ARTHUR GUERRA DE ANDRADE
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Psiquiatria, Faculdade de Medicina - Docente
11 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 11
- The DSM-5 and the diagnosis of substance use disorders: Reflection about validity of the new criteria and possible ""missing pieces' in the puzzle(2015) LIMA, Danielle Ruiz; GONCALVES, Priscila Dib; MALBERGIER, Andre; AMARAL, Ricardo; ANDRADE, Arthur G.; CUNHA, Paulo Jannuzzi
- The role of neurocognitive functioning, substance use variables and the DSM-5 severity scale in cocaine relapse: A prospective study(2019) LIM, Danielle Ruiz; GONCALVES, Priscila Dib; OMETTO, Mariella; MALBERGIER, Andre; AMARAL, Ricardo Abrantes; SANTOS, Bernardo dos; CAVALLET, Mikael; CHAIM-AVANCINI, Tiffany; SERPA, Mauricio Henriques; FERREIRA, Luiz Roberto Kobuti; DURAN, Fabio Luis de Souza; ZANETTI, Marcus Vinicius; NICASTR, Sergio; BUSATTO, Geraldo Filho; ANDRAD, Arthur Guerra; CUNH, Paulo JannuzziBackground: The severity of substance use disorder (SUD) is currently defined by the sum of DSM-5 criteria. However, little is known about the validity of this framework or the role of additional severity indicators in relapse prediction. This study aimed to investigate the relationship between DSM-5 criteria, neurocognitive functioning, substance use variables and cocaine relapse among inpatients with cocaine use disorder (CUD). Methods: 128 adults aged between 18 and 45 years were evaluated; 68 (59 males, 9 females) had CUD and 60 (52 males, 8 females) were healthy controls. For the group with CUD, the use of other substances was not an exclusion criterion. Participants were tested using a battery of neurocognitive tests. Cocaine relapse was evaluated 3 months after discharge. Results: Scores for attention span and working memory were worse in patients compared to controls. Earlier onset and duration of cocaine use were related to poorer inhibitory control and global executive functioning, respectively; recent use was related to worse performance in inhibitory control, attention span and working memory. More DSM-5 criteria at baseline were significantly associated with relapse. Conclusions: Recent cocaine use was the most predictive variable for neurocognitive impairments, while DSM-5 criteria predicted cocaine relapse at three months post treatment. The integration of neurocognitive measures, DSM-5 criteria and cocaine use variables in CUD diagnosis could improve severity differentiation. Longitudinal studies using additional biomarkers are needed to disentangle the different roles of severity indicators in relapse prediction and to achieve more individualized and effective treatment strategies for these patients.
- The Route of Administration Exacerbates Prefrontal Functional Impairments in Crack Cocaine Users(2018) OLIVEIRA, Hercilio P.; GONCALVES, Priscila D.; OMETTO, Mariella; SANTOS, Bernardo; MALBERGIER, Andre; AMARAL, Ricardo; NICASTRI, Sergio; ANDRADE, Arthur G.; CUNHA, Paulo J.Studies have evidenced more severe health consequences in individuals who smoked crack cocaine as compared to intranasal cocaine users. Differential neurocognitive deficits between the crack and intranasal cocaine-addicted patients, associated with prefrontal cortex functions, have never been tested using complex cognitive tasks in humans. In this study, we examined possible distinct neurocognitive deficits in 43 crack-addicted patients (CrD) compared with 36 intranasal cocaine-addicted patients (CD) and 32 controls. CrD and CD were evaluated after 2 weeks of supervised detoxification in two inpatient treatment programs. All the subjects were evaluated using an extensive battery of neurocognitive tasks, including the Trail Making Test, the Stroop Color-Word Test, the Digits Forward and Digits Backward tasks, the Controlled Oral Word Association Test, the Wechsler Adult Intelligence Scale, and the Frontal Assessment Battery. Differences in performance in the neurocognitive tests between the three groups were investigated controlling for age, IQ, psychiatric symptoms, and years of education. Both intranasal and crack users were impaired on a variety of cognitive measures relative to controls. Crack users performed worse than intranasal cocaine users in inhibitory control (p = .05) and general executive functioning (p = .01). Crack use seems to be more deleterious to neurocognitive functions associated with the prefrontal cortex. This may predispose crack-addicted patients to more severe negative clinical outcomes.
- Distinct cognitive performance and patterns of drug use among early and late onset cocaine users(2017) LOPES, Bruna Mayara; GONCALVES, Priscila Dib; OMETTO, Mariella; SANTOS, Bernardo dos; CAVALLET, Mikael; CHAIM-AVANCINI, Tiffany Moukbel; SERPA, Mauricio Henriques; NICASTRI, Sergio; MALBERGIER, Andre; BUSATTO, Geraldo F.; ANDRADE, Arthur Guerra de; CUNHA, Paulo JannuzziIntroduction: Adolescence is a crucial period for neurodevelopment, but few studies have investigated the impact of early cocaine use on cognitive performance and patterns of substance use. Methods: We evaluated 103 cocaine dependent inpatients divided in two groups: early-onset users (EOG; n = 52), late-onset users (LOG; n = 51), and 63 healthy controls. Neuropsychological functioning was evaluated using Digits Forward (DF) and Backward (DB), Trail Making Test (TMT), Stroop Color Word Test (SCWT), Controlled Oral Word Association Test (COWAT), Wisconsin Card Sorting Test (WCST), Rey Osterrieth Complex Figure Test (ROCFT), Frontal Assessment Battery (FAB), and Iowa Gambling Test (IGT). Use of alcohol and other drugs was assessed with the Addiction Severity Index (ASI-6). Results: Analyses of covariance controlling for age, IQ and years of education showed that EOG presented worse performance in attention span (DF, p = 0.020), working memory (DB, p = 0.001), sustained attention (WCST, p = 0.030), declarative memory (ROCFT, p = 0.031) and general executive functioning (FAB, p = 0.003) when compared with the control group. LOG presented impairments on divided attention (TMT, p = 0.003) and general executive functioning (FAB, p = 0.001) in relation to the control group. EOG presented higher use of cannabis and alcohol than LOG (p <= 0.001). Conclusion: Early-onset cocaine users display more pronounced neuropsychological alterations than controls, as well as a greater frequency of polydrug consumption than LOG. The prominent cognitive deficits in EOG probably reflect the deleterious interference of cocaine use with early stages of neurodevelopment. This may be related to more severe clinical characteristics of substance disorder in this subgroup, including polysubstance abuse.
- Distinct effects of cocaine and cocaine plus cannabis on neurocognitive functioning and abstinence: A six-month follow-up study(2019) OLIVEIRA JUNIOR, Hercilio Pereira de; GONCALVES, Priscila di; OMETTO, Mariella; SANTOS, Bernardo dos; MALBERGIER, Andre; AMARAL, Ricardo; NICASTRI, Sergio; ANDRADE, Arthur Guerra de; CUNHA, Paulo JannuzziBackground and Aims: Cannabis use is frequent among individuals with cocaine use disorder. Despite recent non-controlled studies advocating a therapeutic role of smoked cannabis, there is a paucity of evidence-based data on potential therapeutic and cognitive side-effects of this association. Methods: We examined 63 cocaine-addicted subjects who used cannabis more than 50 times in lifetime (COC + CAN), 24 cocaine-addicted patients who use cannabis less than 50 times (COC), and 36 controls (CON). Participants were evaluated with an extensive battery of neurocognitive tests after two weeks of supervised detoxification in an inpatient treatment program. Patients were followed up in one, three, and six months after discharge. Results: Both groups of patients performed worse than CON on working memory, processing speed, inhibitory control, mental flexibility, and decision making. COC + CAN performed worse than COC on speed processing, inhibitory control and sustained attention, while COC performed worse than COC + CAN on mental flexibility. Concomitant cannabis use did not decrease relapses to cocaine use after one, three and six months. Among COC + CAN, earlier cocaine and cannabis use, and impaired executive functioning were predictive of relapse on cocaine after six months. Conclusion: Our results did not support the recommendation of smoked cannabis as a safe therapeutic approach for cocaine-addicted patients due to significant negative cognitive side-effects and absence of efficacy. Further studies investigating frontal brain morphology, neuromaturation, and prescription of the non-psychoactive constituent of cannabis sativa cannabidiol among cocaine-addicted patients who use cannabis are warranted.
- The association between low alcohol use and traffic risk behaviors among Brazilian college students(2012) GONCALVES, Priscila Dib; CUNHA, Paulo Jannuzzi; MALBERGIER, Andre; AMARAL, Ricardo Abrantes do; OLIVEIRA, Lucio Garcia de; YANG, Jasmine J.; ANDRADE, Arthur Guerra deAlthough there are a large number of studies focused on binge drinking and traffic risk behaviors (TRB), little is known regarding low levels of alcohol consumption and its association to TRB. The aim of this cross-sectional study is to examine the association of low to moderate alcohol intake pattern and TRB in college students in Brazil. 7037 students from a National representative sample were selected under rigorous inclusion criteria. All study participants voluntarily fulfilled a structured, anonymous, and self-questionnaire regarding alcohol and drug use, social-demographic data, and TRB. Alcohol was assessed according to the average number of alcoholic units consumed on standard occasions over the past 12 months. The associations between alcohol intake and TRB were summarized with odds ratio and their confidence interval obtained from logistic regression. Compared with abstainers students who consumed only one alcohol unit had the risk of being a passenger in a car driven by a drunk driver increased by almost four times, students who reported using five or more units were increased by almost five times the risk of being involved in a car crash. Compared with students who consumed one alcohol unit, the risk of driving under the influence of alcohol increased four times in students using three alcohol units. Age group, use of illicit drugs, employment status, gender, and marital status significantly influenced occurrence of TRB among college students. Our study highlights the potential detrimental effects of low and moderate pattern of alcohol consumption and its relation to riding with an intoxicated driver and other TRB. These data suggest that targeted interventions should be implemented in order to prevent negative consequences due to alcohol use in this population.
- Distinct effects of cocaine and cocaine + cannabis on neurocognitive functioning and abstinence: A six-month follow-up study (vol 205, 107642, 2019)(2020) OLIVEIRA JUNIOR, Hercilio Pereira de; GONCALVES, Priscila Dib; OMETTO, Mariella; SANTOS, Bernardo dos; MALBERGIER, Andre; AMARAL, Ricardo; NICASTRI, Sergio; ANDRADE, Arthur Guerra de; CUNHA, Paulo Jannuzzi
- Executive functioning and DSM-5 criteria for substance use disorder among addicted inpatients(2017) LIMA, Danielle Ruiz de; GONCALVES, Priscila Dib; OMETTO, Mariella; MALBERGIER, Andre; AMARAL, Ricardo; NICASTRI, Sergio; ANDRADE, Arthur; CUNHA, Paulo Jannuzzi
- Motivational Interviewing combined with chess accelerates improvement in executive functions in cocaine dependent patients: A one-month prospective study(2014) GONCALVES, Priscila Dib; OMETTO, Mariella; BECHARA, Antoine; MALBERGIER, Andre; AMARAL, Ricardo; NICASTRI, Sergio; MARTINS, Paula A.; BERALDO, Livia; SANTOS, Bernardo dos; FUENTES, Daniel; ANDRADE, Arthur G.; BUSATTO, Geraldo F.; CUNHA, Paulo JannuzziBackground: In cocaine-dependent individuals, executive function (EF) deficits are associated with poor treatment outcomes. Psychological interventions and pharmacological approaches have produced only modest effect sizes. To date, studies of this topic have been few and limited. The aim of this study was to examine the effects of a new model of intervention, which integrates chess and Motivational Interviewing, Motivational Chess (MC) Methods: We evaluated 46 cocaine-dependent inpatients (aged 18-45), in two groups-MC (n=26); and active comparison-AC (n=20). Using neuropsychological tests and an impulsivity scale, we assessed the subjects before and after the study period (one month of abstinence monitored by urine toxicology screening). Results: The MC and AC groups did not differ at baseline. In the post-intervention assessment (after one month), both groups showed significant improvements in attention, mental flexibility, inhibitory control, abstraction abilities, and decision-making (p<0.01). In addition, the improvement in working memory was more significant in the MC group than in the AC group (group-by-time interaction, p=01). Conclusions: One month of abstinence was sufficient to improve various attentional and executive domains in cocaine-dependent subjects. The MC intervention was associated with greater improvements in EFs, especially working memory, suggesting that tailored interventions focusing on complex EFs accelerate the process of cognitive recovery during the initial period of abstinence.
- Spirituality, religiosity and addiction recovery: Current perspectives(2019) BERALDO, L.; GIL, F.; VENTRIGLIO, A.; ANDRADE, A.G. de; SILVA, A.G. da; TORALES, J.; GONçALVES, P.D.; BHUGRA, D.; CASTALDELLI-MAIA, J.M.Substance use disorders are an important public health problem with a multifactorial etiology and limited effective treatment options. Within this context, spirituality-based approaches may provide interesting and useful options in managing substance use disorders. This kind of intervention can have positive effects in alleviating some core symptoms associated with substance use, such as aggressiveness. Improvement in cessation rates for alcohol, cocaine and opioid use disorders have also been described in some clinical studies. However, spirituality may not play a beneficial role in some subgroups, such as among individuals with crack cocaine and cannabis use disorders. A widely available intervention for alcohol use disorders is Alcoholics Anonymous (AA), which can be seen as a spirituality-based intervention. Spirituality also seems to be especially beneficial for minorities such as Latinos, African-Americans and Native-Americans. Moreover, spiritual-based interventions are also helpful alternatives in many rural environments where conventional healthcare for substance use disorders may not be easily available. However, spiritual-based interventions may be considered as a possible adjunctive therapeutic option to conventional treatments. There is a need for prospective studies outside U.S., especially where spiritual-based approaches are available. It may be difficult to carry out randomized controlled trials because of the nature of the spiritual/religious dimensions. However, prospective studies that evaluate mediation effect of spirituality and religiosity on recovery would be helpful. Qualitative studies combined with quantitative design offer excellent options to evaluate the recovery process, especially among special populations. © 2019 Bentham Science Publishers.