PAULO JANNUZZI CUNHA
Projetos de Pesquisa
Unidades Organizacionais
LIM/21 - Laboratório de Neuroimagem em Psiquiatria, Hospital das Clínicas, Faculdade de Medicina
34 resultados
Resultados de Busca
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- 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.
- Effects of exercise training on brain metabolism and cognitive functioning in sleep apnea(2022) UENO-PARDI, Linda M.; SOUZA-DURAN, Fabio L.; MATHEUS, Larissa; RODRIGUES, Amanda G.; BARBOSA, Eline R. F.; CUNHA, Paulo J.; CARNEIRO, Camila G.; COSTA, Naomi A.; ONO, Carla R.; BUCHPIGUEL, Carlos A.; NEGRAO, Carlos E.; LORENZI-FILHO, Geraldo; BUSATTO-FILHO, GeraldoImpaired glucose metabolism reflects neuronal/synaptic dysfunction and cognitive function decline in patients with obstructive sleep apnea (OSA). The study investigated the extent to which exercise training (ET) improves cerebral metabolic glucose rate (CMRgl) and cognitive function in patients with OSA. Patients with moderate to severe OSA were randomly assigned to ET (3 times/week, n = 23) or no intervention (control, n = 24). Echocardiography and apolipoprotein epsilon 4 (APOE epsilon 4) genotyping were obtained at baseline. Both groups underwent cardiopulmonary exercise testing, polysomnography, cognitive tests, brain magnetic resonance imaging, and F-18-fluoro-2-deoxy-d-Glucose positron emission tomography ((18)FDG-PET) at baseline and study end. Compared with control, exercise-trained group had improved exercise capacity, decreased apnea-hypopnea index (AHI), oxygen desaturation and arousal index; increased attention/executive functioning, increased CMRgl in the right frontal lobe (P < 0.05). After ET an inverse relationships occurred between CMRgl and obstructive AHI (r = - 0.43, P < 0.05) and apnea arousal index (r = - 0.53, P < 0.05), and between the changes in CMRgl and changes in mean O-2 saturation during sleep and non-rapid eye movement sleep (r = - 0.43, P < 0.05), desaturation during arousal (r = - 0.44, P < 0.05), and time to attention function testing (r = - 0.46, P < 0.05). ET improves OSA severity and CMRg in the frontal lobe, which helps explain the improvement in attention/executive functioning. Our study provides promising data that reinforce the growing idea that ET may be a valuable tool to prevent hypoxia associated with decreased brain metabolism and cognitive functioning in patients with moderate to severe OSA.
- Executive functioning and outpatient treatment adherence after intensive inpatient care in cocaine dependence: A six-month follow-up study(2017) GONCALVES, Priscila Dib; OMETTO, Mariella; MALBERGIER, Andre; MARTINS, Paula; BERALDO, Livia; SANTOS, Bernardo; NICASTRI, Sergio; ANDRADE, Arthur; CUNHA, Paulo Jannuzzi
bookPart Transtornos relacionados ao trauma e ao estresse(2014) CORCHS, Felipe; BOTTINO, Sara Mota Borges; CUNHA, Paulo Jannuzzi; SCIVOLETTO, Sandra- 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.
- Decision-Making Deficits Linked to Real-life Social Dysfunction in Crack Cocaine-Dependent Individuals(2011) CUNHA, Paulo Jannuzzi; BECHARA, Antoine; ANDRADE, Arthur Guerra de; NICASTRI, SergioCrack cocaine-dependent individuals (CCDI) present abnormalities in both social adjustment and decision making, but few studies have examined this association. This study investigated cognitive and social performance of 30 subjects (CCDI x controls); CCDI were abstinent for 2 weeks. We used the Social Adjustment Scale (SAS), Wisconsin Card Sorting Test (WCST), and Iowa Gambling Task (IGT). Disadvantageous choices on the IGT were associated with higher levels of social dysfunction in CCDI, suggesting the ecological validity of the IGT. Social dysfunction and decision making may be linked to the same underlying prefrontal dysfunction, but the nature of this association should be further investigated. (Am J Addict 2010;00: 1-9).
- 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.
- Social skills and psychopathic traits in maltreated adolescents(2016) OMETTO, Mariella; OLIVEIRA, Paula Approbato de; MILIONI, Ana Luiza; SANTOS, Bernardo dos; SCIVOLETTO, Sandra; BUSATTO, Geraldo F.; NUNES, Paula V.; CUNHA, Paulo JannuzziChild maltreatment has frequently been associated with impaired social skills and antisocial features, but there are still controversies about the effect of each type of maltreatment on social behaviour. The aim of this study was to compare the social functioning and psychopathic traits of maltreated adolescents (MTA) with a control group (CG) and to investigate what types of maltreatments and social skills were associated with psychopathic traits in both groups. The types and intensity of maltreatment were evaluated through the Childhood Trauma Questionnaire (CTQ) in 107 adolescents, divided into the MTA group (n = 66) and non-maltreated youths (n = 41), our CG. The Hare Psychopathy Checklist: Youth Version (PCL: YV) and a detailed inventory for evaluation of social skills in adolescents were also applied in all individuals. MTA presented more psychopathic traits than the CG, in all domains measured by PCL: YV, independently of IQ levels and the presence of psychiatric disorders. Interestingly, the groups did not differ significantly from each other on indicators of social skills. Multiple regression analysis revealed that emotional neglect was the only maltreatment subtype significantly associated with psychopathic traits, more specifically with the PCL: YV interpersonal factor (F1), and that some social skills (empathy, self-control and social confidence) were related to specific psychopathic factors. The results highlight that emotional neglect may be more detrimental to social behaviours than physical and sexual abuse, and that neglected children require more specific and careful attention.