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Research paper thumbnail of Manejo do paciente com transtornos relacionados ao uso de substância psicoativa na emergência psiquiátrica

Revista Brasileira de Psiquiatria, 2010

OBJETIVO: Transtornos por uso de substâncias são prevalentes em setores de emergência gerais e ps... more OBJETIVO: Transtornos por uso de substâncias são prevalentes em setores de emergência gerais e psiquiátricos, atingindo taxas de 28% das ocorrências em prontos-socorros gerais. Todavia, profissionais dos setores de emergência identificam menos que 50% dos casos de problemas relacionados ao álcool. Este artigo visa fornecer base fundamentada em evidências para o tratamento específico a pacientes que preencham os critérios diagnósticos de transtornos por uso de substâncias e que se apresentam ao pronto-socorro em quadros de intoxicação ou abstinência. MÉTODO: Uma revisão sobre o tema foi realizada na base de dados Medline, usando-se os descritores "intoxicação aguda", "abstinência",…

Research paper thumbnail of The influence of depressive symptoms and substance use on adherence to antiretroviral therapy. A cross-sectional prevalence study

Sao Paulo Medical Journal, 2014

CONTEXT AND OBJECTIVE:Adherence to antiretroviral treatment (ART) is not a stable condition, but ... more CONTEXT AND OBJECTIVE:Adherence to antiretroviral treatment (ART) is not a stable condition, but is dynamic, like mental conditions. The aim of this study was to examine whether non-adherence to ART is related to demographic and immunological variables, substance use and presence of depressive symptoms.DESIGN AND SETTING:This was a cross-sectional prevalence study carried out at a public AIDS treatment center in the city of São Paulo, Brazil, between July 2006 and January 2007.METHODS:438 patients on regular ART schedules with recent laboratory tests answered a demographic questionnaire, questions about substance use, the Hamilton Depression Rating Scale (HDRS) and the Simplified Medication Adherence Questionnaire (SMAQ).RESULTS:The prevalence of non-adherence over the past three months (a pattern of treatment interruption) was 46.3%, and 27.2% also reported this in the past week (a pattern of missed doses). ART interruption was significantly related to older age, lower CD4+ cell co...

Research paper thumbnail of Fatores associados ao consumo de álcool e drogas entre estudantes universitários

Revista de Saúde …, 2006

Fatores associados ao consumo de álcool e drogas entre estudantes universitários Factors associat... more Fatores associados ao consumo de álcool e drogas entre estudantes universitários Factors associated with drug and alcohol use among university students RESUMO OBJETIVO: Estudos recentes mostram o uso preocupante de álcool e drogas entre universitários. O objetivo do trabalho foi verificar o grau de associação entre o estilo de vida e situação socioeconômica e o uso de álcool, tabaco, medicamentos e "drogas ilícitas" nos últimos 12 meses entre universitários. MÉTODOS: A amostra compreendeu 926 alunos da área de Ciências Biológicas de uma universidade do Município de São Paulo, os quais responderam a questionário anônimo e de auto-preenchimento em 2000 e 2001. Foram utilizados os testes de análise de variância e qui-quadrado para verificar a correlação entre o uso de substâncias e as variáveis estudadas. RESULTADOS: Entre os alunos com alguma religião, o consumo de álcool foi de 83,1%, o de tabaco, 20,7% e o de "drogas ilícitas", 24,6%, nesse período. Entre os alunos que não possuíam religião, o consumo nas três categorias foi superior nos últimos 12 meses: álcool (89,3%), tabaco (27,7%) e "drogas ilícitas" (37,7%). A renda familiar mensal mostrou-se relacionada ao uso de álcool e "drogas ilícitas" (p<0,001 para ambos). Os alunos que utilizaram tabaco e "drogas ilícitas" apresentavam mais horas livres nos dias úteis do que os alunos que não fumavam no período analisado (p=0,033 e p=0,008, respectivamente). CONCLUSÕES: O consumo de substâncias psicoativas entre os alunos estudados foi comum, indicando a necessidade de implementação de medidas para reduzir tal consumo. Alunos com renda familiar alta e sem religião podem ser considerados com maior risco de consumo de drogas nessa população. DESCRITORES: Alcoolismo. Drogas ilícitas. Tabagismo. Estudante. Transtornos relacionados ao uso de substâncias. Transtorno por uso de tabaco. Classe social. Estilo da vida.

Research paper thumbnail of Effectiveness of the CAGE questionnaire, gamma-glutamyltransferase and mean corpuscular volume of red blood cells as markers for alcohol-related problems in the workplace

Addictive Behaviors, 2008

Objective: To evaluate the usefulness of gamma-glutamyltransferase (GGT) and mean corpuscular vol... more Objective: To evaluate the usefulness of gamma-glutamyltransferase (GGT) and mean corpuscular volume (MCV), as well as that of the CAGE questionnaire, in workplace screening for alcohol abuse/dependence. Methods: A total of 183 male employees were submitted to structured interviews (Structured Clinical Interview for DSM-IV 2.0 and CAGE questionnaire). Blood samples were collected. Diagnostic accuracy and odds ratio were determined for the CAGE, GGT and MCV. Results: The CAGE questionnaire presented the best sensitivity for alcohol dependence (91%; specificity, 87.8%) and for alcohol abuse (87.5%, specificity, 80.9%), which increased when the questionnaire was used in combination with GGT (sensitivity, 100% and 87.5%, respectively; specificity, 68% and 61.5, respectively). CAGE positive results and/or alterations in GGT were less likely to occur among employees not presenting alcohol abuse/ dependence than among those presenting such abuse (OR for CAGE = 13, p b 0.05; OR for CAGE-GGT = 11, p b 0.05) or dependence (OR for CAGE = 76, p b 0.01; OR for GGT = 5, p b 0.01). Employees not presenting alcohol abuse/dependence were also several times more likely to present negative CAGE or GGT results. Conclusions: The use short, simple questionnaires, combined with that of low-cost biochemical markers, such as GGT, can serve as an initial screening for alcohol-related problems, especially for employees in hazardous occupations. The data provided can serve to corroborate clinical findings.

Research paper thumbnail of Brazilian guideline for the treatment of patients with opioids dependence syndrome

Revista Brasileira de …, 2004

There is a relatively low prevalence of opioid use in Brazil, particularly involving the non-medi... more There is a relatively low prevalence of opioid use in Brazil, particularly involving the non-medical use of codeine and opiatecontaining syrups. However, opioid dependence syndrome shows a significant total impact on mortality and morbidity. Over the past 20 years, scientific progress has changed our understanding of the nature of opioid addiction and its various possible treatments. Addiction is a chronic illness treatable if the treatment is well-delivered and tailored to the needs of the particular patient. There is indeed an array of treatments that can effectively reduce drug use, help manage drug cravings, prevent relapses and restore people to productive social functioning. The treatment of drug addiction will be part of long-term, medical, psychological, and social perspectives. This guideline aims at providing guidance to psychiatrists and other mental health professionals who care for patients with Opioid Dependence Syndrome. It comments on the somatic and psychosocial treatment that is used for such patients, and reviews scientific evidences and their strength. Also, the essential historical, epidemiological and neurobiological aspects of Opioid Dependence are reviewed.

Research paper thumbnail of Depression in women living with HIV: clinical and psychosocial correlates

Archives of Women's Mental Health, 2010

The number of Brazilian women living with HIV has increased significantly in past years, renderin... more The number of Brazilian women living with HIV has increased significantly in past years, rendering studies of their particular care demands including psychiatric issues. This study measures the prevalence of major depression, using the Structured Clinical Interview for DSM-IV Axis I Disorders, in a sample of 120 women living with HIV in treatment at a reference centre in São Paulo. Socio-demographic variables, HIV-related clinical and laboratory data, including CD4+ cell counts and HIV plasma viral loads, as well as psychosocial features (intimate relationships, disclosure of HIV serostatus, partner's serostatus and patient's emotional and financial support) were investigated as factors potentially associated with depression. The prevalence of major depression at the time of evaluation was 25.8% (95% CI 18.2-33.4%). Clinical status (p=0.002), lack of emotional support (p= 0.02), use of antidepressants (p=0.028) and length of time since HIV diagnosis (p=0.05) were associated with major depression in univariate analysis. In multivariate multipleregression model, HIV clinical status, lack of emotional support and higher plasma viral loads were associated with depression. Sixty per cent of the women have a major depression diagnosis during lifetime. We conclude that major depression is highly prevalent among women living with HIV, but it is still underdiagnosed and undertreated.

Research paper thumbnail of Manejo do paciente com transtornos relacionados ao uso de substância psicoativa na emergência psiquiátrica

Revista Brasileira de Psiquiatria, 2010

OBJETIVO: Transtornos por uso de substâncias são prevalentes em setores de emergência gerais e ps... more OBJETIVO: Transtornos por uso de substâncias são prevalentes em setores de emergência gerais e psiquiátricos, atingindo taxas de 28% das ocorrências em prontos-socorros gerais. Todavia, profissionais dos setores de emergência identificam menos que 50% dos casos de problemas relacionados ao álcool. Este artigo visa fornecer base fundamentada em evidências para o tratamento específico a pacientes que preencham os critérios diagnósticos de transtornos por uso de substâncias e que se apresentam ao pronto-socorro em quadros de intoxicação ou abstinência. MÉTODO: Uma revisão sobre o tema foi realizada na base de dados Medline, usando-se os descritores "intoxicação aguda", "abstinência",…

Research paper thumbnail of The influence of depressive symptoms and substance use on adherence to antiretroviral therapy. A cross-sectional prevalence study

Sao Paulo Medical Journal, 2014

CONTEXT AND OBJECTIVE:Adherence to antiretroviral treatment (ART) is not a stable condition, but ... more CONTEXT AND OBJECTIVE:Adherence to antiretroviral treatment (ART) is not a stable condition, but is dynamic, like mental conditions. The aim of this study was to examine whether non-adherence to ART is related to demographic and immunological variables, substance use and presence of depressive symptoms.DESIGN AND SETTING:This was a cross-sectional prevalence study carried out at a public AIDS treatment center in the city of São Paulo, Brazil, between July 2006 and January 2007.METHODS:438 patients on regular ART schedules with recent laboratory tests answered a demographic questionnaire, questions about substance use, the Hamilton Depression Rating Scale (HDRS) and the Simplified Medication Adherence Questionnaire (SMAQ).RESULTS:The prevalence of non-adherence over the past three months (a pattern of treatment interruption) was 46.3%, and 27.2% also reported this in the past week (a pattern of missed doses). ART interruption was significantly related to older age, lower CD4+ cell co...

Research paper thumbnail of Fatores associados ao consumo de álcool e drogas entre estudantes universitários

Revista de Saúde …, 2006

Fatores associados ao consumo de álcool e drogas entre estudantes universitários Factors associat... more Fatores associados ao consumo de álcool e drogas entre estudantes universitários Factors associated with drug and alcohol use among university students RESUMO OBJETIVO: Estudos recentes mostram o uso preocupante de álcool e drogas entre universitários. O objetivo do trabalho foi verificar o grau de associação entre o estilo de vida e situação socioeconômica e o uso de álcool, tabaco, medicamentos e "drogas ilícitas" nos últimos 12 meses entre universitários. MÉTODOS: A amostra compreendeu 926 alunos da área de Ciências Biológicas de uma universidade do Município de São Paulo, os quais responderam a questionário anônimo e de auto-preenchimento em 2000 e 2001. Foram utilizados os testes de análise de variância e qui-quadrado para verificar a correlação entre o uso de substâncias e as variáveis estudadas. RESULTADOS: Entre os alunos com alguma religião, o consumo de álcool foi de 83,1%, o de tabaco, 20,7% e o de "drogas ilícitas", 24,6%, nesse período. Entre os alunos que não possuíam religião, o consumo nas três categorias foi superior nos últimos 12 meses: álcool (89,3%), tabaco (27,7%) e "drogas ilícitas" (37,7%). A renda familiar mensal mostrou-se relacionada ao uso de álcool e "drogas ilícitas" (p<0,001 para ambos). Os alunos que utilizaram tabaco e "drogas ilícitas" apresentavam mais horas livres nos dias úteis do que os alunos que não fumavam no período analisado (p=0,033 e p=0,008, respectivamente). CONCLUSÕES: O consumo de substâncias psicoativas entre os alunos estudados foi comum, indicando a necessidade de implementação de medidas para reduzir tal consumo. Alunos com renda familiar alta e sem religião podem ser considerados com maior risco de consumo de drogas nessa população. DESCRITORES: Alcoolismo. Drogas ilícitas. Tabagismo. Estudante. Transtornos relacionados ao uso de substâncias. Transtorno por uso de tabaco. Classe social. Estilo da vida.

Research paper thumbnail of Effectiveness of the CAGE questionnaire, gamma-glutamyltransferase and mean corpuscular volume of red blood cells as markers for alcohol-related problems in the workplace

Addictive Behaviors, 2008

Objective: To evaluate the usefulness of gamma-glutamyltransferase (GGT) and mean corpuscular vol... more Objective: To evaluate the usefulness of gamma-glutamyltransferase (GGT) and mean corpuscular volume (MCV), as well as that of the CAGE questionnaire, in workplace screening for alcohol abuse/dependence. Methods: A total of 183 male employees were submitted to structured interviews (Structured Clinical Interview for DSM-IV 2.0 and CAGE questionnaire). Blood samples were collected. Diagnostic accuracy and odds ratio were determined for the CAGE, GGT and MCV. Results: The CAGE questionnaire presented the best sensitivity for alcohol dependence (91%; specificity, 87.8%) and for alcohol abuse (87.5%, specificity, 80.9%), which increased when the questionnaire was used in combination with GGT (sensitivity, 100% and 87.5%, respectively; specificity, 68% and 61.5, respectively). CAGE positive results and/or alterations in GGT were less likely to occur among employees not presenting alcohol abuse/ dependence than among those presenting such abuse (OR for CAGE = 13, p b 0.05; OR for CAGE-GGT = 11, p b 0.05) or dependence (OR for CAGE = 76, p b 0.01; OR for GGT = 5, p b 0.01). Employees not presenting alcohol abuse/dependence were also several times more likely to present negative CAGE or GGT results. Conclusions: The use short, simple questionnaires, combined with that of low-cost biochemical markers, such as GGT, can serve as an initial screening for alcohol-related problems, especially for employees in hazardous occupations. The data provided can serve to corroborate clinical findings.

Research paper thumbnail of Brazilian guideline for the treatment of patients with opioids dependence syndrome

Revista Brasileira de …, 2004

There is a relatively low prevalence of opioid use in Brazil, particularly involving the non-medi... more There is a relatively low prevalence of opioid use in Brazil, particularly involving the non-medical use of codeine and opiatecontaining syrups. However, opioid dependence syndrome shows a significant total impact on mortality and morbidity. Over the past 20 years, scientific progress has changed our understanding of the nature of opioid addiction and its various possible treatments. Addiction is a chronic illness treatable if the treatment is well-delivered and tailored to the needs of the particular patient. There is indeed an array of treatments that can effectively reduce drug use, help manage drug cravings, prevent relapses and restore people to productive social functioning. The treatment of drug addiction will be part of long-term, medical, psychological, and social perspectives. This guideline aims at providing guidance to psychiatrists and other mental health professionals who care for patients with Opioid Dependence Syndrome. It comments on the somatic and psychosocial treatment that is used for such patients, and reviews scientific evidences and their strength. Also, the essential historical, epidemiological and neurobiological aspects of Opioid Dependence are reviewed.

Research paper thumbnail of Depression in women living with HIV: clinical and psychosocial correlates

Archives of Women's Mental Health, 2010

The number of Brazilian women living with HIV has increased significantly in past years, renderin... more The number of Brazilian women living with HIV has increased significantly in past years, rendering studies of their particular care demands including psychiatric issues. This study measures the prevalence of major depression, using the Structured Clinical Interview for DSM-IV Axis I Disorders, in a sample of 120 women living with HIV in treatment at a reference centre in São Paulo. Socio-demographic variables, HIV-related clinical and laboratory data, including CD4+ cell counts and HIV plasma viral loads, as well as psychosocial features (intimate relationships, disclosure of HIV serostatus, partner's serostatus and patient's emotional and financial support) were investigated as factors potentially associated with depression. The prevalence of major depression at the time of evaluation was 25.8% (95% CI 18.2-33.4%). Clinical status (p=0.002), lack of emotional support (p= 0.02), use of antidepressants (p=0.028) and length of time since HIV diagnosis (p=0.05) were associated with major depression in univariate analysis. In multivariate multipleregression model, HIV clinical status, lack of emotional support and higher plasma viral loads were associated with depression. Sixty per cent of the women have a major depression diagnosis during lifetime. We conclude that major depression is highly prevalent among women living with HIV, but it is still underdiagnosed and undertreated.