Flávio Pechansky | Universidade Federal do Rio Grande do Sul (original) (raw)

Papers by Flávio Pechansky

Research paper thumbnail of Prevalência de sintomas psiquiátricos e consumo de cocaína em uma amostra de mulheres usuárias de club drugs na cidade de Porto Alegre

Research paper thumbnail of The Effects of ADHD in Adult Substance Abusers

Journal of Addictive Diseases, 2013

The aim of this study was to evaluate the psychiatric comorbidities and different areas of life f... more The aim of this study was to evaluate the psychiatric comorbidities and different areas of life functioning in substance abusers with attention deficit hyperactivity disorder symptoms. A cross-sectional, multi-center study involving 285 adult substance abusers from outpatient and inpatient clinics was performed. The Adult ADHD Self-Report Scale, the sixth version of the Addiction Severity Index, and the Mini International Neuropsychiatry Interview were used for data collection. Individuals with comorbid attention deficit hyperactivity disorder and substance use disorders showed increased addiction severity when compared with individuals without attention deficit hyperactivity disorder (53.3 ± 7.3 vs. 48.4 ± 8.4, respectively). Our results suggest that comorbid attention deficit hyperactivity disorder and substance use disorders is associated with a more severe course of substance use and with social and psychiatric impairment.

Research paper thumbnail of www.mdpi.com/journal/ijerph Article Genomic Instability in Human Lymphocytes from Male Users of Crack Cocaine

Abstract: Recent research suggests that crack cocaine use alters systemic biochemical markers, li... more Abstract: Recent research suggests that crack cocaine use alters systemic biochemical markers, like oxidative damage and inflammation markers, but very few studies have assessed the potential effects of crack cocaine at the cellular level. We assessed genome instability by means of the comet assay and the cytokinesis-block micronucleus technique in crack cocaine users at the time of admission to a rehabilitation clinic and at two times after the beginning of withdrawal. Thirty one active users of crack cocaine and forty control subjects were evaluated. Comparison between controls and crack cocaine users at the first analysis showed significant differences in the rates of DNA damage (p = 0.037). The frequency of micronuclei (MN) (p < 0.001) and nuclear buds (NBUDs) (p < 0.001) was increased, but not

Research paper thumbnail of Higher levels of BDNF are associated with inpatient treatment adherence of crack-cocaine users

Drug and Alcohol Dependence, 2015

Research paper thumbnail of Risk behaviors for HCV- and HIV-seroprevalence among female crack users in Porto Alegre, Brazil

Archives of Women's Mental Health, 2009

Several studies have shown a high prevalence of HIV-seropositive status among crack users, though... more Several studies have shown a high prevalence of HIV-seropositive status among crack users, though most refer to North American populations. Few studies evaluate HCV prevalence among female crack users. In addition, there is a particular lack of data about risk behaviors and HIV/HCV prevalence in this population around the world. In order to ascertain the HIV/HCV serostatus and associated risk behaviors for infection of female crack users of Porto Alegre, Brazil. A cross-sectional study of a convenience sample of 73 current female crack users was conducted. Subjects answered NIDA's Risk Behavior Assessment and an AIDS Information Questionnaire. In addition, blood was collected from subjects for HIV/HCV tests. The overall prevalence of HIV was 37.0%; HCV seroprevalence was 27.7%; of 15.1% the sample was co-infected with HIV and HCV. Four years of schooling or fewer (OR 4.72-CI 95%; 1.49-14.99) and having three or more HIV tests in one's lifetime (OR 4.26-CI 95% (1.29-14.04)) were associated with HIV infection (after multivariate logistic regression). The single greatest risk factor for HCV infection was having 4 years of schooling or fewer (OR 4.51-CI 95%; 1.18-17.27). We found a very high prevalence of HIV and HCV infection among female crack users, and low education was the most significant risk factor associated with both infections.

Research paper thumbnail of Increase in brain-derived neurotrophic factor in first episode psychotic patients after treatment with atypical antipsychotics

International Clinical Psychopharmacology, 2010

Some preclinical and postmortem studies suggest that the effects of atypical antipsychotics could... more Some preclinical and postmortem studies suggest that the effects of atypical antipsychotics could be mediated by brain-derived neurotrophic factor (BDNF). Olanzapine is an atypical antipsychotic with shown efficacy in psychosis treatment. The aim of this study was to compare plasma BDNF levels at baseline and after 1 year of olanzapine treatment in 18 drug-naive patients who experienced a first psychotic episode with those of 18 healthy control participants matched by age, sex, and socioeconomic level. Plasma BDNF levels were measured in patients at the index episode and at 1, 6, and 12 months of follow-up using an enzyme-linked immunosorbent assay. Symptoms and functioning of patients and controls were assessed with the Positive and Negative Symptom Scale and Global Assessment of Function Scale. BDNF levels of patients at onset were significantly lower than controls but increased toward control values during olanzapine treatment. There was a significant positive correlation between BDNF levels and functioning (Global Assessment of Function Scale). BDNF levels were also negatively correlated with positive symptoms, but not with negative symptoms or general psychopathology. Results suggest that olanzapine can offset the low BDNF levels at the onset of first psychotic episodes, and improving psychotic symptoms. The increase in BDNF levels may be its mechanism of action in improving positive symptoms.

Research paper thumbnail of High rates of incarceration due to drug trafficking in the last decade in Brazil

Research paper thumbnail of Satisfaction and burden of mental health personnel: data from healthcare services for substance users and their families

Revista Brasileira de Psiquiatria, 2018

Objective: To evaluate satisfaction and burden of mental health personnel providing mental health... more Objective: To evaluate satisfaction and burden of mental health personnel providing mental health services for substance users and their families. Method: Five hundred twenty-seven mental health workers who provide treatment for substance users in five Brazilian states were interviewed. Data on sociodemographic characteristics and measures of satisfaction (SATIS-BR) and burden of mental health personnel (IMPACTO-BR) were collected. Results: Type of mental health service and educational attainment were associated with degree of satisfaction and burden. Therapeutic community workers and those with a primary education level reported being more satisfied with the treatment offered to patients, their engagement in service activities, and working conditions. Workers from psychosocial care centers, psychosocial care centers focused on alcohol and other drugs, and social care referral centers (both general and specialized), as well as workers with a higher education, reported feeling overburdened. Conclusion: This study offers important information regarding the relationship of mental health personnel with their work. Care providers within this sample reported an overall high level of job satisfaction, while perceived burden differed by type of service and educational attainment. To our knowledge, this is the first study with a sample of mental health professionals working with substance users across five Brazilian states.

Research paper thumbnail of Álcool, nicotina e substâncias ilícitas: prevalência de uso problemático e associação com fatores sócio-demográficos e idade de primeiro consumo de álcool: estudo transversal com adolescentes masculinos – amostra comunitária, sul do Brasil

Research paper thumbnail of Tratamento do transtorno de déficit de atenção/hiperatividade com metilfenidato de longa ação em adolescentes com transtorno por uso de substâncias psicoativas ilícitas : um estudo de crossover, controlado com placebo

Introdução: O Transtorno de Déficit de Atenção/Hiperatividade (TDAH) é altamente prevalente em ad... more Introdução: O Transtorno de Déficit de Atenção/Hiperatividade (TDAH) é altamente prevalente em adolescentes com Transtorno por Uso de Substâncias Psicoativas (TUSP), podendo piorar a gravidade do TUSP. A efetividade dos psicoestimulantes ainda não foi avaliada nestes sujeitos. Objetivos: Avaliar a efetividade do metilfenidato de longa ação (MFD-LA) nos sintomas de TDAH em adolescentes com TDAH/TUSP. Secundariamente, avaliar o efeito do tratamento com MFD-LA sobre o uso de substâncias psicoativas (SPA), bem como a sua tolerabilidade. Método: Estudo de crossover, one-blind, controlado com placebo, sobre o efeito de doses escalonadas de MFD-LA nos sintomas de TDAH. Os participantes (N=16) foram randomicamente alocados ao grupo A (semanas 1-3 com MFD-LA e semanas 4-6 com placebo) ou B (ordem inversa). O desfecho primário foi a gravidade do TDAH (SNAP-IV e CGI-severidade). Foram aferidos o uso de SPA durante o protocolo e os efeitos adversos da intervenção (Barkley Scale). Análise estatística com mixed effect model. Resultados: A amostra caracterizou-se, sobretudo, por usuários de maconha, com escores basais no SNAP-IV e CGI-gravidade de 50.63 (SD=13.76) e 5.69 (SD=0.70), respectivamente. Os sujeitos, mediante o uso de MFD-LA, apresentaram melhora clínica superior ao placebo, com maiores reduções no SNAP-IV e CGI-gravidade (26.79, SD=9.08 vs. 38.09, SD=12.90 e 3.93, SD=1.00 vs. 4.93, SD= 1.08, respectivamente; pConclusões: o MFD-LA mostrou-se superior ao placebo no tratamento do TDAH em adolescentes com TDAH/TUSP, sem agravar o uso de SPA e com boa tolerabilidade.

Research paper thumbnail of Quality of life, social functioning, family structure, and treatment history associated with crack cocaine use in youth from the general population

Brazilian Journal of Psychiatry, 2015

Objective: To assess the relationship between crack cocaine use and dimensions of quality of life... more Objective: To assess the relationship between crack cocaine use and dimensions of quality of life and social functioning in young adults. Methods: This was a cross-sectional, population-based study involving 1,560 participants in Pelotas, Brazil. Crack cocaine use and abuse were investigated using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) inventory. Outcomes of interest were quality of life, religiosity, and social functioning in terms of education, occupational status, family structure, and medical treatment history. Results: Lifetime crack cocaine use was associated with poor quality of life, worse functioning, impaired academic performance, and lower religious involvement. A greater maternal presence and higher paternal absence were more also more pronounced in crack cocaine users, who were also more likely to seek psychological and psychiatric treatment than the general population. Conclusion: Quality of life was severely impacted by crack cocaine use, especially in terms of general and physical health. Social functioning also differed between the general population and crack users, who had lower educational attainment and religious involvement. Maternal presence, paternal absence, and mental health-seeking behaviors were also more frequent among crack cocaine users, although these individuals reported lower rates of treatment satisfaction. Crack cocaine users also had significant social impairment, so that interventions involving family management and a greater focus on general health, quality of life, and functioning may make crucial contributions to the recovery of this group.

Research paper thumbnail of Correlates of unprotected sex in a sample of young club drug users

Clinics (São Paulo, Brazil), 2013

To assess the demographic characteristics, psychiatric symptoms, substance use patterns, and sexu... more To assess the demographic characteristics, psychiatric symptoms, substance use patterns, and sexual risk behaviors in a sample of club drug users to identify factors associated with unprotected sex during the 12 months prior to the interview. This cross-sectional study employed the targeted sampling and ethnographic mapping approaches via face-to-face interviews conducted at bars and electronic music festivals using an adapted, semi-structured version of the Global Appraisal of Individual Needs questionnaire. The sample comprised 240 male and female young adults who had used ecstasy and/or LSD in the 90 days prior to the interview and who were not receiving treatment for alcohol or drug abuse. Of the 240 subjects selected (mean age: 22.9±4.5 years), 57.9% were men; of the male subjects, 52.5% reported having had unprotected sex in the previous 12 months. Of the total sample, 63.33% reported having had unprotected sex. Multivariate regression analysis showed that anal sex (PR = 1.26;...

Research paper thumbnail of BDNF levels of crack users are associated with clinical outcome during inpatient treatment

Drug and Alcohol Dependence, 2015

In nonclinical samples, young women have been shown to be more dependent on alcohol and perceive ... more In nonclinical samples, young women have been shown to be more dependent on alcohol and perceive less need to enter treatment when compared to older women (Wu and Ringwalt, 2004). Upon entering treatment, young women are more likely to drop out (Copeland and Hall, 2006) and generally have poorer treatment outcomes (Satre et al., 2004) than older women. Examination of factors that may explain treatment dropout and poorer treatment outcomes in younger women are needed. Methods: The present study examined differences between three age groups of women (18-25, 26-40, and 41-65) on multiple characteristics including trauma symptoms, anxiety, depression, alcohol dependence, craving, impulsivity, emotion regulation, and both self-reported craving and salivation following a cue reactivity procedure. Results: The sample (n = 56) was assessed at entry to a residential substance use treatment program, had a mean age of 32.41 (SD = 10.16), and was 85.7% Caucasian. The entire sample had a current diagnosis of PTSD, 98.2% were alcohol dependent, and 96.4% were drug dependent. Group differences were examined with one-way ANOVAs and any significant differences were examined with Bonferroni posthoc analyses. Results indicated young women reported significantly higher scores on the following measures when compared to older women: impulsivity (p = .01), difficulty regulating emotion (p = .02), craving (p = .02), and both self-reported craving (p = .02) and salivation (p = .03) following the presentation of combined trauma and alcohol cues. Conclusions: These findings suggest younger women, despite not differing from older women on level of alcohol dependence and trauma symptoms, reported significant elevations on multiple variables. Young women presenting to substance use treatment may benefit from interventions specifically targeting some of these areas (e.g., impulsivity and emotion regulation), as well as additional interventions for craving, which could lead to increased treatment retention and better treatment outcomes.

Research paper thumbnail of Evaluation of psychiatric symptoms in cocaine users in the Brazilian public health system: Need for data and structure

Research paper thumbnail of Alcohol use on premises of gas stations of Porto Alegre, Brazil: Pilot study | Uso de bebidas alcoólicas em postos de gasolina de Porto Alegre: Estudo piloto

Revista de Psiquiatria do Rio Grande do Sul, 2008

Introdução: O uso de álcool é um forte preditor de acidentes de trânsito. Este artigo descreve a ... more Introdução: O uso de álcool é um forte preditor de acidentes de trânsito. Este artigo descreve a factibilidade e dados preliminares de um estudo que avalia a alcoolemia entre jovens que utilizam bebidas alcoólicas em estacionamentos de postos de gasolina de Porto Alegre (RS). Método: Estudo transversal, com amostra em alvo, estratificada por idade e gênero. Os dados foram coletados através de um questionário autopreenchido, e a alcoolemia foi estimada com uso de bafômetro. Resultados: A taxa de recusa foi de 13,7%, e medida da alcoolemia acima de 0,06% foi encontrada em 35,5% (IC95% 24,3-47,9) da amostra. Aproximadamente 10% destes indivíduos (18% dos homens) relatavam intenção de dirigir nas 2 horas subseqüentes à coleta. Conclusão: É discutida a potencial utilização deste tipo de dado, bem como a necessidade de novos estudos sobre uso de substâncias em motoristas brasileiros. Descritores: Consumo de bebidas alcoólicas, acidentes de trânsito, assunção de riscos.

Research paper thumbnail of Psychiatric and substance-use comorbidities associated with lifetime crack cocaine use in young adults in the general population

Comprehensive Psychiatry, 2014

Research paper thumbnail of Tradução e adaptação da escala Motorcycle Rider Behavior Questionnaire: versão brasileira

Cadernos de Saúde Pública, 2012

Mundialmente os acidentes de trânsito aparecem como uma das principais causas de morte entre adul... more Mundialmente os acidentes de trânsito aparecem como uma das principais causas de morte entre adultos jovens. No Brasil, os acidentes de trânsito são mais prevalentes em condutores de moto do que nos dos demais veículos. Não dispomos, no entanto, de instrumentos para avaliar o comportamento no trânsito em motociclistas. Temos o objetivo de traduzir e adaptar para o português brasileiro o instrumento Motorcycle Rider Behavior Questionnaire (MRBQ). O processo consistiu em: duas traduções independentes para o português; unificação das traduções, gerando a primeira versão; retrotradução para o inglês; apreciação formal de equivalência semântica, elaboração e aplicação em uma amostra de conveniência; discussão dos itens com problemas e elaboração de uma versão final; retrotradução desta e envio para o autor original, sendo aceita pelo mesmo. A versão brasileira do MRBQ conservou a equivalência semântica. O instrumento, de autopreenchimento, conservou suas propriedades, mostrando-se de fác...

Research paper thumbnail of Age of Sexual Initiation, Psychiatric Symptoms, and Sexual Risk Behavior among Ecstasy and LSD Users in Porto Alegre, Brazil: A Preliminary Analysis

Journal of Drug Issues, 2011

Ecstasy and LSD use is widespread in large Brazilian cities, but there is limited information on ... more Ecstasy and LSD use is widespread in large Brazilian cities, but there is limited information on their use among young, middle-class, club goers in Brazil. We conducted standardized face-to-face interviews with 200 male and female ecstasy and/or LSD users, focusing on drug use and sexual history, current risk behaviors, and psychiatric symptomatology. Participants with early sexual debut (before 14) were more likely to report lifetime use of marijuana and powder and crack cocaine than those with later sexual initiation. Early sexual debut was associated with past year sexual risk behaviors, including having sex while high (Prevalence Ratio (PR)=1.3), having two or more sex partners (PR=1.3), as well as history of sexual abuse (PR=13.6). Depression and anxiety scores were similar by age of sexual initiation. The implications of these findings are discussed.

Research paper thumbnail of Ethical, legal and social issues related to alcohol and drug research

Current Opinion in Psychiatry, 2011

Purpose of review To present some highlights and comments about ethical, legal and social issues ... more Purpose of review To present some highlights and comments about ethical, legal and social issues related to alcohol and drug research. Recent findings Alcohol and drug research has a lack of scientific production related to ethical, legal and social issues. Many papers simply describe summarily the informed consent process and other related issues. Summary Informed consent process is one of the most important issues in research ethics. Obtaining a valid consent from a prospective research participant is always a challenge. We present many different ways to reach ethical, legal and social adequacy related to the informed consent process.

Research paper thumbnail of Crack Users Show High Rates of Antisocial Personality Disorder, Engagement in Illegal Activities and Other Psychosocial Problems

The American Journal on Addictions, 2012

The aim of this study was to compare three groups of Brazilian psychoactive substance (PAS) abuse... more The aim of this study was to compare three groups of Brazilian psychoactive substance (PAS) abuse patients (crack cocaine users, cocaine snorters, and non-cocaine PAS users) in terms of psychiatric comorbidities and severity of psychosocial problems. A cross-sectional, multi-center study was conducted at five Brazilian research centers. A total of 738 current PAS abusers seeking specialized treatment (outpatient and inpatient clinics) were assessed using the sixth version of the Addiction Severity Index (ASI-6): 293 patients using crack cocaine were compared with 126 using powder cocaine and 319 using non-cocaine PAS (mostly alcohol and marijuana). Psychiatric comorbidities were assessed in a smaller sample (290 cases), originating from three of the centers, using the Mini International Neuropsychiatric Interview Plus (MINI-Plus). Crack and powder cocaine users were significantly younger than non-cocaine PAS users (31.1 ± 8.1 and 32.9 ± 8.8 vs. 42.4 ± 12, respectively; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). Crack users presented a higher rate of antisocial personality disorder (25%) than powder cocaine (9%) and non-cocaine PAS users (9%), even when adjusted for confounding factors (Pr = 2.6; 95% CI 1.10-6.40). According to ASI-6 summary scores, crack users presented a significantly higher rate of occupational, family, and legal problems and reported more illegal and violent activities such as burglary and theft (23%) and threatening or assaulting (32%) than non-cocaine PAS users. Our findings, combined with the recent increase observed in the prevalence of crack use in Brazil, highlight the severity of psychiatric symptoms and psychosocial problems related to this powerful drug and corroborate the already suggested association between crack/cocaine, violence, and legal problems. Treatment programs for crack users should routinely consider the possibility of associated psychiatric comorbidities, such as antisocial personality disorder, which may affect treatment outcomes.

Research paper thumbnail of Prevalência de sintomas psiquiátricos e consumo de cocaína em uma amostra de mulheres usuárias de club drugs na cidade de Porto Alegre

Research paper thumbnail of The Effects of ADHD in Adult Substance Abusers

Journal of Addictive Diseases, 2013

The aim of this study was to evaluate the psychiatric comorbidities and different areas of life f... more The aim of this study was to evaluate the psychiatric comorbidities and different areas of life functioning in substance abusers with attention deficit hyperactivity disorder symptoms. A cross-sectional, multi-center study involving 285 adult substance abusers from outpatient and inpatient clinics was performed. The Adult ADHD Self-Report Scale, the sixth version of the Addiction Severity Index, and the Mini International Neuropsychiatry Interview were used for data collection. Individuals with comorbid attention deficit hyperactivity disorder and substance use disorders showed increased addiction severity when compared with individuals without attention deficit hyperactivity disorder (53.3 ± 7.3 vs. 48.4 ± 8.4, respectively). Our results suggest that comorbid attention deficit hyperactivity disorder and substance use disorders is associated with a more severe course of substance use and with social and psychiatric impairment.

Research paper thumbnail of www.mdpi.com/journal/ijerph Article Genomic Instability in Human Lymphocytes from Male Users of Crack Cocaine

Abstract: Recent research suggests that crack cocaine use alters systemic biochemical markers, li... more Abstract: Recent research suggests that crack cocaine use alters systemic biochemical markers, like oxidative damage and inflammation markers, but very few studies have assessed the potential effects of crack cocaine at the cellular level. We assessed genome instability by means of the comet assay and the cytokinesis-block micronucleus technique in crack cocaine users at the time of admission to a rehabilitation clinic and at two times after the beginning of withdrawal. Thirty one active users of crack cocaine and forty control subjects were evaluated. Comparison between controls and crack cocaine users at the first analysis showed significant differences in the rates of DNA damage (p = 0.037). The frequency of micronuclei (MN) (p < 0.001) and nuclear buds (NBUDs) (p < 0.001) was increased, but not

Research paper thumbnail of Higher levels of BDNF are associated with inpatient treatment adherence of crack-cocaine users

Drug and Alcohol Dependence, 2015

Research paper thumbnail of Risk behaviors for HCV- and HIV-seroprevalence among female crack users in Porto Alegre, Brazil

Archives of Women's Mental Health, 2009

Several studies have shown a high prevalence of HIV-seropositive status among crack users, though... more Several studies have shown a high prevalence of HIV-seropositive status among crack users, though most refer to North American populations. Few studies evaluate HCV prevalence among female crack users. In addition, there is a particular lack of data about risk behaviors and HIV/HCV prevalence in this population around the world. In order to ascertain the HIV/HCV serostatus and associated risk behaviors for infection of female crack users of Porto Alegre, Brazil. A cross-sectional study of a convenience sample of 73 current female crack users was conducted. Subjects answered NIDA's Risk Behavior Assessment and an AIDS Information Questionnaire. In addition, blood was collected from subjects for HIV/HCV tests. The overall prevalence of HIV was 37.0%; HCV seroprevalence was 27.7%; of 15.1% the sample was co-infected with HIV and HCV. Four years of schooling or fewer (OR 4.72-CI 95%; 1.49-14.99) and having three or more HIV tests in one's lifetime (OR 4.26-CI 95% (1.29-14.04)) were associated with HIV infection (after multivariate logistic regression). The single greatest risk factor for HCV infection was having 4 years of schooling or fewer (OR 4.51-CI 95%; 1.18-17.27). We found a very high prevalence of HIV and HCV infection among female crack users, and low education was the most significant risk factor associated with both infections.

Research paper thumbnail of Increase in brain-derived neurotrophic factor in first episode psychotic patients after treatment with atypical antipsychotics

International Clinical Psychopharmacology, 2010

Some preclinical and postmortem studies suggest that the effects of atypical antipsychotics could... more Some preclinical and postmortem studies suggest that the effects of atypical antipsychotics could be mediated by brain-derived neurotrophic factor (BDNF). Olanzapine is an atypical antipsychotic with shown efficacy in psychosis treatment. The aim of this study was to compare plasma BDNF levels at baseline and after 1 year of olanzapine treatment in 18 drug-naive patients who experienced a first psychotic episode with those of 18 healthy control participants matched by age, sex, and socioeconomic level. Plasma BDNF levels were measured in patients at the index episode and at 1, 6, and 12 months of follow-up using an enzyme-linked immunosorbent assay. Symptoms and functioning of patients and controls were assessed with the Positive and Negative Symptom Scale and Global Assessment of Function Scale. BDNF levels of patients at onset were significantly lower than controls but increased toward control values during olanzapine treatment. There was a significant positive correlation between BDNF levels and functioning (Global Assessment of Function Scale). BDNF levels were also negatively correlated with positive symptoms, but not with negative symptoms or general psychopathology. Results suggest that olanzapine can offset the low BDNF levels at the onset of first psychotic episodes, and improving psychotic symptoms. The increase in BDNF levels may be its mechanism of action in improving positive symptoms.

Research paper thumbnail of High rates of incarceration due to drug trafficking in the last decade in Brazil

Research paper thumbnail of Satisfaction and burden of mental health personnel: data from healthcare services for substance users and their families

Revista Brasileira de Psiquiatria, 2018

Objective: To evaluate satisfaction and burden of mental health personnel providing mental health... more Objective: To evaluate satisfaction and burden of mental health personnel providing mental health services for substance users and their families. Method: Five hundred twenty-seven mental health workers who provide treatment for substance users in five Brazilian states were interviewed. Data on sociodemographic characteristics and measures of satisfaction (SATIS-BR) and burden of mental health personnel (IMPACTO-BR) were collected. Results: Type of mental health service and educational attainment were associated with degree of satisfaction and burden. Therapeutic community workers and those with a primary education level reported being more satisfied with the treatment offered to patients, their engagement in service activities, and working conditions. Workers from psychosocial care centers, psychosocial care centers focused on alcohol and other drugs, and social care referral centers (both general and specialized), as well as workers with a higher education, reported feeling overburdened. Conclusion: This study offers important information regarding the relationship of mental health personnel with their work. Care providers within this sample reported an overall high level of job satisfaction, while perceived burden differed by type of service and educational attainment. To our knowledge, this is the first study with a sample of mental health professionals working with substance users across five Brazilian states.

Research paper thumbnail of Álcool, nicotina e substâncias ilícitas: prevalência de uso problemático e associação com fatores sócio-demográficos e idade de primeiro consumo de álcool: estudo transversal com adolescentes masculinos – amostra comunitária, sul do Brasil

Research paper thumbnail of Tratamento do transtorno de déficit de atenção/hiperatividade com metilfenidato de longa ação em adolescentes com transtorno por uso de substâncias psicoativas ilícitas : um estudo de crossover, controlado com placebo

Introdução: O Transtorno de Déficit de Atenção/Hiperatividade (TDAH) é altamente prevalente em ad... more Introdução: O Transtorno de Déficit de Atenção/Hiperatividade (TDAH) é altamente prevalente em adolescentes com Transtorno por Uso de Substâncias Psicoativas (TUSP), podendo piorar a gravidade do TUSP. A efetividade dos psicoestimulantes ainda não foi avaliada nestes sujeitos. Objetivos: Avaliar a efetividade do metilfenidato de longa ação (MFD-LA) nos sintomas de TDAH em adolescentes com TDAH/TUSP. Secundariamente, avaliar o efeito do tratamento com MFD-LA sobre o uso de substâncias psicoativas (SPA), bem como a sua tolerabilidade. Método: Estudo de crossover, one-blind, controlado com placebo, sobre o efeito de doses escalonadas de MFD-LA nos sintomas de TDAH. Os participantes (N=16) foram randomicamente alocados ao grupo A (semanas 1-3 com MFD-LA e semanas 4-6 com placebo) ou B (ordem inversa). O desfecho primário foi a gravidade do TDAH (SNAP-IV e CGI-severidade). Foram aferidos o uso de SPA durante o protocolo e os efeitos adversos da intervenção (Barkley Scale). Análise estatística com mixed effect model. Resultados: A amostra caracterizou-se, sobretudo, por usuários de maconha, com escores basais no SNAP-IV e CGI-gravidade de 50.63 (SD=13.76) e 5.69 (SD=0.70), respectivamente. Os sujeitos, mediante o uso de MFD-LA, apresentaram melhora clínica superior ao placebo, com maiores reduções no SNAP-IV e CGI-gravidade (26.79, SD=9.08 vs. 38.09, SD=12.90 e 3.93, SD=1.00 vs. 4.93, SD= 1.08, respectivamente; pConclusões: o MFD-LA mostrou-se superior ao placebo no tratamento do TDAH em adolescentes com TDAH/TUSP, sem agravar o uso de SPA e com boa tolerabilidade.

Research paper thumbnail of Quality of life, social functioning, family structure, and treatment history associated with crack cocaine use in youth from the general population

Brazilian Journal of Psychiatry, 2015

Objective: To assess the relationship between crack cocaine use and dimensions of quality of life... more Objective: To assess the relationship between crack cocaine use and dimensions of quality of life and social functioning in young adults. Methods: This was a cross-sectional, population-based study involving 1,560 participants in Pelotas, Brazil. Crack cocaine use and abuse were investigated using the Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) inventory. Outcomes of interest were quality of life, religiosity, and social functioning in terms of education, occupational status, family structure, and medical treatment history. Results: Lifetime crack cocaine use was associated with poor quality of life, worse functioning, impaired academic performance, and lower religious involvement. A greater maternal presence and higher paternal absence were more also more pronounced in crack cocaine users, who were also more likely to seek psychological and psychiatric treatment than the general population. Conclusion: Quality of life was severely impacted by crack cocaine use, especially in terms of general and physical health. Social functioning also differed between the general population and crack users, who had lower educational attainment and religious involvement. Maternal presence, paternal absence, and mental health-seeking behaviors were also more frequent among crack cocaine users, although these individuals reported lower rates of treatment satisfaction. Crack cocaine users also had significant social impairment, so that interventions involving family management and a greater focus on general health, quality of life, and functioning may make crucial contributions to the recovery of this group.

Research paper thumbnail of Correlates of unprotected sex in a sample of young club drug users

Clinics (São Paulo, Brazil), 2013

To assess the demographic characteristics, psychiatric symptoms, substance use patterns, and sexu... more To assess the demographic characteristics, psychiatric symptoms, substance use patterns, and sexual risk behaviors in a sample of club drug users to identify factors associated with unprotected sex during the 12 months prior to the interview. This cross-sectional study employed the targeted sampling and ethnographic mapping approaches via face-to-face interviews conducted at bars and electronic music festivals using an adapted, semi-structured version of the Global Appraisal of Individual Needs questionnaire. The sample comprised 240 male and female young adults who had used ecstasy and/or LSD in the 90 days prior to the interview and who were not receiving treatment for alcohol or drug abuse. Of the 240 subjects selected (mean age: 22.9±4.5 years), 57.9% were men; of the male subjects, 52.5% reported having had unprotected sex in the previous 12 months. Of the total sample, 63.33% reported having had unprotected sex. Multivariate regression analysis showed that anal sex (PR = 1.26;...

Research paper thumbnail of BDNF levels of crack users are associated with clinical outcome during inpatient treatment

Drug and Alcohol Dependence, 2015

In nonclinical samples, young women have been shown to be more dependent on alcohol and perceive ... more In nonclinical samples, young women have been shown to be more dependent on alcohol and perceive less need to enter treatment when compared to older women (Wu and Ringwalt, 2004). Upon entering treatment, young women are more likely to drop out (Copeland and Hall, 2006) and generally have poorer treatment outcomes (Satre et al., 2004) than older women. Examination of factors that may explain treatment dropout and poorer treatment outcomes in younger women are needed. Methods: The present study examined differences between three age groups of women (18-25, 26-40, and 41-65) on multiple characteristics including trauma symptoms, anxiety, depression, alcohol dependence, craving, impulsivity, emotion regulation, and both self-reported craving and salivation following a cue reactivity procedure. Results: The sample (n = 56) was assessed at entry to a residential substance use treatment program, had a mean age of 32.41 (SD = 10.16), and was 85.7% Caucasian. The entire sample had a current diagnosis of PTSD, 98.2% were alcohol dependent, and 96.4% were drug dependent. Group differences were examined with one-way ANOVAs and any significant differences were examined with Bonferroni posthoc analyses. Results indicated young women reported significantly higher scores on the following measures when compared to older women: impulsivity (p = .01), difficulty regulating emotion (p = .02), craving (p = .02), and both self-reported craving (p = .02) and salivation (p = .03) following the presentation of combined trauma and alcohol cues. Conclusions: These findings suggest younger women, despite not differing from older women on level of alcohol dependence and trauma symptoms, reported significant elevations on multiple variables. Young women presenting to substance use treatment may benefit from interventions specifically targeting some of these areas (e.g., impulsivity and emotion regulation), as well as additional interventions for craving, which could lead to increased treatment retention and better treatment outcomes.

Research paper thumbnail of Evaluation of psychiatric symptoms in cocaine users in the Brazilian public health system: Need for data and structure

Research paper thumbnail of Alcohol use on premises of gas stations of Porto Alegre, Brazil: Pilot study | Uso de bebidas alcoólicas em postos de gasolina de Porto Alegre: Estudo piloto

Revista de Psiquiatria do Rio Grande do Sul, 2008

Introdução: O uso de álcool é um forte preditor de acidentes de trânsito. Este artigo descreve a ... more Introdução: O uso de álcool é um forte preditor de acidentes de trânsito. Este artigo descreve a factibilidade e dados preliminares de um estudo que avalia a alcoolemia entre jovens que utilizam bebidas alcoólicas em estacionamentos de postos de gasolina de Porto Alegre (RS). Método: Estudo transversal, com amostra em alvo, estratificada por idade e gênero. Os dados foram coletados através de um questionário autopreenchido, e a alcoolemia foi estimada com uso de bafômetro. Resultados: A taxa de recusa foi de 13,7%, e medida da alcoolemia acima de 0,06% foi encontrada em 35,5% (IC95% 24,3-47,9) da amostra. Aproximadamente 10% destes indivíduos (18% dos homens) relatavam intenção de dirigir nas 2 horas subseqüentes à coleta. Conclusão: É discutida a potencial utilização deste tipo de dado, bem como a necessidade de novos estudos sobre uso de substâncias em motoristas brasileiros. Descritores: Consumo de bebidas alcoólicas, acidentes de trânsito, assunção de riscos.

Research paper thumbnail of Psychiatric and substance-use comorbidities associated with lifetime crack cocaine use in young adults in the general population

Comprehensive Psychiatry, 2014

Research paper thumbnail of Tradução e adaptação da escala Motorcycle Rider Behavior Questionnaire: versão brasileira

Cadernos de Saúde Pública, 2012

Mundialmente os acidentes de trânsito aparecem como uma das principais causas de morte entre adul... more Mundialmente os acidentes de trânsito aparecem como uma das principais causas de morte entre adultos jovens. No Brasil, os acidentes de trânsito são mais prevalentes em condutores de moto do que nos dos demais veículos. Não dispomos, no entanto, de instrumentos para avaliar o comportamento no trânsito em motociclistas. Temos o objetivo de traduzir e adaptar para o português brasileiro o instrumento Motorcycle Rider Behavior Questionnaire (MRBQ). O processo consistiu em: duas traduções independentes para o português; unificação das traduções, gerando a primeira versão; retrotradução para o inglês; apreciação formal de equivalência semântica, elaboração e aplicação em uma amostra de conveniência; discussão dos itens com problemas e elaboração de uma versão final; retrotradução desta e envio para o autor original, sendo aceita pelo mesmo. A versão brasileira do MRBQ conservou a equivalência semântica. O instrumento, de autopreenchimento, conservou suas propriedades, mostrando-se de fác...

Research paper thumbnail of Age of Sexual Initiation, Psychiatric Symptoms, and Sexual Risk Behavior among Ecstasy and LSD Users in Porto Alegre, Brazil: A Preliminary Analysis

Journal of Drug Issues, 2011

Ecstasy and LSD use is widespread in large Brazilian cities, but there is limited information on ... more Ecstasy and LSD use is widespread in large Brazilian cities, but there is limited information on their use among young, middle-class, club goers in Brazil. We conducted standardized face-to-face interviews with 200 male and female ecstasy and/or LSD users, focusing on drug use and sexual history, current risk behaviors, and psychiatric symptomatology. Participants with early sexual debut (before 14) were more likely to report lifetime use of marijuana and powder and crack cocaine than those with later sexual initiation. Early sexual debut was associated with past year sexual risk behaviors, including having sex while high (Prevalence Ratio (PR)=1.3), having two or more sex partners (PR=1.3), as well as history of sexual abuse (PR=13.6). Depression and anxiety scores were similar by age of sexual initiation. The implications of these findings are discussed.

Research paper thumbnail of Ethical, legal and social issues related to alcohol and drug research

Current Opinion in Psychiatry, 2011

Purpose of review To present some highlights and comments about ethical, legal and social issues ... more Purpose of review To present some highlights and comments about ethical, legal and social issues related to alcohol and drug research. Recent findings Alcohol and drug research has a lack of scientific production related to ethical, legal and social issues. Many papers simply describe summarily the informed consent process and other related issues. Summary Informed consent process is one of the most important issues in research ethics. Obtaining a valid consent from a prospective research participant is always a challenge. We present many different ways to reach ethical, legal and social adequacy related to the informed consent process.

Research paper thumbnail of Crack Users Show High Rates of Antisocial Personality Disorder, Engagement in Illegal Activities and Other Psychosocial Problems

The American Journal on Addictions, 2012

The aim of this study was to compare three groups of Brazilian psychoactive substance (PAS) abuse... more The aim of this study was to compare three groups of Brazilian psychoactive substance (PAS) abuse patients (crack cocaine users, cocaine snorters, and non-cocaine PAS users) in terms of psychiatric comorbidities and severity of psychosocial problems. A cross-sectional, multi-center study was conducted at five Brazilian research centers. A total of 738 current PAS abusers seeking specialized treatment (outpatient and inpatient clinics) were assessed using the sixth version of the Addiction Severity Index (ASI-6): 293 patients using crack cocaine were compared with 126 using powder cocaine and 319 using non-cocaine PAS (mostly alcohol and marijuana). Psychiatric comorbidities were assessed in a smaller sample (290 cases), originating from three of the centers, using the Mini International Neuropsychiatric Interview Plus (MINI-Plus). Crack and powder cocaine users were significantly younger than non-cocaine PAS users (31.1 ± 8.1 and 32.9 ± 8.8 vs. 42.4 ± 12, respectively; p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; .001). Crack users presented a higher rate of antisocial personality disorder (25%) than powder cocaine (9%) and non-cocaine PAS users (9%), even when adjusted for confounding factors (Pr = 2.6; 95% CI 1.10-6.40). According to ASI-6 summary scores, crack users presented a significantly higher rate of occupational, family, and legal problems and reported more illegal and violent activities such as burglary and theft (23%) and threatening or assaulting (32%) than non-cocaine PAS users. Our findings, combined with the recent increase observed in the prevalence of crack use in Brazil, highlight the severity of psychiatric symptoms and psychosocial problems related to this powerful drug and corroborate the already suggested association between crack/cocaine, violence, and legal problems. Treatment programs for crack users should routinely consider the possibility of associated psychiatric comorbidities, such as antisocial personality disorder, which may affect treatment outcomes.