Treatment resistance in schizophrenia: a meta-analysis of prevalence and correlates

Objectives: To determine the prevalence and correlates of treatment-resistant schizophrenia (TRS) through a systematic review and meta-analysis. Methods: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, an electronic search was performed in PubMed and Embase through May 17, 2022. All study designs that assessed a minimum of 20 schizophrenia-spectrum patients and provided data on TRS prevalence or allowed its calculation were included. Estimates were produced using a random-effects model meta-analysis. Results: The TRS prevalence across 50 studies (n = 29,390) was 36.7% (95%CI 33.1-40.5, p < 0.0001). The prevalence ranged from 22% (95%CI 18.4-25.8) in first-episode to 39.5% (95%CI 32.2-47.0) in multiple-episode samples (Q = 18.27, p < 0.0001). Primary treatment resistance, defined as no response from the first episode, was 23.6% (95%CI 20.5-26.8) vs. 9.3% (95%CI 6.8-12.2) for later-onset/secondary (≥ 6 months after initial treatment response). Longer illness duration and recruitment from long-term hospitals or clozapine clinics were associated with higher prevalence estimates. In meta-regression analyses, older age and poor functioning predicted greater TRS. When including only studies with lower bias risk, the TRS prevalence was 28.4%. Conclusion: Different study designs and recruitment strategies accounted for most of the observed heterogeneity in TRS prevalence rates. The results point to early-onset and later-onset TRS as two separate disease pathways requiring clinical attention. Registration number: PROSPERO CRD42018092033.

Treatment resistance in schizophrenia: a meta-analysis of prevalence and correlates.

OBJECTIVES: To determine the prevalence and correlates of treatment-resistant schizophrenia (TRS) through a systematic review and meta-analysis. METHODS: Following Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) criteria, an electronic search was performed in PubMed and Embase through May 17, 2022. All study designs that assessed a minimum of 20 schizophrenia-spectrum patients and provided data on TRS prevalence or allowed its calculation were included. Estimates were produced using a random-effects model meta-analysis. RESULTS: The TRS prevalence across 50 studies (n = 29,390) was 36.7% (95%CI 33.1-40.5, p < 0.0001). The prevalence ranged from 22% (95%CI 18.4-25.8) in first-episode to 39.5% (95%CI 32.2-47.0) in multiple-episode samples (Q = 18.27, p < 0.0001). Primary treatment resistance, defined as no response from the first episode, was 23.6% (95%CI 20.5-26.8) vs. 9.3% (95%CI 6.8-12.2) for later-onset/secondary (≥ 6 months after initial treatment response). Longer illness duration and recruitment from long-term hospitals or clozapine clinics were associated with higher prevalence estimates. In meta-regression analyses, older age and poor functioning predicted greater TRS. When including only studies with lower bias risk, the TRS prevalence was 28.4%. CONCLUSION: Different study designs and recruitment strategies accounted for most of the observed heterogeneity in TRS prevalence rates. The results point to early-onset and later-onset TRS as two separate disease pathways requiring clinical attention.

The Interactions Between Vulnerabilities for HIV and Syphilis among Cisgender and Transgender People Who Use Drugs.

In Brazil, transgender people are most affected by HIV, and crack cocaine addiction may contribute to social vulnerability and exposure to sexual and violence-related risks. This cross-sectional study comprised 2393 individuals seeking addiction treatment, consisting of 43 trans women, 1995 cisgender men, and 355 cisgender women. Records of rapid test results for HIV and syphilis and screening responses of trans women were compared to both cisgender groups using a logistic regression model to identify associated risk factors. HIV prevalence was higher in the transgender group (39.5%) than in cis women and men (5.9% and 3.6%, respectively). Our study showed an eightfold higher chance of a positive HIV test among transgender individuals who used drugs (OR: 8.79, p < .01, 95% CI: 3.90-19.78) compared to cisgender people who used drugs. A lifetime history of syphilis infection was more common in transgender people (60.0%) and cis women (32.8%) than in cis men (9.5%). Active syphilis was also more common in the transgender population (OR: 5.46, p < .01, 95% CI: 2.63 11.32). In our sample, 44.2% of transgender individuals had a history of at least one suicide attempt in their lifetime. Our results showed that transgender women were at higher risk of crack cocaine use (OR: 5.51, p < .01, 95% CI: 2.16-14.06) than cisgender men and women. The study showed that trans women had a higher prevalence of syphilis and HIV, and a greater chance of being homeless. The synergy of these vulnerabilities may have led to our findings of high psychotic symptoms and a history of suicide attempts in transgender individuals.

From Cursed to Blessed: the Impact of Spirituality on the Life Course of 10 Brazilian Spiritist Mediums.

This qualitative study analyzed the life course of ten Brazilian spiritist mediums who presented anomalous experiences (AEs). A socio-demographic questionnaire and semi-structured interviews were carried out with a non-clinical group, focusing on spiritual background. The inicial AEs were frightening and anguishing, as mediums have related uncertainty and feeling of being controlled; however, after their contact to Spiritism a new positive context was provided, through acceptance and supportiveness, promoting resilience, altruism and self-knowledge, besides an omnipotence status related to mediumship. It was concluded that harmful spiritual experiences may be positively transformed by reframing processes driven by organized religious doctrines.

Appraising the effectiveness of electrical and magnetic brain stimulation techniques in acute major depressive episodes: an umbrella review of meta-analyses of randomized controlled trials

Electrical and magnetic brain stimulation techniques present distinct mechanisms and efficacy in the acute treatment of depression. This was an umbrella review of meta-analyses of randomized controlled trials of brain stimulation techniques for managing acute major depressive episodes. A systematic review was performed in the PubMed/MEDLINE databases from inception until March 2020. We included the English language meta-analysis with the most randomized controlled trials on the effects of any brain stimulation technique vs. control in adults with an acute depressive episode. Continuous and dichotomous outcomes were assessed. A Measurement Tool to Assess Systematic Reviews-2 was applied and the credibility of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. Seven meta-analyses were included (5,615 patients), providing evidence for different modalities of brain stimulation techniques. Three meta-analyses were evaluated as having high methodological quality, three as moderate, and one as low. The highest quality of evidence was found for high frequency-repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation, and bilateral rTMS. There is strong clinical research evidence to guide future clinical use of some techniques. Our results confirm the heterogeneity of the effects across these techniques, indicating that different mechanisms of action lead to different efficacy profiles.

Is Obesity A Determinant Of Success With Pharmacological Treatment For Depression? A Systematic Review, Meta-Analysis And Meta-Regression.

BACKGROUND: The bidirectional association between Major Depressive Disorder (MDD) and obesity suggests that body mass index (BMI) at the baseline could influence remission rates (RR) with pharmacological treatment. We evaluated the influence of baseline BMI on the chances of remission among patients with MDD administered antidepressants. METHODS: Based on the guidelines of the PRISMA statement, we conducted a systematic review on PubMed, Cochrane and Embase databases with subsequent meta-analysis and meta-regression. We included only randomized controlled trials evaluating the efficacy of antidepressants of different classes (monotherapy and combined therapies) that evidenced baseline BMI assessment. We created a model to describe the linear relationship between baseline BMI and RR. RESULTS: Our systematic review yielded 70 studies with a total of 9,779 patients in the active group and 7,136 patients in the placebo group. In placebo controlled studies, BMI influenced the RR of patients randomized to active treatment. The RR for antidepressants in monotherapy was higher in normal weight to overweight patients rather than obese patients (33% vs 12%, respectively). Also in monotherapy, the RR is higher when the study is conducted on patients with a lower baseline BMI (p=0.029). For combined therapies, the pooled RR was higher in obese patients rather than in normal weight to overweight patients (75% vs 17%, respectively). LIMITATIONS: BMI provides no information about body composition and obesity can be related to several potential confounders that potentially influence RR. CONCLUSION: The RR with antidepressant therapy seems to be associated with baseline BMI in patients with MDD, although this simple variable was insufficiently explored so far.

Appraising the effectiveness of electrical and magnetic brain stimulation techniques in acute major depressive episodes: an umbrella review of meta-analyses of randomized controlled trials.

Electrical and magnetic brain stimulation techniques present distinct mechanisms and efficacy in the acute treatment of depression. This was an umbrella review of meta-analyses of randomized controlled trials of brain stimulation techniques for managing acute major depressive episodes. A systematic review was performed in the PubMed/MEDLINE databases from inception until March 2020. We included the English language meta-analysis with the most randomized controlled trials on the effects of any brain stimulation technique vs. control in adults with an acute depressive episode. Continuous and dichotomous outcomes were assessed. A Measurement Tool to Assess Systematic Reviews-2 was applied and the credibility of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation framework. Seven meta-analyses were included (5,615 patients), providing evidence for different modalities of brain stimulation techniques. Three meta-analyses were evaluated as having high methodological quality, three as moderate, and one as low. The highest quality of evidence was found for high frequency-repetitive transcranial magnetic stimulation (rTMS), transcranial direct current stimulation, and bilateral rTMS. There is strong clinical research evidence to guide future clinical use of some techniques. Our results confirm the heterogeneity of the effects across these techniques, indicating that different mechanisms of action lead to different efficacy profiles.

Transcranial Direct Current Stimulation for Prader-Willi Syndrome.

BACKGROUND: Given the limited therapeutic options for Prader-Willi syndrome (PWS), we conducted an open-label clinical trial to evaluate the effects of transcranial direct current stimulation (tDCS) for hyperphagia, food craving, and aberrant behaviors on this population. METHODS: Twelve subjects with PWS (11-35 years old) were included. The subjects underwent 10 daily 20-minute sessions of tDCS in 2 weeks. The anode was positioned over the left dorsolateral prefrontal cortex, and the cathode over the contralateral region. RESULTS: We observed amelioration of hyperphagic and food craving symptoms (P < 0.05), as well as amelioration of behavioral symptoms measured with the Aberrant Behavior Checklist (P < 0.05). DISCUSSION: To our knowledge, this is the first proof-of-concept trial to report the positive effects of increasing excitability of the left dorsolateral prefrontal cortex, using tDCS, for the behavioral, hyperphagia, and food craving symptoms in PWS, which is a low-cost, well-studied, safe alternative for brain stimulation.

Caloric restriction, resting metabolic rate and cognitive performance in Non-obese adults: A post-hoc analysis from CALERIE study.

Physical activity (PA) has been proposed as a determinant of cognitive function and is one component of energy balance (EB). EB is the difference between energy intake (EI) and the total daily energy expenditure (TDEE). TDEE is a combination of resting metabolic rate (RMR), thermic effect of food and PA. The potential role of each of these components on cognitive function has not yet been systemically investigated. We aim to evaluate the association between each component of EB on cognition, using baseline and longitudinal data from a clinical trial of caloric restriction (CR). This is a parallel-group, randomized clinical trial comparing two years of 25% CR with two years of ad libitum diet (AL), with 220 healthy volunteers of both sex, aged between 21 and 50 years and initial BMI ≥ 22 kg/m2 and <28 kg/m2. Body weight, fat mass (FM), fat-free mass (FFM), and bone mineral content were evaluated, as well as RMR, TDEE, cognitive performance and baseline energy intake. A 30 min/day of a moderate level on a minimum of 5 days/week was advised as PA measure. Longitudinal analysis demonstrated that the influence of CR in the improvement of cognitive performance was moderated by changes in RMR, suggesting that in individuals submitted to CR, the cognitive performance and the RMR improved proportionally, independently of changes in EI and body mass. EB and homeostasis are crucial to modulate the RMR. Moreover, RMR presents an important influence on cognitive function in individuals submitted to CR in a long term.

HIV and syphilis infections and associated factors among patients in treatment at a Specialist Alcohol, Tobacco, and Drugs Center in São Paulo's "Cracolândia".

INTRODUCTION: This study describes the epidemiological scenario of human immunodeficiency virus (HIV) and syphilis at the biggest specialist drug addiction center in Brazil. The great challenge is to find strategies to reduce the impact of inequality and discrimination and develop policies to protect individuals living with - or at risk of - infections. METHODS: During the period from January 1 to May 31, 2016, a cross-sectional study was conducted on which all patients (N = 806) seeking inpatient treatment were enrolled. A structured diagnostic interview and rapid tests were conducted initially, and diagnoses were confirmed by tests conducted at a venereal disease research laboratory (VDRL). RESULTS: HIV and syphilis rates were 5.86% and 21.9%, respectively. Women were nearly 2.5 times more likely to have syphilis. HIV infection was associated with unprotected sex (odds ratio [OR]: 3.27, p = 0.003, 95% confidence interval [95%CI]: 1.51-7.11), and suicidal ideation (OR: 6.63, p = 0.001, 95%CI: 3.37-14.0). Although only 1.86% reported injecting drugs at any point during their lifetimes, this variable was associated with both HIV and syphilis. Elevated rates of HIV and syphilis were observed in the context of this severe social vulnerability scenario. CONCLUSION: The risk factors identified as associated with HIV and syphilis should be taken into consideration for implementation of specific prevention strategies including early diagnosis and treatment of sexually transmitted infections (STI) to tackle the rapid spread of STIs in this population.

HIV and syphilis infections and associated factors among patients in treatment at a Specialist Alcohol, Tobacco, and Drugs Center in São Paulo's "Cracolândia"

Abstract Introduction This study describes the epidemiological scenario of human immunodeficiency virus (HIV) and syphilis at the biggest specialist drug addiction center in Brazil. The great challenge is to find strategies to reduce the impact of inequality and discrimination and develop policies to protect individuals living with - or at risk of - infections. Methods During the period from January 1 to May 31, 2016, a cross-sectional study was conducted on which all patients (N = 806) seeking inpatient treatment were enrolled. A structured diagnostic interview and rapid tests were conducted initially, and diagnoses were confirmed by tests conducted at a venereal disease research laboratory (VDRL). Results HIV and syphilis rates were 5.86% and 21.9%, respectively. Women were nearly 2.5 times more likely to have syphilis. HIV infection was associated with unprotected sex (odds ratio [OR]: 3.27, p = 0.003, 95% confidence interval [95%CI]: 1.51-7.11), and suicidal ideation (OR: 6.63, p = 0.001, 95%CI: 3.37-14.0). Although only 1.86% reported injecting drugs at any point during their lifetimes, this variable was associated with both HIV and syphilis. Elevated rates of HIV and syphilis were observed in the context of this severe social vulnerability scenario. Conclusion The risk factors identified as associated with HIV and syphilis should be taken into consideration for implementation of specific prevention strategies including early diagnosis and treatment of sexually transmitted infections (STI) to tackle the rapid spread of STIs in this population.

The effect of caloric restriction on working memory in healthy non-obese adults.

OBJECTIVE: We aim to evaluate the effect of caloric restriction (CR) in cognition by comparing performance in neuropsychological tests for working memory between a group of non-obese healthy subjects doing CR for 2 years with another consuming ad libitum diet (AL). METHODS: This study was part of a larger multicenter trial called CALERIE that consisted of a randomized clinical trial with parallel-group comparing 2 years of 25% CR and AL in 220 volunteers with a BMI between 22 and 28 kg/m2, across 3 sites. The cognitive tests used were the Cambridge Neuropsychological Tests Automated Battery (CANTAB) for Spatial Working Memory (SWM) including the total number of errors (SWMTE) and strategy (SWMS). Included as possible moderators were sleep quality, mood states, perceived stress, and energy expenditure. Analyses were performed at baseline and months 12 and 24. RESULTS: After adjustments, there was a significantly greater improvement in working memory assessed by the SWM for CR individuals, compared to AL. At month 24, it was related mostly to lower protein intake, compared to other macronutrients. Changes in SWM were moderated by changes in sleep quality, physical activity, and energy expenditure. CONCLUSION: On the long term, CR in healthy individuals seems to have a slightly positive effect on working memory. The study of brain CR targets opens new possibilities to prevent and treat cognitive deficits.

Transcranial direct current stimulation (tDCS) in elderly with mild cognitive impairment: A pilot study.

Transcranial direct current stimulation (tDCS) is a non-invasive, painless and easy-to use-technology. It can be used in depression, schizophrenia and other neurological disorders. There are no studies about longer usage protocols regarding the ideal duration and weekly frequency of tDCS. OBJECTIVE: to study the use of tDCS twice a week for longer periods to improve memory in elderly with MCI. METHODS: a randomized double-blind controlled trial of anodal tDCS on cognition of 58 elderly aged over 60 years was conducted. A current of 2.0 mA was applied for 30 minutes for 10 sessions, twice a week. The anode was placed over the left dorsolateral prefrontal cortex (LDLFC). Subjects were evaluated before and after 10 sessions by the following tests: CAMCOG, Mini-Mental State Examination (MMSE), Trail Making, Semantic Verbal Fluency (Animals), Boston naming, Clock Drawing Test, Word list memory (WLMT), Direct and Indirect Digit Order (WAIS-III and WMS-III) and N-back. RESULTS: After 10 sessions of tDCS, significant group-time interactions were found for the CAMCOG - executive functioning (χ2 = 3.961, p = 0.047), CAMCOG - verbal fluency (χ2 = 3.869, p = 0.049), CAMCOG - Memory recall (χ2 = 9.749, p = 0.004), and WMLT - recall (χ2 = 7.254, p = 0.007). A decline in performance on the CAMCOG - constructional praxis (χ2 = 4.371, p = 0.037) was found in the tDCS group after intervention. No significant differences were observed between the tDCS and Sham groups for any other tasks. CONCLUSION: tDCS at 2 mA for 30 min twice a week over 5 consecutive weeks proved superior to placebo (Sham) for improving memory recall, verbal fluency and executive functioning in elderly with MCI.

A ETCC (estimulação transcraniana por corrente contínua) é uma tecnologia não-invasiva, indolor e de fácil utilização. Pode ser usada na depressão, esquizofrenia e outros distúrbios neurológicos. Não há orientações ideais sobre o uso de protocolos mais longos quanto à duração e frequência semanal da ETCC. OBJETIVO: estudar o uso de ETCC duas vezes por semana por 5 semanas em idosos com CCL. MÉTODOS: o estudo foi controlado, randomizado, duplo-cego com ETCC anódica em 58 idosos acima de 60 anos. Uma corrente de 2,0 mA foi aplicada por 30 minutos durante 10 sessões consecutivas, 2 vezes por semana. O ânodo foi colocado no córtex pré-frontal dorsolateral esquerdo (LDLFC). Os pacientes foram avaliados antes e após 10 sessões pelos testes: CAMCOG, Mini-Exame do Estado Mental (MMSE), Trilhas, Fluência Verbal Semântica - Animais, Boston, Relógio, Memória da Lista de Palavras (WLMT), Dígitos - ordem direta e indireta (WAIS-III e WMS-III) e N-back. RESULTADOS: foram encontradas interações significativas (tempo/grupo) para CAMCOG - funcionamento executivo (χ2 = 3,961, p = 0,047), CAMCOG - fluência verbal (χ2 = 3,869, p = 0,049), CAMCOG - recuperação da memória (χ2 = 9.749, p = 0,004), WMLT - recordação (χ2 = 7,254, p = 0,007). Foi observado um declínio no grupo ETCC após a intervenção para CAMCOG - praxia construtiva (χ2 = 4,371, p = 0,037). Não encontramos diferenças significativas entre os grupos ETCC e placebo para outros testes. CONCLUSÃO: A ETCC de 2 mA por 30 min, 2x por semana, por 5 semanas consecutivas, é superior ao placebo (Sham) na melhoria da recuperação de memória, fluência verbal e funcionamento executivo em idosos com CCL.

Adulterants in crack cocaine in Brazil.

INTRODUCTION: Brazil is the world's biggest consumer of crack cocaine, and dependence is a major public health issue. This is the first study to investigate the prevalence of potentially harmful adulterants present in hair samples from Brazilian patients with crack cocaine dependence. METHOD: We evaluated adulterants in hair samples extracted by convenience from 100 patients admitted at the 48 hour-observation unit of Centro de Referência de Álcool, Tabaco e Outras Drogas (CRATOD), Brazil's largest center for addiction treatment. A cross-sectional analysis was performed with the data obtained. RESULTS: Adulterants were found in 97% of the analyzed hair samples. The most prevalent adulterant was lidocaine (92%), followed by phenacetin (69%) and levamisole (31%). CONCLUSION: Adulterants were widely prevalent in hair samples from crack users treated at CRATOD: at least one adulterant was present in virtually all the hair samples collected. This points to a need to monitor adverse effects in the clinical setting in order to provide this high-risk group of patients with prompt and effective care related to the acute and chronic complications associated with these adulterants.

Transcranial direct current stimulation (tDCS) in elderly with mild cognitive impairment: A pilot study / Estimulação Transcraniana por Corrente Direta (ETCD) em idosos com comprometimento cognitivo leve: um estudo piloto

ABSTRACT. Transcranial direct current stimulation (tDCS) is a non-invasive, painless and easy-to use-technology. It can be used in depression, schizophrenia and other neurological disorders. There are no studies about longer usage protocols regarding the ideal duration and weekly frequency of tDCS. Objective: to study the use of tDCS twice a week for longer periods to improve memory in elderly with MCI. Methods: a randomized double-blind controlled trial of anodal tDCS on cognition of 58 elderly aged over 60 years was conducted. A current of 2.0 mA was applied for 30 minutes for 10 sessions, twice a week. The anode was placed over the left dorsolateral prefrontal cortex (LDLFC). Subjects were evaluated before and after 10 sessions by the following tests: CAMCOG, Mini-Mental State Examination (MMSE), Trail Making, Semantic Verbal Fluency (Animals), Boston naming, Clock Drawing Test, Word list memory (WLMT), Direct and Indirect Digit Order (WAIS-III and WMS-III) and N-back. Results: After 10 sessions of tDCS, significant group-time interactions were found for the CAMCOG - executive functioning (χ2 = 3.961, p = 0.047), CAMCOG - verbal fluency (χ2 = 3.869, p = 0.049), CAMCOG - Memory recall (χ2 = 9.749, p = 0.004), and WMLT - recall (χ2 = 7.254, p = 0.007). A decline in performance on the CAMCOG - constructional praxis (χ2 = 4.371, p = 0.037) was found in the tDCS group after intervention. No significant differences were observed between the tDCS and Sham groups for any other tasks. Conclusion: tDCS at 2 mA for 30 min twice a week over 5 consecutive weeks proved superior to placebo (Sham) for improving memory recall, verbal fluency and executive functioning in elderly with MCI.

RESUMO. A ETCC (estimulação transcraniana por corrente contínua) é uma tecnologia não-invasiva, indolor e de fácil utilização. Pode ser usada na depressão, esquizofrenia e outros distúrbios neurológicos. Não há orientações ideais sobre o uso de protocolos mais longos quanto à duração e frequência semanal da ETCC. Objetivo: estudar o uso de ETCC duas vezes por semana por 5 semanas em idosos com CCL. Métodos: o estudo foi controlado, randomizado, duplo-cego com ETCC anódica em 58 idosos acima de 60 anos. Uma corrente de 2,0 mA foi aplicada por 30 minutos durante 10 sessões consecutivas, 2 vezes por semana. O ânodo foi colocado no córtex pré-frontal dorsolateral esquerdo (LDLFC). Os pacientes foram avaliados antes e após 10 sessões pelos testes: CAMCOG, Mini-Exame do Estado Mental (MMSE), Trilhas, Fluência Verbal Semântica - Animais, Boston, Relógio, Memória da Lista de Palavras (WLMT), Dígitos - ordem direta e indireta (WAIS-III e WMS-III) e N-back. Resultados: foram encontradas interações significativas (tempo/grupo) para CAMCOG - funcionamento executivo (χ2 = 3,961, p = 0,047), CAMCOG - fluência verbal (χ2 = 3,869, p = 0,049), CAMCOG - recuperação da memória (χ2 = 9.749, p = 0,004), WMLT - recordação (χ2 = 7,254, p = 0,007). Foi observado um declínio no grupo ETCC após a intervenção para CAMCOG - praxia construtiva (χ2 = 4,371, p = 0,037). Não encontramos diferenças significativas entre os grupos ETCC e placebo para outros testes. Conclusão: A ETCC de 2 mA por 30 min, 2x por semana, por 5 semanas consecutivas, é superior ao placebo (Sham) na melhoria da recuperação de memória, fluência verbal e funcionamento executivo em idosos com CCL.

Adulterants in crack cocaine in Brazil / Adulterantes no crack vendido na "Cracolândia"

Abstract Introduction Brazil is the world's biggest consumer of crack cocaine, and dependence is a major public health issue. This is the first study to investigate the prevalence of potentially harmful adulterants present in hair samples from Brazilian patients with crack cocaine dependence. Method We evaluated adulterants in hair samples extracted by convenience from 100 patients admitted at the 48 hour-observation unit of Centro de Referência de Álcool, Tabaco e Outras Drogas (CRATOD), Brazil's largest center for addiction treatment. A cross-sectional analysis was performed with the data obtained. Results Adulterants were found in 97% of the analyzed hair samples. The most prevalent adulterant was lidocaine (92%), followed by phenacetin (69%) and levamisole (31%). Conclusion Adulterants were widely prevalent in hair samples from crack users treated at CRATOD: at least one adulterant was present in virtually all the hair samples collected. This points to a need to monitor adverse effects in the clinical setting in order to provide this high-risk group of patients with prompt and effective care related to the acute and chronic complications associated with these adulterants.

Resumo Introdução O Brasil é o maior consumidor mundial de crack, e a dependência é um grande problema de saúde pública. Este é o primeiro estudo a investigar a prevalência de adulterantes potencialmente nocivos presentes em amostras de cabelo de pacientes brasileiros com dependência de crack. Métodos Foram avaliados adulterantes em amostras de cabelos extraídos por conveniência de 100 pacientes internados na unidade de observação de 48 horas do Centro de Referência de Álcool, Tabaco e Outras Drogas (CRATOD), o maior centro de tratamento de dependência do Brasil. Uma análise transversal foi realizada com os dados obtidos. Resultados Foram encontrados adulterantes em 97% das amostras de cabelo analisadas. O adulterante mais prevalente foi a lidocaína (92%), seguida da fenacetina (69%) e levamisol (31%). Conclusão Os adulterantes foram amplamente prevalentes em amostras de cabelo de usuários de crack tratados no CRATOD: pelo menos um adulterante estava presente em praticamente todas as amostras de cabelo coletadas. Isso aponta para a necessidade de monitorar os efeitos adversos no ambiente clínico, a fim de proporcionar a esse grupo de pacientes de alto risco cuidados imediatos e efetivos relacionados às complicações agudas e crônicas associadas a esses adulterantes.

A critical literature review on emotional intelligence in addiction.

INTRODUCTION: Emotional intelligence (EI) has been defined as the ability to perceive, understand, use and manage emotions. Studying EI could potentially be useful in understanding addictive behaviors as well as for designing and planning interventions. OBJECTIVES: To conduct a critical review on EI impairment in addiction disorders. METHODS: MEDLINE/PubMed, Google Scholar, Cochrane, LILACS, and SciELO databases were searched. Articles that used the standardized Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) instrument to assess EI in people with addictions and healthy controls were selected for the review. RESULTS: We selected seven articles assessing EI and its associations with addiction disorders, mainly alcohol abuse and cocaine dependence. Most studies reported that individuals with addiction disorders had worse EI scores when compared to controls. CONCLUSION: Overall, the studies reviewed demonstrated that addictions are associated with EI deficits, compared to controls. However, aspects such as the small number of addictive disorders analyzed, methodological issues related to instruments for assessment of IE and the lack of follow-up remain significant limitations.

Emotional intelligence and schizophrenia spectrum disorders: a critical review.

INTRODUCTION: Emotional intelligence (EI) is a theoretical construct postulated by Mayer and Salovey to designate the ability to perceive, understand, use and manage emotions. The study of EI in schizophrenia offers new insights into the disorder's cognitive and functional impacts. OBJECTIVES: To comprehensively review studies analyzing EI impairment in schizophrenia spectrum disorders using standardized instruments. METHODS: Searches were run on MEDLINE/PubMed, Google Scholar, Cochrane, LILACS, Embase, ClinicalTrials.gov and SciELO databases. The only validated instrument used was the Multifactor Emotional Intelligence Scale (MSCEIT). Articles that used all branches of the MSCEIT to assess EI in schizophrenia spectrum disorders and healthy controls were included in the review. RESULTS: We found 30 articles on this topic. The studies analyzed showed a significant impairment of MSCEIT total score in patients with schizophrenia spectrum disorders when compared to healthy controls. In relation to the MSCEIT branches, understanding of emotions and management of emotions are the most impaired branches. CONCLUSION: Since most studies are cross-sectional, it is not possible to establish a cause and effect relationship between EI deficits and schizophrenia spectrum disorders. Therefore, longitudinal studies are needed to establish a clearer relationship between these variables. By so doing, we may be able to intervene for prevention and management of these disorders, aiming at better quality of life for patients.

A critical literature review on emotional intelligence in addiction / Revisão crítica da literatura em inteligência emocional e adição

Abstract Introduction Emotional intelligence (EI) has been defined as the ability to perceive, understand, use and manage emotions. Studying EI could potentially be useful in understanding addictive behaviors as well as for designing and planning interventions. Objectives To conduct a critical review on EI impairment in addiction disorders. Methods MEDLINE/PubMed, Google Scholar, Cochrane, LILACS, and SciELO databases were searched. Articles that used the standardized Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) instrument to assess EI in people with addictions and healthy controls were selected for the review. Results We selected seven articles assessing EI and its associations with addiction disorders, mainly alcohol abuse and cocaine dependence. Most studies reported that individuals with addiction disorders had worse EI scores when compared to controls. Conclusion Overall, the studies reviewed demonstrated that addictions are associated with EI deficits, compared to controls. However, aspects such as the small number of addictive disorders analyzed, methodological issues related to instruments for assessment of IE and the lack of follow-up remain significant limitations.

Resumo Introdução Inteligência emocional (IE) é definida como a habilidade de perceber, compreender, utilizar e manejar emoções. Estudos em IE são potencialmente úteis na compreensão de comportamentos relacionados a adições, assim como no planejamento de intervenções. Objetivos Realizar revisão crítica da literatura em comprometimento da IE em adições. Métodos A busca foi realizada nas plataformas MEDLINE/PubMed, Google Scholar, Cochrane, LILACS e SciELO. Artigos que utilizaram o Mayer-Salovey-Caruso Emotional Intelligence Test (MSCEIT) para a avaliação de IE em adições e controles saudáveis foram incluídos na revisão. Resultados Nós selecionamos sete artigos que avaliaram IE e sua associação com dependência química e não química, especialmente abuso de álcool e dependência de cocaína. A maior parte dos estudos reportou que indivíduos com transtornos relacionados ao uso de substâncias apresentaram valores inferiores na MSCEIT em comparação a controles saudáveis. Conclusão De forma geral, os estudos revisados demostraram uma associação entre dependência química e déficits em IE na comparação com controles saudáveis. No entanto, a reduzida quantidade de transtornos de uso de substância analisada, problemas metodológicos relacionados a instrumentos de avaliação de IE e a ausência de seguimento dos sujeitos incluídos nos estudos são limitações significativas.