésico intra y postoperatorio. La pasta base de cocaína provoca un aumento transitorio en la neurotransmisión dopaminérgica, siendo similar a la cocaína por lo que se recomienda un manejo perioperatorio parecido. Las drogas psicoestimulantes tienen efecto simpaticomimético, afectando esencialmente los sistemas cardiovascular y metabólico. Esta revisión resume la evidencia médica vigente sobre el tema, con el fin de unificar criterios y sugerir pautas de manejo de estos pacientes durante el período perioperatorio, donde los efectos de estas drogas ilícitas posiblemente sean más significativos, pudiendo generar complicaciones graves y poniendo en riesgo la vida del paciente.

Due to the significant increase of illicit or recreational drugs in our society, it is increasingly likely that we find patients using them in the surgical context. It is important to understand the main effects of illegal substances most commonly used by patients undergoing surgery, such as cocaine, marijuana, cocaine paste and psychostimulants, as the most significant effects that can be produced by combining these recreational drugs with related substances of surgery and anesthesia. It is also relevant to consider the major perioperative considerations (surgical and anesthetic) in consumer patients of these illicit drugs. Cocaine alters the cardiovascular, respiratory, central nervous, gastrointestinal and renal systems, addicted patients taking higher risk of acute myocardial infarction, arrhythmias and arterial hypertensive crisis. Marijuana inhibits muscarinic acetylcholine receptors, primarily affecting the cardiovascular, respiratory and neuropsychiatric systems, and has an important role in intra and postoperative analgesic management. The cocaine base paste causes transient increase in dopaminergic neurotransmission, being similar to cocaine so a similar perioperative management is recommended. The psychostimulant drugs are sympathomimetic effect, essentially affecting the cardiovascular and metabolic systems. This review summarizes the current medical evidence on the subject, in order to unify criteria and management guidelines suggest these patients during the perioperative period, where the effects of these illicit drugs are likely to be more significant, potentially leading to serious complications and endangering the patient's life.

Púrpura de Schönlein-Henoch en adulto HIV positivo adicto a cocaína y ANCA-p positivo / Henoch-Schönlein purpura in a cocaine consumer man with HIV infection and ANCA-p positivity

La púrpura de Schönlein-Henoch (PSH) es una vasculitis de pequeños vasos con depósito de inmunocomplejos de IgA. La presentación en adultos es rara y grave. Los casos comunicados de PSH en pacientes infectados por HIV son escasos. Los anticuerpos anticitoplasma de neutrófilos (ANCA), detectados por inmunofluorescencia indirecta (IFI), se encuentran comúnmente en otras vasculitis sistémicas primarias pero rara vez en PSH y es aún más inusual el patrón perinuclear (ANCA-p). Por otra parte, la positividad de los ANCA puede ser detectada en una serie de condiciones patológicas distintas de las vasculitis de pequeños vasos en asociación a procesos infecciosos, incluyendo el HIV, o a consumo de cocaína, y en especial el patrón de ANCA-p vinculado a medicamentos o enfermedades autoinmunes e inflamatorias intestinales. Se presenta el caso de un varón de 35 años con hábitos tóxicos (cocaína, marihuana) que consultó por dolor abdominal, hematoquecia y lesiones purpúricas en extremidades inferiores, que agregó fiebre, artralgias y progresión de lesiones purpúricas asociadas a síndrome nefrítico y ANCA-p (+). Durante la internación se detectó infección por HIV. La biopsia renal evidenció una nefropatía a IgA que tuvo una respuesta favorable al tratamiento corticoideo y antiproteinúrico. La comunicación del caso obedece a la rareza de la presentación y a la complejidad para establecer el diagnóstico y la terapéutica. Aún resta dilucidar el rol de los ANCA en la etiopatogenia y el manejo de la PSH del adulto.

The Henoch-Schönlein purpura (HSP) is a small vessel vasculitis with IgA immune complex deposition. The presentation in adults is rare and severe. Reported cases of HSP in patients infected with HIV are scarce. Neutrophil cytoplasmic antibodies (ANCA) are commonly found in other systemic vasculitis, but rarely in HSP and even more unusual the perinuclear pattern. Beside small vessel vasculitis, positivity of ANCA can be detected in a number of different pathological conditions in association with infectious processes, including HIV, or cocaine use, and especially the pattern of ANCA-p, associated with drugs, inflammatory bowel or autoimmune diseases. We report the case of a 35 years old man with toxic habits (cocaine, marijuana) who consulted for abdominal pain, hematochezia and purpura on lower extremities, and later fever, joint pain and progression of purpura associated with nephritic syndrome and ANCA-p (+). During hospitalization HIV infection was detected. Renal biopsy showed IgA nephropathy with favorable response to corticosteroid and antiproteinuric treatment. The communication of the case is due to the rarity of the presentation and therapeutic diagnostic challenge. It remains to elucidate the role of ANCA in the pathogenesis and management of adult PSH.

Efectos de las adicciones en la práctica odontológica: un problema de salud pública / Effects of addictions in dental practice: a public health concern

En la actualidad el consumo de sustancias psicoactivas se vincula al aumento delos accidentes de tránsito y a las situaciones de violencia (robos, asaltos, suicidios, homicidios) y está presente en las causas más frecuentemente de muerte en el grupo de 15-24 años de edad. Los trastornos biológicos, psicológicos y sociales involucrados en el consumo y sus efectos en la salud de la población, nos motivan como profesionales de la salud a comprender y profundizar en esta problemática y aportar las bases suficientes en los programas de prevención y promoción de la salud.

The prevalence of inhalant use and associated factors among adolescents in Belo Horizonte, Brazil / Prevalência do uso de inalantes e fatores associados em adolescentes de Belo Horizonte, Brasil

The scope of this study was to establish the prevalence of inhalant use among adolescents and its association with marijuana use, alcohol consumption, socioeconomic status and gender. A cross-sectional study was performed with a representative sample of 891 adolescents from public and private schools in the city of Belo Horizonte, Brazil. Data were collected using two self-administered questionnaires: the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) and the Alcohol Use Disorders Identification Test (AUDIT C). The socioeconomic status was evaluated using the Social Vulnerability Index, mother's education level and type of school (public or private). The data were analyzed using the chi-square test (p < 0.05) and logistic regression analysis. The prevalence of inhalant use was 7.9%. No significant association was found between the use of inhalants and socioeconomic status after the logistic regression analysis. Inhalant use among adolescents was associated with marijuana use (OR: 4.61; 95% CI: 2.27 - 9.36) and with binge drinking (OR: 5.02; 95% CI: 2.57 - 9.81).

O objetivo deste estudo foi avaliar a prevalência do uso de inalantes em adolescentes e sua associação com o uso de maconha, consumo de álcool, condição socioeconômica e gênero. Um estudo transversal foi realizado em uma amostra representativa de 891 adolescentes de escolas públicas e privadas de Belo Horizonte, Brasil. Os dados foram coletados por meio de dois questionários autoaplicáveis: o Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) e o Alcohol Use Disorders Identification Test (AUDIT C). O Índice de Vulnerabilidade Social, o nível de escolaridade da mãe e o tipo de escola (pública ou privada) foram utilizados para determinar o nível socioeconômico. Os dados foram analisados utilizando o teste qui-quadrado (p < 0.05) e a análise de regressão logística. A prevalência do uso de inalantes foi de 7,9%. Não houve associação entre o uso de inalantes e o nível socioeconômico após a análise de regressão logística. O uso de inalantes por adolescentes esteve associado ao uso de maconha (OR: 4.61; 95% CI: 2.27 - 9.36) e ao consumo abusivo de álcool (OR: 5.02; 95% CI: 2.57 - 9.81).

Potenciais evocados auditivos de tronco encefálico de ex-usuários de drogas / Brain stem evoked response audiometry of former drug users

As drogas ilícitas são conhecidas pelos seus efeitos deletérios no sistema nervoso central; no entanto, elas também podem atingir o sistema auditivo, provocando alterações. OBJETIVOS: Analisar e comparar os resultados dos potenciais evocados auditivos de tronco encefálico (PEATE) de frequentadores de grupos de apoio a ex-usuários de drogas. MÉTODO: Estudo transversal, não experimental, descritivo e quantitativo. A amostra foi composta por 17 indivíduos divididos conforme o tipo de droga mais consumida: 10 indivíduos no grupo maconha (G1) e sete no grupo crack/cocaína (G2). Eles foram subdivididos pelo tempo de uso de drogas: um a cinco anos, seis a 10 anos e mais que 15 anos. A avaliação foi feita por meio de anamnese, audiometria tonal liminar, medidas de imitância acústica e PEATE. RESULTADOS: Ao comparar os resultados de G1 e G2, independente do tempo de uso de drogas, não se observou diferença estatisticamente significante nas latências absolutas e nos intervalos interpicos. No entanto, apenas cinco dos 17 indivíduos tiveram PEATE com resultados adequados para a faixa etária. CONCLUSÃO: Independentemente do tempo de utilização das drogas, o uso de maconha e crack/cocaína pode provocar alterações difusas no tronco encefálico, comprometendo a transmissão do estímulo auditivo.

Illicit drugs are known for their deleterious effects upon the central nervous system and more specifically for how they adversely affect hearing. OBJECTIVE: This study aims to analyze and compare the hearing complaints and the results of brainstem evoked response audiometry (BERA) of former drug user support group goers. METHODS: This is a cross-sectional non-experimental descriptive quantitative study. The sample consisted of 17 subjects divided by their preferred drug of use. Ten individuals were placed in the marijuana group (G1) and seven in the crack/cocaine group (G2). The subjects were further divided based on how long they had been using drugs: 1 to 5 years, 6 to 10 years, and over 15 years. They were interviewed, and assessed by pure tone audiometry, acoustic impedance tests, and BERA. RESULTS: No statistically significant differences were found between G1 and G2 or time of drug use in absolute latencies and interpeak intervals. However, only five of the 17 individuals had BERA results with adequate results for their ages. CONCLUSION: Marijuana and crack/cocaine may cause diffuse disorders in the brainstem and compromise the transmission of auditory stimuli regardless of how long these substances are used for.

Efectos de la marihuana en la cognición: una revisión desde la perspectiva neurobiológica / Effects of marijuana on cognition: a review form the neurobiological perspective

La marihuana es una sustancia psicoactiva ampliamente usada en la sociedad, especialmente entre los más jóvenes. El uso de esta sustancia ha sido asociado consistentemente con diversos problemas de salud, muchos de los cuales tienen en común una alteración en las manifestaciones cognitivas de la conducta, incluyendo la memoria, la atención, la emoción y la toma de decisiones. Se encontró evidencia que los cannabinoides, la sustancia activa de la marihuana, impactan negativamente en la memoria a corto plazo, memoria de trabajo y la toma de decisiones. Asimismo, los cannabinoides afectan la atención y la interacción entre los eventos cognitivos y la emoción. Esta información puede ser usada como argumento de plausibilidad biológica para interpretar una serie de hallazgos clínicos y epidemiológicos en los que el uso de marihuana se ha mostrado relacionado con problemas tales como accidentes de tránsito, psicosis, depresión, pobre trayectoria académica, entre otros.

Marijuana is one of the most commonly used psychoactive substances in society, mainly among youths. Its use has been consistently associated with several health problems, many of which have in common an impairment in the cognitive processes of behavior, including the memory, attention, emotion and decision making. There is evidence suggesting that cannabinoids, marijuana´s primary psychoactive substance, have a negative effect in short-term memory, working memory, and decision making. It has also been found that cannabinoids affect attention and the interaction between cognitive events and emotion. This information can be used as an argument of biological plausibility to assess clinical and epidemiological research findings that show that marijuana`s use is associated to problems such as traffic accidents, psychosis, depression and poor academic records, among others.

Manifestações do uso de maconha e opiáceos durante a gravidez / Outcomes of marijuana and opioids use during pregnancy

Visando a analisar o uso de maconha e opiáceos durante a gestação e suas consequências, tanto na formação como no futuro desenvolvimento da criança, realizou-se uma revisão crítica da literatura, com foco nos efeitos deletérios dessas drogas no recém-nato. Muitas dúvidas ainda não foram sanadas referentes à ação das drogas e o reflexo no concepto. Foram observadas coincidências entre o uso de maconha e o mau desenvolvimento do tubo neural do recém-nato, além de possíveis anencefalias. Em relação à ação dos opiáceos durante a gestação, foi observado um maior número de partos prematuros, bebês nascidos com baixo peso, com menor circunferência craniana e menor estatura

Aiming at analyzing the marijuana and opioids use during pregnancy and their consequences both in formation and in the future development of the child, a critic review of the literature was carried out focusing on the deleterious effects of these drugs in the recent born. Many questions have not been answered referring to the action of the drug and its reflection on the concept. It had been observed a relationship between use of marijuana and the poor development of the neural tube of the newly born and possible anencephalies. In relation to the opioids outcomes during pregnancy, an increase of premature births, babies born with low-birth weight, small cephalic circumference, and lower height were observed

Cannabis e humor / Cannabis and mood

OBJETIVO: Avaliar as relações entre o uso agudo e crônico de cannabis e alterações do humor. MÉTODO: Os artigos foram selecionados por meio de busca eletrônica no indexador PubMed. Capítulos de livros e as listas de referências dos artigos selecionados também foram revisados. RESULTADOS: Observam-se elevados índices de comorbidade entre abuso/dependência de cannabis e transtornos afetivos em estudos transversais e em amostras clínicas. Estudos longitudinais indicam que, em longo prazo, o uso mais intenso de cannabis está relacionado com um risco maior de desenvolvimento de doença bipolar e, talvez, depressão maior em indivíduos inicialmente sem quadros afetivos; porém, os mesmos não encontraram maior risco de uso de cannabis entre aqueles com mania ou depressão sem esta comorbidade. Outra importante observação é que o uso de substâncias psicoativas em bipolares pode estar associado a uma série de características negativas, como dificuldade na recuperação dos sintomas afetivos, maior número de internações, piora na adesão ao tratamento, risco aumentado de suicídio, agressividade e a uma pobre resposta ao lítio. Tratamentos psicossociais e farmacológicos são indicados para o manejo da comorbidade entre cannabis e transtornos afetivos. CONCLUSÃO: As relações entre o uso de cannabis e alterações do humor são observadas tanto epidemiologicamente quanto nos contextos clínicos.

OBJECTIVE: Evaluate the relationship between acute and chronic use of cannabis and mood changes. METHOD: Articles were selected by electronic search in PubMed. Chapters in books and reference lists of selected articles were also reviewed. As the research did not involve humans, there was no evaluation by a Research Ethics Committee. RESULTS: High rates of comorbidity between use/abuse/dependence of cannabis and affective disorders in longitudinal studies and in clinical samples were observed. Longitudinal studies indicate that, in long-term, the higher use of cannabis is associated with an increased risk of developing bipolar disorder, and probably, major depression in subjects initially without affective disorder, but was not found increased risk of cannabis use among those initially only with mania or depression. Another important observation is that substance abuse in bipolar patients may be associated with a number of negative characteristics, such as difficulty in recovering the affective symptoms, more hospitalizations, poor compliance with treatment, increased risk of suicide, aggression and a poor response to lithium. Psychosocial and pharmacological treatments are indicated for the management of comorbidity between cannabis and affective disorders. CONCLUSION: The relationship between cannabis use and mood changes are observed both in the epidemiological research and in the clinical settings.