Alcohol use patterns and disorders among individuals with personality disorders in the Sao Paulo Metropolitan Area.

INTRODUCTION: Alcohol Use Disorders are frequently comorbid with personality disorders. However, the heterogeneity of the prevalence estimates is high, and most data come from high income countries. Our aim is to estimate the prevalence and association between alcohol use outcomes and the three DSM-5 clusters of personality disorders in a representative sample of the São Paulo Metropolitan Area. MATERIALS AND METHODS: A representative household sample of 2,942 adults was interviewed using the WHO Composite International Diagnostic Interview and the International Personality Disorder Examination Screening Questionnaire. Lifetime PD diagnoses were multiply imputed, and AUD diagnoses were obtained using DSM-5 criteria. We conducted cross-tabulations and logistic regression to estimate the associations between AUDs and PDs. RESULTS AND DISCUSSION: Our study did not find significant associations of PDs with heavy drinking patterns or mild AUD. Cluster B PD respondents tended to show the highest conditional prevalence estimates of most alcohol use patterns and AUD, including its severity subtypes. When alcohol outcomes were regressed on all PD Clusters simultaneously, with adjustment for sex and age, only cluster B was significantly associated with past-year alcohol use (OR 3.0), regular drinking (OR 3.2), and AUDs (OR 8.5), especially moderate and severe cases of alcohol use disorders (OR 9.7 and 16.6, respectively). These associations between Cluster B PDs and these alcohol outcomes were shown to be independent of other PD Clusters and individuals´ sex and age. CONCLUSION: The main finding of our study is that AUDs are highly comorbid with PDs. The presence of Cluster B PDs significantly increases the odds of alcohol consumption and disorders and of more severe forms of AUDs. Considering the local context of poor treatment provision, more specific prevention and intervention strategies should be directed to this population.

Estimating Service Needs for Alcohol and Other Drug Users According to a Tiered Framework: The Case of the São Paulo, Brazil, Metropolitan Area.

OBJECTIVE: The purpose of this study was to estimate the need for population-level services for alcohol and other drug abuse in support of local planning. METHOD: Data were drawn from a subsample of 2,942 interviewees from the São Paulo Megacity Study, which evaluated mental health in the general population (18 years and older) of residents in the São Paulo metropolitan area. This population was classified into five hierarchical categories of severity, making it possible to obtain estimates of need for services, combining evaluation criteria regarding drug and alcohol use and general and mental health comorbidities over the last 12 months. For the at-risk groups in this population, estimates from the Potential Demand for the Use of Services survey interviews over the last year were generated. RESULTS: Concerning the need for services, 86.5% of the population (Tier 1) had no problems related to drug and alcohol use, 8.9% (Tier 2) used heavily, 3.5% (Tiers 3, 4, and 5) met criteria for substance abuse disorders, among whom 1.3% (Tiers 4 and 5) require more specialized and intensive treatment and support. The following estimates for the Potential Demand for the Use of Services were found: 25.5% (Tier 3) and 51.1% (Tier 4), indicating that a significant number of individuals met criteria for substance abuse disorders but did not perceive any need for professional help or neglected the help available. CONCLUSIONS: In São Paulo there exists a large sector of the population that requires prevention strategies regarding the risks and harm resulting from alcohol and drug use, followed by a group requiring more specialized care. But a large number of substance users requiring specialized support did not use services and did not believe that they needed professional help.

Dual burden of chronic physical diseases and anxiety/mood disorders among São Paulo Megacity Mental Health Survey Sample, Brazil.

BACKGROUND: We assessed comorbid associations of 12-month DSM-IV mood/any anxiety disorders with chronic physical conditions within the São Paulo (SP) Megacity Mental Health cross-sectional survey of 5037 participants and explored whether strength of comorbid associations were modified when controlling for demographics. METHODS: Chi-square tests and logistic regressions were used to examine comorbid associations of DSM-IV mood/anxiety disorders as measured by the WHO Composite International Diagnostic Interview (CIDI 3.0), and self-reported chronic physical conditions among adults from the SP Megacity Mental Health Survey. RESULTS: Among those with any mood or anxiety disorder, chronic pain disorder was the most common physical condition (48.9% and 44.9%, respectively). Significant unadjusted odds ratios (OR) of comorbidity were found between diagnosis of two or more physical conditions and any mood disorders (3.08, 95% CI: 2.27-4.17), and any anxiety disorders (2.49, 95% CI: 1.95-3.17). Comorbidities remained significant when stratified by gender and controlling for marital status, household income, and education (latter two only included within anxiety models). LIMITATIONS: These results cannot be generalized to other cities or rural populations. Homeless and institutionalized populations were not surveyed. Due to cross-sectional study design, the direction of association between chronic disease/chronic disease risk factors and mood disorders is unclear. CONCLUSIONS: Dual burden of chronic physical conditions and mood/anxiety disorders is a notable problem among the São Paulo Megacity Survey population, with enhanced comorbidity experienced by community members with multiple physical conditions. Clinicians should consider these findings in understanding healthcare delivery for individuals suffering from both psychiatric disorders and chronic physical conditions.

Drinking patterns and alcohol use disorders in São Paulo, Brazil: the role of neighborhood social deprivation and socioeconomic status.

BACKGROUND: Research conducted in high-income countries has investigated influences of socioeconomic inequalities on drinking outcomes such as alcohol use disorders (AUD), however, associations between area-level neighborhood social deprivation (NSD) and individual socioeconomic status with these outcomes have not been explored in Brazil. Thus, we investigated the role of these factors on drink-related outcomes in a Brazilian population, attending to male-female variations. METHODS: A multi-stage area probability sample of adult household residents in the São Paulo Metropolitan Area was assessed using the WHO Composite International Diagnostic Interview (WMH-CIDI) (n = 5,037). Estimation focused on prevalence and correlates of past-year alcohol disturbances [heavy drinking of lower frequency (HDLF), heavy drinking of higher frequency (HDHF), abuse, dependence, and DMS-5 AUD] among regular users (RU); odds ratio (OR) were obtained. RESULTS: Higher NSD, measured as an area-level variable with individual level variables held constant, showed an excess odds for most alcohol disturbances analyzed. Prevalence estimates for HDLF and HDHF among RU were 9% and 20%, respectively, with excess odds in higher NSD areas; schooling (inverse association) and low income were associated with male HDLF. The only individual-level association with female HDLF involved employment status. Prevalence estimates for abuse, dependence, and DSM-5 AUD among RU were 8%, 4%, and 8%, respectively, with excess odds of: dependence in higher NSD areas for males; abuse and AUD for females. Among RU, AUD was associated with unemployment, and low education with dependence and AUD. CONCLUSIONS: Regular alcohol users with alcohol-related disturbances are more likely to be found where area-level neighborhood characteristics reflect social disadvantage. Although we cannot draw inferences about causal influence, the associations are strong enough to warrant future longitudinal alcohol studies to explore causal mechanisms related to the heterogeneous patterns of association and male-female variations observed herein. Hopefully, these findings may help guide future directions for public health.

Dependência química: álcool

Texto que compõe a unidade 2 ­ parte I do módulo 3 "Álcool e outras drogas" do Curso de Capacitação em Dependência Química, produzido pela UNA-SUS/UFMA. Aborda os aspectos neurobiológicos e farmacocinéticos da dependência química, os transtornos e comorbidades relacionados ao uso do álcool, bem como o apoio da família do dependente na superação de dificuldades no modo de vida sem o uso de álcool.

Tratamento para dependência química de álcool e outras drogas

Texto que compõe a unidade 4 do módulo 3 "Álcool e outras drogas" do Curso de Capacitação em Dependência Química, produzido pela UNA-SUS/UFMA. Aborda os tipos de tratamento: medicamentoso, psicológico e a atividade física e ocupacional destinado a usuários de álcool e drogas.

Gender differences in drinking patterns and alcohol-related problems in a community sample in São Paulo, Brazil.

OBJECTIVE: To investigate drinking patterns and gender differences in alcohol-related problems in a Brazilian population, with an emphasis on the frequency of heavy drinking. METHODS: A cross-sectional study was conducted with a probability adult household sample (n = 1,464) in the city of São Paulo, Brazil. Alcohol intake and ICD-10 psychopathology diagnoses were assessed with the Composite International Diagnostic Interview 1.1. The analyses focused on the prevalence and determinants of 12-month non-heavy drinking, heavy episodic drinking (4-5 drinks per occasion), and heavy and frequent drinking (heavy drinking at least 3 times/week), as well as associated alcohol-related problems according to drinking patterns and gender. RESULTS: Nearly 22% (32.4% women, 8.7% men) of the subjects were lifetime abstainers, 60.3% were non-heavy drinkers, and 17.5% reported heavy drinking in a 12-month period (26.3% men, 10.9% women). Subjects with the highest frequency of heavy drinking reported the most problems. Among subjects who did not engage in heavy drinking, men reported more problems than did women. A gender convergence in the amount of problems was observed when considering heavy drinking patterns. Heavy and frequent drinkers were twice as likely as abstainers to present lifetime depressive disorders. Lifetime nicotine dependence was associated with all drinking patterns. Heavy and frequent drinking was not restricted to young ages. CONCLUSIONS: Heavy and frequent episodic drinking was strongly associated with problems in a community sample from the largest city in Latin America. Prevention policies should target this drinking pattern, independent of age or gender. These findings warrant continued research on risky drinking behavior, particularly among persistent heavy drinkers at the non-dependent level.

Mental disorders in megacities: findings from the São Paulo megacity mental health survey, Brazil.

BACKGROUND: World population growth is projected to be concentrated in megacities, with increases in social inequality and urbanization-associated stress. São Paulo Metropolitan Area (SPMA) provides a forewarning of the burden of mental disorders in urban settings in developing world. The aim of this study is to estimate prevalence, severity, and treatment of recently active DSM-IV mental disorders. We examined socio-demographic correlates, aspects of urban living such as internal migration, exposure to violence, and neighborhood-level social deprivation with 12-month mental disorders. METHODS AND RESULTS: A representative cross-sectional household sample of 5,037 adults was interviewed face-to-face using the WHO Composite International Diagnostic Interview (CIDI), to generate diagnoses of DSM-IV mental disorders within 12 months of interview, disorder severity, and treatment. Administrative data on neighborhood social deprivation were gathered. Multiple logistic regression was used to evaluate individual and contextual correlates of disorders, severity, and treatment. Around thirty percent of respondents reported a 12-month disorder, with an even distribution across severity levels. Anxiety disorders were the most common disorders (affecting 19.9%), followed by mood (11%), impulse-control (4.3%), and substance use (3.6%) disorders. Exposure to crime was associated with all four types of disorder. Migrants had low prevalence of all four types compared to stable residents. High urbanicity was associated with impulse-control disorders and high social deprivation with substance use disorders. Vulnerable subgroups were observed: women and migrant men living in most deprived areas. Only one-third of serious cases had received treatment in the previous year. DISCUSSION: Adults living in São Paulo megacity had prevalence of mental disorders at greater levels than similar surveys conducted in other areas of the world. Integration of mental health promotion and care into the rapidly expanding Brazilian primary health system should be strengthened. This strategy might become a model for poorly resourced and highly populated developing countries.

Gender differences in drinking patterns and alcohol-related problems in a community sample in São Paulo, Brazil

OBJECTIVE: To investigate drinking patterns and gender differences in alcohol-related problems in a Brazilian population, with an emphasis on the frequency of heavy drinking. METHODS: A cross-sectional study was conducted with a probability adult household sample (n = 1,464) in the city of São Paulo, Brazil. Alcohol intake and ICD-10 psychopathology diagnoses were assessed with the Composite International Diagnostic Interview 1.1. The analyses focused on the prevalence and determinants of 12-month nonheavy drinking, heavy episodic drinking (4-5 drinks per occasion), and heavy and frequent drinking (heavy drinking at least 3 times/week), as well as associated alcohol-related problems according to drinking patterns and gender. RESULTS: Nearly 22% (32.4% women, 8.7% men) of the subjects were lifetime abstainers, 60.3% were non-heavy drinkers, and 17.5% reported heavy drinking in a 12-month period (26.3% men, 10.9% women). Subjects with the highest frequency of heavy drinking reported the most problems. Among subjects who did not engage in heavy drinking, men reported more problems than did women. A gender convergence in the amount of problems was observed when considering heavy drinking patterns. Heavy and frequent drinkers were twice as likely as abstainers to present lifetime depressive disorders. Lifetime nicotine dependence was associated with all drinking patterns. Heavy and frequent drinking was not restricted to young ages. CONCLUSIONS: Heavy and frequent episodic drinking was strongly associated with problems in a community sample from the largest city in Latin America. Prevention policies should target this drinking pattern, independent of age or gender. These findings warrant continued research on risky drinking behavior, particularly among persistent heavy drinkers at the non-dependent level.

Uso prescrito de cloridrato de metilfenidato e correlatos entre estudantes universitários brasileiros / Prescribed use of methylphenidate hydrochloride and its correlates among Brazilian college students

CONTEXTO: A prevalência do uso prescrito de metilfenidato (MPH) e correlatos ainda é pouco conhecida no Brasil.OBJETIVO: Estimar a prevalência do uso prescrito de MPH e correlatos em uma amostra populacional de universitários brasileiros.MÉTODOS: Doze mil setecentos e onze universitários foram solicitados a responder a um questionário sobre o uso de drogas. Em relação ao uso na vida de MPH, os universitários foram divididos em dois grupos: usuários de MPH (MPHU) e não usuários de MPH (MPHNU). Um modelo de regressão quasibinomial foi usado para avaliar a correlação desse uso com as demais variáveis.RESULTADOS: 0,9% dos universitários relataram ter feito uso de MPH na vida (MPHU). Ser da região Centro-Oeste (RP = 4,8; p < 0,01) e Sul (RP = 5,2; p < 0,05), morar em repúblicas (RP = 5,8; p < 0,001), já ter feito uso prescrito de anfetaminas (RP = 8,9; p < 0,001) e benzodiazepínicos (< 3 semanas: RP = 4,4; p < 0,001; ≥ 3 semanas: RP = 6,7; p < 0,001) e fazer uso recente e de risco de álcool (RP = 4,0; p < 0,05) foram variáveis associadas ao MPHU.CONCLUSÃO: A associação do uso de álcool e de outras drogas com o uso prescrito de MPH entre universitários sugere a importância da triagem do padrão do uso de álcool e de outras drogas entre estudantes com sintomas de transtorno de déficit de atenção e hiperatividade (TDAH).

BACKGROUND: The prevalence of prescribed use of methylphenidate (MPH) and its correlates are not well-known in Brazil.OBJECTIVE: To estimate the prevalence of prescribed use of MPH and its correlates in a sample of Brazilian college students.METHODS: Twelve-thousand seven hundred and eleven college students filled out a drug use questionnaire. They were divided into two groups based on the lifetime use of MPH: MPH users (MPHU) and MPH non-users (MPHNU). Quasi-binomial regression models were carried out in order to evaluate the correlation among MPHU and other variables.RESULTS: A lifetime use of MPH was reported from 0.9% of college students (MPHU). Being from the Midwest (PR = 4.8, p < 0.01) and South (PR = 5.2, p < 0.05), living in students housing (PR = 5.8, p < 0.001), prescribed use of amphetamines (PR = 8.9, p < 0.001) and benzodiazepines (< 3 weeks: PR = 4.4, p < 0.001; ≥ 3 weeks: PR = 6.7, p < 0.001), and harmful use of alcohol (PR = 4.0, p < 0.05) were correlated with MPHU.DISCUSSION: The association of alcohol and drug use with prescribed use of MPH among college students suggests the importance of screening drinking patterns and use of other drugs among students with ADHD symptoms.

Sociodemographic correlates of transitions from alcohol use to disorders and remission in the São Paulo megacity mental health survey, Brazil.

AIMS: To evaluate sociodemographic correlates associated with transitions from alcohol use to disorders and remission in a Brazilian population. METHODS: Data are from a probabilistic, multi-stage clustered sample of adult household residents in the São Paulo Metropolitan Area. Alcohol use, regular use (at least 12 drinks/year), DSM-IV abuse and dependence and remission from alcohol use disorders (AUDs) were assessed with the World Mental Health version of the Composite International Diagnostic Interview. Age of onset (AOO) distributions of the cumulative lifetime probability of each alcohol use stage were prepared with data obtained from 5037 subjects. Correlates of transitions were obtained from a subsample of 2942 respondents, whose time-dependent sociodemographic data were available. RESULTS: Lifetime prevalences were 85.8% for alcohol use, 56.2% for regular use, 10.6% for abuse and 3.6% for dependence; 73.4 and 58.8% of respondents with lifetime abuse and dependence, respectively, had remitted. The number of sociodemographic correlates decreased from alcohol use to disorders. All transitions across alcohol use stages up to abuse were consistently associated with male gender, younger cohorts and lower education. Importantly, low education was a correlate for developing AUD and not remitting from dependence. Early AOO of first alcohol use was associated with the transition of regular use to abuse. CONCLUSION: The present study demonstrates that specific correlates differently contribute throughout alcohol use trajectory in a Brazilian population. It also reinforces the need of preventive programs focused on early initiation of alcohol use and high-risk individuals, in order to minimize the progression to dependence and improve remission from AUD.

The psychosis continuum in the general population: findings from the São Paulo Epidemiologic Catchment Area Study.

The aim of the study was to examine the psychosis continuum in a Latin-American community setting. Data were from the Brazilian São Paulo Epidemiologic Catchment Area Study, a cross-sectional survey conducted in two boroughs of the city of São Paulo. The Composite International Diagnosis Interview (version 1.1) was applied to a probabilistic sample of 1,464 adults, who were interviewed in their household, in order to identify the presence of psychotic symptoms. A subsample was assessed with Schedules for Clinical Assessment in Neuropsychiatry interview. We described the occurrence of psychotic symptoms, categorized into subgroups according to their clinical impact, disability, and help-seeking behavior. The correlation of socio-demographic variables, depressive symptoms, and alcohol and substance use disorders with those psychotic subgroups was analyzed. Polychotomic logistic regression tested the associations between subgroups of psychosis (clinical and subclinical) and the correlates. Of the total sample, 38.0% presented at least one lifetime psychotic symptom, 1.9% met the criteria for an ICD-10 diagnosis of non-affective psychosis, 5.4% presented clinically relevant psychotic symptoms, and 30.7% endorsed clinically non-relevant symptoms. The most common psychotic symptom was delusion with a plausible explanation (in 18.6%). The presence of any psychiatric diagnosis was associated with the presence of psychotic symptoms (OR range, 1.9-8.9). Subclinical psychosis subgroups were found to be associated with the 18-24 year age bracket, chronic depressive mood, and alcohol use disorder. Our results support the concept of a psychosis continuum in Latin-American populations, suggesting that different risk factors influence their manifestation across the continuum.

Preditores sociodemográficos das transições entre os estágios do uso de álcool (uso na vida, uso regular, abuso e dependência) e remissão dos transtornos relacionados ao uso do álcool na população geral adulta residente na região metropolitana de São Paulo / Socio-demographic correlates of transitions from alcohol use to disorders and remission in the São Paulo megacity mental health survey, Brazil

Objetivos: Avaliar os correlatos sociodemográficos associados com as transições entre os estágios de uso do álcool (desde o primeiro uso na vida até o desenvolvimento de transtornos relacionados ao uso, como abuso e dependência, AUD) e remissão, em uma amostra da população geral residente na Região Metropolitana de São Paulo (RMSP), com 18 anos de idade ou mais. Métodos: Uma amostra probabilística e multiestratificada de adultos domiciliados (n = 5.037) na RMSP foi estudada. O uso de álcool, uso regular (pelo menos 12 doses/ ano), abuso e dependência de acordo com os critérios do DSM-IV, e remissão de AUD foram avaliados utilizando-se a versão do Composite International Diagnostic Interview para o World Mental Health Survey. As curvas de idade de início cumulativas (AOO) para o primeiro uso de álcool na vida, o uso regular, o abuso e a dependência foram elaboradas com dados obtidos a partir da amostra de 5.037 indivíduos. Os correlatos sociodemográficos das transições entre os estágios de uso do álcool e da remissão de AUD foram obtidos a partir de uma subamostra de 2.942 entrevistados, para os quais, os dados sociodemográficos tempo dependentes estavam disponíveis. Resultados: as prevalências encontradas foram: 85,8% de uso de álcool na vida, 56,2% de uso regular, 10,6% de abuso e 3,6% de dependência. As probabilidades de transição foram: 63,1% do primeiro uso na vida para o uso regular, 17,9% do uso regular para o abuso, e 28,3% do abuso para dependência. Remitiram 73,4% e 58,8% dos entrevistados com diagnóstico de abuso e dependência de álcool na vida, respectivamente. Todas as transições entre os estágios de uso de álcool até o abuso estiveram consistentemente associadas ao sexo masculino, às gerações mais jovens e à baixa escolaridade, sendo que outros correlatos variaram entre as transições. Vale a pena destacar que baixa escolaridade foi um correlato para o desenvolvimento de abuso e dependência e para a não remissão destes transtornos. Idade de início...

Aims: To evaluate socio-demographic correlates associated with transitions across alcohol use stages (from first use to alcohol use disorders, AUD) and remission in a sample of household residents in the São Paulo Metropolitan Area adult, aged 18 years and over. Methods: A probabilistic, multi-stage clustered sample of adult household residents (n=5,037) in the São Paulo Metropolitan Area was analyzed. Alcohol use, regular use (at least 12 drinks/year), DSM-IV abuse and dependence, and remission from AUD were assessed with the World Mental Health version of the Composite International Diagnostic Interview. Age of onset (AOO) distributions of the cumulative lifetime probability of alcohol use, regular use, abuse, and dependence were prepared with data obtained from 5,037 subjects. Correlates of transition across alcohol use stages and remission were obtained from a subsample of 2,942 respondents, whose time-dependent sociodemographic data were available. Results: Lifetime prevalences were 85.8% for alcohol use, 56.2% for regular use, 10.6% for abuse, and 3.6% for dependence. The transitions probabilities were 63.1% for everuse to regular use, 17.9% for regular use to abuse, and 28.3% for abuse to dependence; 73.4% and 58.8% of respondents with lifetime abuse and dependence, respectively, had remitted. All transitions across alcohol use stages up to abuse were consistently associated with male gender, younger cohorts and low education, with other correlates varying among transitions. Importantly, low education was a correlate for developing AUD and for not remitting from them. Early AOO of regular use was associated with alcohol abuse among regular users. Conclusions: The present study demonstrates that specific correlates differently contribute throughout alcohol use trajectory in a Brazilian population. Our findings reinforce the need of programs to prevent early initiation of alcohol use and that efforts should focus on individuals of lower...

Neuropsychological assessment of current and past crack cocaine users.

BACKGROUND: Cognitive changes due to crack cocaine consumption remain unclear. METHODS: For clarification, 55 subjects were assigned to three groups: control group, crack cocaine current users, and ex-users. Participants were submitted to Mini-Mental State Examination (MMSE) and tasks evaluating executive functioning and verbal memory. Mood state was also measured. Intergroup comparisons were carried out. RESULTS: Control group performance on the MMSE was better than that of users and ex-users. Verbal memory performance for logical memory of users was impaired. Ex-users scored lower on DSST and Trail Making Test (Part B). CONCLUSION: Chronic crack cocaine use seems to disrupt general cognitive functioning (MMSE), verbal memory, and attentional resources, but findings suggest that some of these effects could be reversed by abstinence.

Abnormal corpus callosum myelination in pediatric bipolar patients.

BACKGROUND: Decreased signal intensity in the corpus callosum, reported in adult bipolar disorder patients, has been regarded as an indicator of abnormalities in myelination. Here we compared the callosal signal intensity of children and adolescents with bipolar disorder to that of matched healthy subjects, to investigate the hypothesis that callosal myelination is abnormal in pediatric bipolar patients. METHODS: Children and adolescents with DSM-IV bipolar disorder (n=16, mean age+/-S.D.=15.5+/-3.4 y) and matched healthy comparison subjects (n=21, mean age+/-S.D.=16.9+/-3.8 y) underwent a 1.5 T MRI brain scan. Corpus callosum signal intensity was measured using an Apple Power Mac G4 running NIH Image1.62 software. RESULTS: Bipolar children and adolescents had significantly lower corpus callosum signal intensity for all callosal sub-regions (genu, anterior body, posterior body, isthmus and splenium) compared to healthy subjects (ANCOVA, all p<0.05, age and gender as covariates). LIMITATIONS: Relatively small sample size. CONCLUSIONS: Abnormalities in corpus callosum, probably due to altered myelination during neurodevelopment, may play a role in the pathophysiology of bipolar disorder among children and adolescents.

Epidemiologia do beber pesado e beber pesado episódico no Brasil: uma revisão sistemática da literatura / Epidemiology of heavy drinking and heavy episodic drinking in Brazil: a systematic review of literature

CONTEXTO: O beber pesado episódico (BPE) tem sido fortemente associado a danos e a uma carga social consideráveis. OBJETIVOS: Este estudo tem como finalidade avaliar o panorama brasileiro a partir de aspectos sociodemográficos, fatores individuais e sociais relacionados ao beber pesado. MÉTODOS: A busca de artigos científicos foi realizada com base em um programa de computador nos principais bancos de dados científicos. RESULTADOS: Os homens beberam pesado mais freqüentemente que as mulheres. O beber pesado episódico foi mais prevalente em adolescentes e adultos jovens, e a prevalência tende a diminuir com o aumento da idade. As condições socioeconômicas parecem ter um efeito sobre o beber pesado. O início precoce do beber pesado esteve associado com história de dependência do álcool na vida adulta. O beber pesado episódico esteve associado ao uso concomitante de outras substâncias psicoativas. Os fatores de risco para BPE incluíram atividades sociais e disponibilidade de dinheiro. A pressão dos pares mostrou influenciar mais do que o suporte parental especialmente no final de adolescência. O BP também variou de acordo com a cultura, com mais episódios de BP no Sul em comparação com o Norte do País. CONCLUSÕES: Uma variedade de aspectos sociodemográficos e individuais associados ao beber pesado foi identificada. Porém, o conhecimento nessa área ainda é muito limitado. Mais pesquisas no Brasil são urgentemente necessárias visto que os resultados provenientes de outras culturas não podem ser generalizados.

BACKGROUND: Heavy episodic drinking has been shown to be closely associated with considerable damage to and burden on society. OBJECTIVES: This review aims to give an overview of the Brazilian reality based on socio-demographic aspects, considering individual and social factors related to heavy drinking. METHODS: A computer-assisted search of relevant articles was conducted in the foremost scientific databases. RESULTS: Males tended to heavy drinking more frequently than females. Heavy episodic drinking was most prevalent among adolescents and young adults, though this prevalence tended to level off as they age. Socioeconomic conditions appear to have an effect on heavy drinking. The early onset of heavy drinking has been associated with a history of alcohol dependency in the adult phase. Heavy episodic drinking coincided with other psychoactive substance usage. Motives for heavy drinking included both social activities as well as the availability of money. Peer pressure was one of the strongest influencing factors in binge drinking and seemed to outweigh parental influence, particularly from late adolescence onward. Heavy drinking also varied according to both the predominant adult and adolescent drinking culture, with more binge drinking in the southern areas of Brazil as compared with the northern and central regions. CONCLUSIONS: A myriad of socio-demographical, individual, and social characteristics associated with heavy drinking have been identified. However, knowledge in these areas remain limited, as most research has been conducted on specific groups and situations, in particular, that of North American college students. More research in Brazil is urgently needed, as results from other cultural contexts should not be generalized.

Heavy episodic drinking in the São Paulo epidemiologic catchment area study in Brazil: gender and sociodemographic correlates.

OBJECTIVE: The aims of this study were to quantify heavy episodic drinking (HED) among adults living in two middle-class boroughs in the city of São Paulo, Brazil, and to estimate possible effects of gender, age, and other sociodemographic factors. METHOD: Data were taken from the São Paulo Catchment Area Study. A representative sample (N = 1,464) of the adult population living in households was assessed through Composite International Diagnostic Interview Version 1.1. The pattern of lifetime and last-12-month alcohol consumption was evaluated. HED was defined as consuming five or more drinks per drinking day for men and four or more drinks per drinking day for women. Prevalence rates and sociodemographic correlates were examined separately for men and women. RESULTS: The overall 12-month prevalence of HED in this sample was 10.7%, with 15.4% of the men and 7.2% of the women reporting HED. Lifetime overall abstinence was 22.2%, with 32.4% of the women and 8.7% of the men being lifetime abstainers. The odds of HED among women were increased for those between 18 and 44 years of age and for those who were not married (separated, divorced, widowed, and never married). Among men the risk was increased for those between 18 and 24 years of age. CONCLUSIONS: HED is a common pattern of drinking in this sample, mainly in young men. Among women, HED is not confined to the younger groups. Future studies are needed to assess the impact of HED on physical health, mental health, and social functioning.

Epidemiologia dos transtornos psiquiátricos na mulher / Epidemiology of women's psychiatric disorders

A conscientização de que os transtornos mentais representam um sério problema de saúde pública é relativamente recente, ocorrendo a partir da publicação do estudo The Global Burden of Disease pela Organização Mundial da Saúde. Diferenças de gênero na incidência, prevalência e curso de transtornos mentais, assim como na apresentação clínica e na resposta terapêutica, têm sido extensivamente demonstradas por estudos epidemiológicos.

The awareness that mental disorders present a serious public health problem is relatively new, occurring after the publication of The Global Burden of Disease by the World Health Organization. Gender differences in the incidence, prevalence, and course of mental disorders, as well as in their clinical features and response to treatment; have been extensively demonstrated in epidemiological studies.