Estimating the size of the population of persons who inject drugs in the island of Montréal, Canada, using a six-source capture-recapture model

BACKGROUND: To plan and implement services to persons who inject drugs (PWID), knowing their number is essential. For the island of Montréal, Canada, the only estimate, of 11,700 PWID, was obtained in 1996 through a capture-recapture method. Thirteen years later, this study was undertaken to produce a new estimate. METHODS: PWID were defined as individuals aged 14-65 years, having injected recently and living on the island of Montréal. The study period was 07/01/2009 to 06/30/2010. An estimate was produced using a six-source capture-recapture log-linear regression method. The data sources were two epidemiological studies and four drug dependence treatment centres. Model selection was conducted in two steps, the first focusing on interactions between sources and the second, on age group and gender as covariates and as modulators of interactions. RESULTS: A total of 1480 PWID were identified in the six capture sources. They corresponded to 1132 different individuals. Based on the best-fitting model, which included age group and sex as covariates and six two-source interactions (some modulated by age), the estimated population was 3910 PWID (95% confidence intervals (CI): 3180-4900) which represents a prevalence of 2.8 (95% CI: 2.3-3.5) PWID per 1000 persons aged 14-65 years. CONCLUSIONS: The 2009-2010 estimate represents a two-third reduction compared to the one for 1996. The multisource capture-recapture method is useful to produce estimates of the size of the PWID population. It is of particular interest when conducted at regular intervals thus allowing for close monitoring of the injection phenomenon.

Capacité en matière de prise de décisions chez des récidivistes de conduite avec capacités affaiblies par l’alcool

Thomas G. Brown, Ph.D., co-directeur de recherche

Impact of psychiatric disturbance on identifying psychiatric disorder in relatives: study of mothers and daughters

Previous studies have suggested that collecting psychiatric data on relatives in family studies by asking probands to provide information on them leads to a bias in estimates of morbidity risk, because probands' accounts are influenced by their own psychiatric histories. We investigated this in a UK sample and found that daughters' anxiety disorder histories did not influence their reports of anxiety disorder in mothers, but their history of mood disorder/alcohol dependence made them more sensitive in predicting mood disorder/alcohol dependence in mothers.

Integrated motivational interviewing and cognitive behavioural therapy for people with psychosis and comorbid substance misuse: randomised controlled trial

Objectives To evaluate the effectiveness of integrated motivational interviewing and cognitive behaviour therapy in addition to standard care for patients with psychosis and a co-morbid substance use problem. Design Two-centre, open, rater-blind randomised controlled trial Setting UK Secondary Care Participants 327 patients with clinical diagnoses of schizophrenia, schizophreniform or schizoaffective disorder and DSM-IV diagnoses of drug and/or alcohol dependence or abuse Interventions Participants were randomly allocated to integrated motivational interviewing and cognitive behaviour therapy or standard care. Therapy has two phases. Phase one – “motivation building” – concerns engaging the patient, then exploring and resolving ambivalence for change in substance use. Phase two –“Action” – supports and facilitates change using cognitive behavioural approaches. Up to 26 therapy sessions were delivered over one year. Main outcomes The primary outcome was death from any cause or admission to hospital in the 12 months after therapy. Secondary outcomes were frequency and amount of substance use (Timeline Followback), readiness to change, perceived negative consequences of use, psychotic symptom ratings, number and duration of relapses, global assessment of functioning and deliberate self harm, at 12 and 24 months, with additional Timeline Followback assessments at 6 and 18 months. Analysis was by intention-to-treat with robust treatment effect estimates. Results 327 participants were randomised. 326 (99.7%) were assessed on the primary outcome, 246 (75.2%) on main secondary outcomes at 24 months. Regarding the primary outcome, there was no beneficial treatment effect on hospital admissions/ death during follow-up, with 20.2% (33/163) of controls and 23.3% (38/163) of the therapy group deceased or admitted (adjusted odds-ratio 1.16; P= 0.579; 95% confidence interval 0.68 to 1.99). For secondary outcomes there was no treatment effect on frequency of substance use or perceived negative consequences, but a statistically significant effect of therapy on amount used per substance-using day (adjusted odds-ratios: (a) for main substance 1.50; P=0.016; 1.08 to 2.09, (b) all substances 1.48; P=0.017; 1.07 to 2.05). There was a statistically significant treatment effect on readiness to change use at 12 months (adjusted odds-ratio 2.05; P=0.004; 1.26 to 3.31), not maintained at 24 months. There were no treatment effects on assessed clinical outcomes. Conclusions Integrated motivational interviewing and cognitive behaviour therapy for people with psychosis and substance misuse does not improve outcome in terms of hospitalisation, symptom outcomes or functioning. It does result in a reduction in amount of substance use which is maintained over the year’s follow up. Trial registration Current Controlled Trials: ISRCTN14404480

Adaptação e validação da escala de dependência de exercício físico em versão tradicional e informatizada

While providing physical and psychological benefits, excessive exercise could be or cause a compulsive behavior, making the individual dependent on it. In a parallel discussion, computerized psychological instruments, for a hand, reflects the development of information technology and your applicability to other areas, but also shows little advance for Psychological Assessment. In this perspective, this study aims to adapt the Exercise Dependence Scale (EDS-R) in two formats (paper-and-pencil and computerized) and evaluate evidence of factorial and convergent validity, and reliability of each version and compare them with each other. It is also proposed to observe the relationship of some bio-demographic (Sex, age, frequency, duration and intensity of practice exercise) and the exercise dependence (DEF). For this purpose, 709 regular physical activity practitioners, selected by procedures non-probabilistic sampling, responded a adapted version of EDS-R, Muscle Appearance Satisfaction Scale (MASS), Body Modification Scale (BMS) and a demographic questionnaire, analyzed through Exploratory Factor Analysis, Cronbach's Alpha and not parametric tests. Both the traditional version and the computer showed a seven factors structure, explaining 57 and 62% of the variance, respectively, and Cronbach's alphas of 0.83 and 0.89. Factors were: (1) intentionality, (2) continuity, (3) tolerance, (4) reduction of other activities, (5) lack of control, (6) abstinence and (7) time spent on exercise. Relationships were observed between the Exercise Dependence and the variables: age, diets, consumption of food supplements and medicines for weight change, desire to do plastic surgery and body satisfaction. We observed also a positive correlation between the DEF and the frequency, duration and intensity of exercise, and the factor "Dependence on exercising" from MASS, indicating convergent validity of the EDS-R. Finally, comparisons between the two formats were equivalent, with few changes: computerized version achieved higher DEF scores. Based on these results, it can be concluded that the EDS-R has factorial and convergent validity, reliability, to measure exerceise dependence on traditional e computerized formats. DEF is related to actions used to body modification and behaviors toward exercise. Finally, it was found equivalence between the formats, especially in psychometric parameters, thus suggesting feasibility of a computerized assessment. However, it was observed that the computerized data has sample recruiting strategies more limited

Tradução e adaptação da escala de dependência de substâncias do Millon Clinical Multiaxial III para o Brasil

Millon describes the normal personality by means of adaptation styles that are effective in normal environments and personality disorders such as unadapted operating styles. To operacionalize his theoretical model, Millon has built several instruments, including the Millon Clinical Multiaxial Inventory III (MCMI-III), wich consists of a self report inventory composed by 175 true or false response items, containing four verification scales, and others scales wich evaluates 14 personality patterns and 10 clinical syndromes. The Substance Dependence scale (T) is placed along with Clinical Syndromes scales. This research is justified by the lack of a Brazilian instrument to assess personality psychopathological aspects, and aims to translate and semantically adapt the MCMI-III to the Brazilian context, checking validity elements of the Substance Dependence scale, and developing a computer application for assisting the evaluation of assessment results. To this intent, 2.588 individuals data was collected, male and female, aged between 18 and 85 years, characterized as belonging to a clinical or non-clinical group, who took part in the survey via the internet or in person. Respondents completed the MCMI-III, a socio-demographic questionnaire and a subgroup also answered to the Goldberg General Health Questionnaire (GHQ). Besides descriptive statistics, we performed the analysis using the Student t test, principal components analysis and internal consistency. Despite difficulties related to translating very specific English terms, the assessment by judges, experts on Millon´s theory, and the back translation, attested the adequacy of the Brazilian version. Factorial analysis indicated the grouping of translated T scale items into three factors (social activities prejudice, lack of impulse control, and oppositional behavior), by presenting a single item on a fourth factor (apparently related to seeking pleasurable stimuli). The Cronbach alpha for this set of items was 0,82, indicating an acceptable scale reliability. The data analysis resulted in distinction of scores between clinical and non-clinical groups and between men and women; the relationship between high scores on the scale T and the other scales; scores of drug users according to the declared used substance; and the relationship between high scores on T and the verification of disorder or risk on GHQ mental health factor, indicating the instrument´s adequate sensistivity in identifying psychopathologies and the relationship between the different disorders or psychopathological personality patterns. Although further studies are necessary to develop the scores transformation factors, the computerized correction tool was adequate.

Alcoholic women and men: a comparative study of social and familial aspects and outcome

Objetivos: A proporção de ocorrência de alcoolismo em homens e mulheres tem uma variação de 14:1 até 2:1, mostrando a necessidade de estudos específicos para a população feminina. O objetivo deste estudo foi analisar o perfil e a evolução de alcoolistas, segundo gênero e gravidade da dependência. Métodos: Realizou-se um estudo longitudinal retrospectivo de 114 homens e 57 mulheres alcoolistas (CID-10), inscritos no ambulatório da Faculdade de Medicina de Botucatu, no período de 1990-1994 e avaliados até julho de 1997. Utilizou-se um questionário semi-estruturado, e, para avaliação da gravidade do alcoolismo, o Short Alcohol Dependence Data. Resultados/Conclusões: Os principais resultados mostraram que a estrutura familiar estava comprometida com: relacionamento difícil para 55,6% das mulheres e 65,7% dos homens; violência familiar em 74,1% das mulheres e 61,1% dos homens. As mulheres iniciaram a ingestão mais tarde que os homens (p=0,01), em geral com seus cônjuges (p=0,00). Não houve diferença de evolução no tratamento entre os gêneros. Os principais fatores associados à melhor resposta ao tratamento, independentemente do sexo, foram: nível de gravidade de dependência do álcool (dependentes leves e moderados apresentaram 5,59 vezes mais chances de melhorar do que os dependentes graves); ser praticante de alguma religião (2,3 vezes mais chances de melhora do que os pacientes que não eram praticantes); e tempo de seguimento no programa, negativamente correlacionado a chances de melhora (0,68 vezes menos chances de melhora que aqueles que permaneceram por tempo menor em tratamento).

Obsessive-compulsive disorder: Prevalence, comorbidity, impact, and help-seeking in the British National Psychiatric Morbidity Survey of 2000

Objective: There is little information about obsessive-compulsive disorder in large representative community samples. The authors aimed to establish obsessive-compulsive disorder prevalence and its clinical typology among adults in private households in Great Britain and to obtain generalizable estimates of impairment and help-seeking.Method: Data from the British National Psychiatric Morbidity Survey of 2000, comprising 8,580 individuals, were analyzed using appropriate measurements. The study compared individuals with obsessive-compulsive disorder, individuals with other neurotic disorders, and a nonneurotic comparison group. ICD-10 diagnoses were derived from the Clinical Interview Schedule-Revised.Results: the authors identified 114 individuals (74 women, 40 men) with obsessive-compulsive disorder, with a weighted 1-month prevalence of 1.1%. Most individuals (55%) in the obsessive-compulsive group had obsessions only. Comorbidity occurred in 62% of these individuals, which was significantly greater than the group with other neuroses (10%). Co-occurring neuroses were depressive episode (37%), generalized anxiety disorder (31%), agoraphobia or panic disorder (22%), social phobia (17%), and specific phobia (15%). Alcohol dependence was present in 20% of participants, mainly men, and drug dependence was present in 13%. Obsessive-compulsive disorder, compared with other neurotic disorders, was associated with more marked social and occupational impairment. One-quarter of obsessive-compulsive disorder participants had previously attempted suicide. Individuals with pure and comorbid obsessive-compulsive disorder did not differ according to most indices of impairment, including suicidal behavior, but pure individuals were significantly less likely to have sought help (14% versus 56%).Conclusions: A rare yet severe mental disorder, obsessive-compulsive disorder is an atypical neurosis, of which the public health significance has been underestimated. Unmet need among individuals with pure obsessive-compulsive disorder is a cause for concern, requiring further investigation of barriers to care and interventions to encourage help-seeking.

Consumo abusivo e dependência de álcool em população adulta no Estado de São Paulo, Brasil

OBJETIVO: Descrever as prevalências de consumo abusivo e dependência de álcool em população adulta de 20 a 59 anos no Estado de São Paulo, e suas associações com variáveis demográficas e socioeconômicas. MÉTODOS: Inquérito domiciliar do tipo transversal (ISA-SP), em quatro áreas do Estado de São Paulo: a) Região Sudoeste da Grande São Paulo, constituída pelos Municípios de Taboão da Serra, Itapecerica da Serra e Embu; b) Distrito do Butantã, no Município de São Paulo; c) Município de Campinas e; d) Município de Botucatu. Foi considerado consumo abusivo de álcool a ingestão em dia típico de 30 gramas ou mais de etanol para os homens, e 24 gramas ou mais para as mulheres. A dependência de álcool foi caracterizada pelo questionário CAGE. Análises bivariadas e multivariadas dos dados foram realizadas a partir de Modelos de Regressão de Poisson. Todas as análises foram estratificadas por sexo. RESULTADOS: em 1.646 adultos entrevistados, a prevalência de consumo abusivo de álcool foi de 52,9% no sexo masculino e 26,8% no sexo feminino. Quanto à dependência de álcool, foram observadas duas ou mais respostas positivas no teste CAGE em 14,8% dos homens e em 5,4% das mulheres que relataram consumir álcool. Isto corresponde a uma prevalência populacional de dependência de 10,4% nos homens e 2,6% nas mulheres. O consumo abusivo de álcool no sexo masculino apresentou associação inversa à faixa etária e associação direta à escolaridade e ao tabagismo. No sexo feminino, observou-se associação direta do consumo abusivo de álcool com a escolaridade e o tabagismo, e com as situações conjugais sem companheiro. A dependência de álcool no sexo masculino associou-se a não exercer atividade de trabalho e à baixa escolaridade. No sexo feminino não houve associação do CAGE com nenhuma das variáveis estudadas. CONCLUSÕES: Pela alta prevalência de consumidores e dependentes, é essencial a identificação dos segmentos sociodemográficos mais vulneráveis ao consumo abusivo e dependência de álcool. As associações entre a dependência/abuso e não estar exercendo atividade de trabalho, no sexo masculino, e a maior prevalência em mulheres de escolaridade universitária, sugerem componentes para programas de intervenção e controle.

Complicações psiquiátricas do uso crônico do álcool: síndrome de abstinência e outras doenças psiquiátricas

A síndrome de abstinência alcoólica é um quadro agudo, caracterizado por um conjunto de sinais e sintomas autolimitados, com gravidade variada, secundário à interrupção total ou parcial do consumo de álcool, podendo ser associado a inúmeros problemas clínicos e/ou outros transtornos psiquiátricos. O objetivo deste artigo é rever as principais complicações psiquiátricas secundárias à síndrome de abstinência alcoólica, como convulsões e delirium tremens, bem como algumas outras condições psiquiátricas associadas à dependência de álcool, como as síndromes de Wernicke Korsakoff e de Marchiava Bignami. Pretende-se, com isso, auxiliar no diagnóstico precoce e tratamento adequado, minimizando assim a morbidade e a mortalidade associadas a tais complicações.

A qualidade de vida de dependentes de álcool

Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES)

Qualidade de vida de mulheres alcoolistas atendidas em serviço ambulatorial

Pós-graduação em Saúde Coletiva - FMB

Obsessive-compulsive symptoms among alcoholics in outpatient treatment: prevalence, severity and correlates

Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq)

Associação entre Síndrome de burnout, uso prejudicial de álcool e tabagismo em profissionais de enfermagem nas unidades de teripa intensiva do Hospital das Clínicas de Botucatu-UNESP

Pós-graduação em Saúde Coletiva - FMB

Cocaine effects on mouse incentive-learning and human addiction are linked to alpha 2 subunit-containing GABA(A) receptors

Because GABA(A) receptors containing alpha 2 subunits are highly represented in areas of the brain, such as nucleus accumbens (NAcc), frontal cortex, and amygdala, regions intimately involved in signaling motivation and reward, we hypothesized that manipulations of this receptor subtype would influence processing of rewards. Voltage-clamp recordings from NAcc medium spiny neurons of mice with alpha 2 gene deletion showed reduced synaptic GABA(A) receptor-mediated responses. Behaviorally, the deletion abolished cocaine`s ability to potentiate behaviors conditioned to rewards (conditioned reinforcement), and to support behavioral sensitization. In mice with a point mutation in the benzodiazepine binding pocket of alpha 2-GABA(A) receptors (alpha 2H101R), GABAergic neurotransmission in medium spiny neurons was identical to that of WT (i.e., the mutation was silent), but importantly, receptor function was now facilitated by the atypical benzodiazepine Ro 15-4513 (ethyl 8-amido-5,6-dihydro-5-methyl-6-oxo-4H-imidazo [1,5-a] [1,4] benzodiazepine-3-carboxylate). In alpha 2H101R, but not WT mice, Ro 15-4513 administered directly into the NAcc-stimulated locomotor activity, and when given systemically and repeatedly, induced behavioral sensitization. These data indicate that activation of alpha 2-GABA(A) receptors (most likely in NAcc) is both necessary and sufficient for behavioral sensitization. Consistent with a role of these receptors in addiction, we found specific markers and haplotypes of the GABRA2 gene to be associated with human cocaine addiction.