Experimentation with tobacco during adolescence as a factor influencing treatment of smoking in adulthood. A retrospective cohort.

BACKGROUND: There are still few studies on predictors of smoking cessation in Brazilian samples. Experimentation with tobacco during adolescence (ETA) may be one of the important predictors. OBJECTIVE: This study aimed, within the context of a treatment-seeking group of subjects, to test the hypothesis that ETA negatively affects the outcome of smoking cessation during adulthood. DESIGN AND SETTING: Retrospective (historic) cohort study conducted at a psychosocial care center in São Paulo, Brazil, between 2007 and 2010. METHODS: Data on sociodemographics, smoking and medical profiles were obtained through self-report questionnaires that were completed at the baseline and at any follow-up appointment. Logistic regression models were constructed to describe factors associated with the outcome of smoking cessation, measured according to the self-reported four-week success rate among 367 outpatient smokers. RESULTS: ETA was found to be associated with not quitting smoking through the treatment (odds ratio = 0.57; 95% confidence interval = 0.33-0.96; P < 0.05), even after adjustment for dependence level, sociodemographics, nicotine patch use and number of years of smoking. CONCLUSIONS: Early exposure to nicotine may lead to higher risk of continuing smoking after treatment, in adulthood.

Pathological gambling treated with lithium: the role of assessing temperament.

BACKGROUND AND AIMS: Pathological gambling is a condition for which there is still no FDA-approved treatment although some medications seem to be effective at reducing its symptoms. In DSM-V, it is now classified as an addiction disorder. Data show that baseline comorbidities in patients with gambling and substance misuse behavior are frequent. These might include not only major syndromes but also subclinical ones. Bipolar spectrum conditions are often among these comorbidities. Lithium has been showed to be effective in PG subjects with bipolar spectrum comorbidity, and we present a case where assessment of temperament was helpful in treatment selection. CONCLUSIONS: This case illustrates the clinical benefits of how the assessment of temperament and comorbidities in pathological gambling patients may guide the clinician to a successful treatment choice. The case presented also corroborates previous evidence on the efficacy of lithium in patients with pathological gambling and comorbid bipolar spectrum conditions and euphoric temperament. Future clinical trials on pathological gambling pharmacotherapy should include temperament assessment to evaluate its influence on different outcomes.

High-frequency rTMS to treat refractory binge eating disorder and comorbid depression: a case report.

Binge eating disorder (BED) has limited therapeutic options. Repetitive transcranial magnetic stimulation (rTMS) is a modulation technique of cortical excitability that has shown good results in treating certain psychiatric disorders by correcting dysfunctional cortical regions. We hypothesize that rTMS could be an alternative therapy for BED through potential modulation action on frontostriatal abnormalities and dopaminergic pathways noted by neuroimaging. We report the case of a young woman presenting refractory BED and comorbid depression treated with 20 sessions of rTMS for 30 minutes over the left dorsolateral prefrontal cortex at 10 Hz for about a month (2400 stimuli per day). She answered two self-report questionnaires, the Binge Eating Scale (BES) and the Beck Depression Inventory (BDI). Before rTMS treatment, the BES score was 38, and the BDI score was 42. Three days after rTMS treatment, the BES score was 27 and the BDI score was 23, and the patient referred to no binge eating episodes for that week. Therefore, rTMS could offer a new option of treatment for BED and comorbid depression.