ARTHUR GUERRA DE ANDRADE
Projetos de Pesquisa
Unidades Organizacionais
Departamento de Psiquiatria, Faculdade de Medicina - Docente
13 resultados
Resultados de Busca
Agora exibindo 1 - 10 de 13
- 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.
- Pharmacological Treatment of Alcohol Cravings(2023) MARIN, Matheus Cheibub David; PEDRO, Maria Olivia Pozzolo; PERROTTE, Giuliana; MARTINS-DA-SILVA, Anderson S.; LASSI, Dangela L. S.; BLAAS, Israel Kanaan; CASTALDELLI, Fernando Ikeda; SANTOS, Maria Beatriz Brisola dos; KORTAS, Guilherme Trevizan; CAMPOS, Marcela Waisman; TORALES, Julio; VENTRIGLIO, Antonio; PERICO, Cintia de Azevedo-Marques; NEGRAO, Andre B.; LEOPOLDO, Kae; ANDRADE, Arthur Guerra de; MALBERGIER, Andre; CASTALDELLI-MAIA, Joao Mauricio(1) Background: The treatment of substance addiction is challenging and has persisted for decades, with only a few therapeutic options. Although there are some recommendations for specific treatments for Alcohol Use Disorder (AUD), there is no specific medication used to treat alcohol cravings, which could benefit millions of patients that are suffering from alcoholism. Cravings, or the urge to use drugs, refer to the desire to experience the effects of a previously experienced psychoactive substance. (2) Methods: We included original studies of alcohol abuse or dependence extracted from a controlled, blind, pharmacological treatment study which presented measures and outcomes related to alcohol cravings. (3) Results: Specific drugs used for the treatment of alcoholism, such as Naltrexone and Acamprosate, have had the best results in relieving craving symptoms, as well as promoting abstinence. Baclofen and anticonvulsants such as Gabapentin and Topiramate have shown good results in promoting abstinence and the cessation of cravings. (4) Conclusions: Specific drugs used for the treatment of alcoholism to obtain the best results can be considered the gold standard for promoting abstinence and relieving cravings. Anticonvulsants and Baclofen also had good results, with these medications being considered as second-line ones. Varenicline is an option for alcohol dependents who also concomitantly ingest tobacco.
- Investigating the Dimensional Diagnosis of ICD-11 Nicotine Dependence(2018) CASTALDELLI-MAIA, Joao Mauricio; MARTINS, Silvia S.; STORR, Carla L.; VIANA, Maria C.; ANDRADE, Laura H.; ANDRADE, Arthur G.We investigated the dimensionality and possible measurement bias of ICD-11 Nicotine Dependence (ND) criteria in a sample of smokers from a middle-income country. Data are from the Sao Paulo Megacity Project (part of World Mental Health Surveys) collected between 2005 and 2007 (n = 5,037). The current analyses were restricted to the 1,388 participants who smoked at least once a week for 2 months in their lifetime. Item response theory (IRT) was used to investigate the severity and discrimination properties of 8 selected criteria. Additionally, differential criteria functioning (DCF) with sociodemographic characteristics (income, gender, age, employment status, marital status, and education) was investigated. All analyses were performed in Mplus software taking into account complex survey design features. IRT results indicated that the criterion Given Up had the lowest probability of endorsement (highest severity). The criterion Larger/Longer had the highest probability of endorsement (lowest severity), but the highest value of discrimination. Physical Withdrawal had the lowest discrimination property. No DCF was found both at criterion-and disorder-level, which would tear measurement bias. The absence of measurement bias in all sociodemographic, psychiatric, and medical subgroups gives psychometrical support to this set of criteria for ICD-11 ND diagnosis.
- Brain Correlates of the Alcohol Use Disorder Pharmacotherapy Response: A Systematic Review of Neuroimaging Studies(2022) FLORENCE, Luiza; LASSI, Dangela Layne Silva; KORTAS, Guilherme T.; LIMA, Danielle R.; PERICO, Cintia de Azevedo-Marques; ANDRADE, Arthur G.; TORALES, Julio; VENTRIGLIO, Antonio; BERARDIS, Domenico De; AQUINO, Joao P. De; CASTALDELLI-MAIA, Joao M.Background: Although Alcohol Use Disorder (AUD) is highly prevalent worldwide, treating this condition remains challenging. Further, potential treatments for AUD do not fully address alcohol-induced neuroadaptive changes. Understanding the effects of pharmacotherapies for AUD on the human brain may lead to tailored, more effective treatments, and improved individual clinical outcomes. Objectives: We systematically reviewed the literature for studies investigating pharmacotherapies for AUD that included neuroimaging-based treatment outcomes. We searched the PubMed, Scielo, and PsycINFO databases up to January 2021. Study eligibility criteria, participants, and interventions: Eligible studies included those investigating pharmacotherapies for AUD and employing functional magnetic resonance imaging (fMRI), positron emission tomography (PET), single-photon emission computed tomography (SPECT), and/or proton magnetic resonance spectroscopy (H-MRS). Study appraisal and synthesis methods: Two independent reviewers screened studies' titles and abstracts for inclusion. Data extraction forms were shared among all the authors to standardize data collection. We gathered information on the following variables: sample size; mean age; sociodemographic and clinical characteristics; alcohol use status; study design and methodology; main neuroimaging findings and brain-regions of interest (i.e., brain areas activated by alcohol use and possible pharmacological interactions); and limitations of each study. Results: Out of 177 studies selected, 20 studies provided relevant data for the research topic. Findings indicate that: (1) Acamprosate and gabapentin may selectively modulate limbic regions and the anterior cingulate cortex; (2) Naltrexone and disulfiram effects may involve prefrontal, premotor, and cerebellar regions; (3) Pharmacotherapies acting on glutamate and GABA neurotransmission involve primarily areas underpinning reward and negative affective states, and; (4) Pharmacotherapies acting on opioid and dopamine systems may affect areas responsible for the cognitive and motor factors of AUD. Limitations: Most of the studies were focused on naltrexone. A small number of studies investigated the action of disulfiram and gabapentin, and no neuroimaging studies investigated topiramate. In addition, the time between medication and neuroimaging scans varied widely across studies. Conclusions: We identified key-brain regions modulated by treatments available for AUD. Some of the regions modulated by naltrexone are not specific to the brain reward system, such as the parahippocampal gyrus (temporal lobe), parietal and occipital lobes. Other treatments also modulate not specific regions of the reward system, but play a role in the addictive behaviors, including the insula and dorsolateral prefrontal cortex. The role of these brain regions in mediating the AUD pharmacotherapy response warrants investigation in future research studies.
- Outcome predictors of smoking cessation treatment provided by an addiction care unit between 2007 and 2010(2013) CASTALDELLI-MAIA, Joao Mauricio; CARVALHO, Carlos Felipe Cavalcanti; ARMENTANO, Fabio; FRALLONARDO, Fernanda Piotto; ALVES, Tania Correa de Toledo Ferraz; ANDRADE, Arthur Guerra de; NICASTRI, SergioObjective: To analyze the predictors of smoking cessation treatment outcomes in a sample with a high rate of medical and psychiatric disorders and addictions. Methods: Analysis of predictors of success of a 6-week treatment provided by an addiction care unit (CAPS-AD) to 367 smokers in Brazil from 2007 to 2010. Forty variables were collected at baseline. Success was defined as abstinence from smoking for a period of at least 14 consecutive days, including the last day of treatment. Twenty variables were selected for the logistic regression model. Results: The only condition correlated with successful treatment after logistic regression was smoking one's first cigarette 5 minutes or more after waking (beta = 1.85, 95% confidence interval [95% CI] = 1.11-3.10, p = 0.018). Subjects with hypertension and alcohol use disorders and those who were undergoing psychiatric treatment showed success rates comparable to or greater than the average success rate of the sample (34.2-44.4%). Conclusions: These findings support the importance of the variable time to first cigarette in treatment outcomes for a sample with a high rate of clinical and psychiatric disorders. Good success rates were observed for pharmacological treatment, which was combined with group therapy based on cognitive-behavioral concepts and integrated into ongoing treatment of other addictions and psychiatric disorders.
- Adolescent Characters and Alcohol Use Scenes in Brazilian Movies, 2000-2008(2016) CASTALDELLI-MAIA, Joao Mauricio; ANDRADE, Arthur Guerra de; LOTUFO-NETO, Francisco; BHUGRA, DineshQuantitative structured assessment of 193 scenes depicting substance use from a convenience sample of 50 Brazilian movies was performed. Logistic regression and analysis of variance or multivariate analysis of variance models were employed to test for two different types of outcome regarding alcohol appearance: The mean length of alcohol scenes in seconds and the prevalence of alcohol use scenes. The presence of adolescent characters was associated with a higher prevalence of alcohol use scenes compared to nonalcohol use scenes. The presence of adolescents was also associated with a higher than average length of alcohol use scenes compared to the nonalcohol use scenes. Alcohol use was negatively associated with cannabis, cocaine, and other drugs use. However, when the use of cannabis, cocaine, or other drugs was present in the alcohol use scenes, a higher average length was found. This may mean that most vulnerable group may see drinking as a more attractive option leading to higher alcohol use.
- Discussing prevalence, impacts, and treatment of substance use disorders in athletes(2016) GIL, Felipe; ANDRADE, Arthur Guerra de; CASTALDELLI-MAIA, Joao MauricioThe consumption of alcohol, tobacco, and other drugs has become a concern in high-performance athletes. Professional athletes are more exposed to drugs than the general population. Although some drugs are unquestionably detrimental to performance, several studies have nevertheless shown evidence of increased consumption of these substances within this sub-population. This review aimed to elucidate alcohol, tobacco, cocaine, cannabis, and opioid use among high-performance athletes, discussing the prevalence of substance use, its impacts, and alternatives to treatment in this special population. Unfortunately, no clinical trials for the treatment of substance use disorders were carried out with this specific sub-population. Therefore, the strategies adopted for the general population should be adapted to high-performance athletes. Psychological, psychosocial, psychoeducational, cognitive-behavioural, motivational interviewing approaches can be implemented. As regards pharmacological treatment, medications used in the treatment of alcohol and tobacco dependence, such as naltrexone, disulfiram, acamprosate, varenicline, bupropion, and nicotine replacement treatment can be used without problems. However, some medications used in cocaine and opioid dependence treatment, such as moldafinil and methadone, are prohibited by doping enforcement agencies. Professionals involved with athletes should be aware of the signs and symptoms of the acute effects of substances so as to enable an early identification of substance abuse problems, especially during training periods.
- 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.
- Immigrants, refugees and cannabis use(2022) KORTAS, Guilherme Trevizan; ABRAHAO, Ana Beatriz Balieiro; MALBERGIER, Andre; FIDALGO, Thiago Marques; MOURA, Helena; ANDRADE, Arthur Guerra de; NETO, Francisco Lotufo; TORALES, Julio; VENTRIGLIO, Antonio; CASTALDELLI-MAIA, Joao MauricioImmigration typically occurs from low- to high-income countries and regions. Unfortunately, these wealthier areas also have higher rates of cannabis use (e.g. European Union and the US). This systematic review aimed to summarize available studies on cannabis use among immigrants, refugees, and asylum seekers. In addition, evidence on the association between immigration and cannabis use was reviewed. The rates of cannabis use were lower among immigrants than natives. The risk and protective factors to cannabis use were quite similar to those of the native populations. The population at greatest risk for cannabis use were refugees, males, singles, non-religious, those with lower educational level, living in urban areas, with friends that use cannabis and/or other drugs. Cannabis use tend to increase over generations, and acculturation seems to play a pivotal role. First generation migrants report equal or lower consumption of cannabis when compared with the majority population with a subsequent increase in following generations, with a clear association with acculturation factors. A higher cannabis use was found among migrants with lower cultural congruity as well as a higher level of culture assimilation. This use seems to be unrelated to alcohol or illicit drugs consumption, but possibly associated with tobacco smoking.
- Use transition between illegal drugs among Brazilian university students(2014) CASTALDELLI-MAIA, Joao Mauricio; MARTINS, Silvia S.; OLIVEIRA, Lucio Garcia de; LAAR, Margriet van; ANDRADE, Arthur Guerra de; NICASTRI, SergioPurpose The aim of the present study was to test whether the first use of an illicit drug increases the chance of first use of other illicit drugs. Method The transitions from the first use of a drug to the first use of another drug were analyzed. Comparisons were made between first drug users and non-users. Survival analysis methods were used to compare the cumulative probability of second drug use after adjusting for socio-demographic covariates and the intermediate use of alcohol and/or tobacco. A total of 12,721 Brazilian university students participated in this study. Results Inhalants and marijuana were used prior to the use of several other drugs, whereas the opposite pattern was not found. Ecstasy was used before other drugs in several instances. Other well-examined drugs, such as amphetamines, cocaine and hallucinogens, were used both before and after other illicit drugs without any marked predominance for either of the two roles. Conclusions This study supports the role of the use of marijuana and inhalants almost exclusively before the use of other illicit drugs, whereas the use of ecstasy has an opposite role. These roles could be linked to the prevalence of lifetime use and whether individuals were at an earlier or later age during experimentation.