Objective: To review the literature regarding adolescent suicide risk and explore the associations between treatment compliance (expressed as a concept including measured adherence to treatment and/or mental health service utilization) and risk and protective factors for suicidal behavior (SB), as well as the association between treatment compliance and reattempts. Methods: PubMed, LILACS, and Google Scholar were searched using the following terms: (adolescent*) AND (suicide*) AND (risk factor OR protective factors) AND (treatment compliance OR treatment attrition OR treatment adherence OR treatment drop out OR treatment retention OR mental health utilization). We retrieved studies that focused on the relation of treatment compliance to risk and protective factors for SB and that had only adolescent samples. Results: Of 4,841 articles, 30 original articles were selected for review. Most studies indicated high mental health service (MHS) utilization and poor treatment adherence by SB patients. Social minority status and conduct disorder were associated with less treatment adherence, while female sex, parental perceived need for treatment, and major depression were associated with greater treatment adherence. Inpatient and intensive emergency care after SA and family interventions improved MHS utilization and treatment compliance. However, we found no substantial protective effect of treatment compliance against reattempts. Conclusion: Effective treatment planning for compliance requires considering psychopathology, treatment planning, and social, familial, and individual factors.

Objective: To conduct Brazil’s first clinical trial employing 3,4-methylenedioxymethamphetamine (MDMA)-assisted psychotherapy for post-traumatic stress disorder (PTSD), given its high prevalence resulting from epidemic violence. Methods: Of 60 volunteers, four matched the inclusion & exclusion criteria. Three patients with PTSD secondary to sexual abuse (diagnosed by the Structured Clinical Interview for DSM-IV and the Clinician Administered PTSD Scale for DSMV-4 [CAPS 4]) completed enrollment and treatment, following a standardized Multidisciplinary Association for Psychedelic Studies protocol consisting of 15 weekly therapy sessions: three with orally administered MDMA with concurrent psychotherapy and music, spaced approximately 1 month apart. CAPS-4 scores two months after the final MDMA session were the primary outcome. Results: No serious adverse events occurred. The most frequent adverse events were somatic pains and anguish. CAPS-4 reductions were always greater than 25 points. The final scores were 61, 27, and 8, down from baseline scores of 90, 78, and 72, respectively. All reductions were greater than 30%, which is indicative of clinically significant improvement. Secondary outcomes included lower Beck Depressive Inventory scores and higher Post-Traumatic Growth Inventory and Global Assessment of Functioning scores. Conclusions: Considering the current limitations in safe and efficacious treatments for PTSD and recent studies abroad with larger patient samples, MDMA-assisted psychotherapy could become a viable treatment in Brazil. Clinical trial registration: RBR-6sq4c9

OBJETIVO: Avaliar a relação entre o padrão de uso da cocaína e a perfusão cerebral de dependentes da substância. MÉTODOS: Estudou-se uma amostra de 30 dependentes de cocaína por meio de tomografia computadorizada por emissão de fóton único (single photon emission computed tomography - SPECT) com hexametil-propileno-amina-oxima, marcada com tecnécio 99 m (99 m-Tc-HMPAO), e comparou-se o padrão de perfusão cerebral com o padrão de consumo da droga. RESULTADOS: Dos dependentes, 80% apresentaram alterações de perfusão cerebral, focais ou difusas, com grau de intensidade variável. Não foram observadas diferenças de perfusão cerebral entre usuários de crack e usuários de cloridrato de cocaína. As alterações tomográficas tampouco permitiram distinguir os dependentes em abstinência dos dependentes na vigência do uso. Não foi possível evidenciar associação entre o relato da quantidade diária de droga utilizada e a perfusão cerebral dos pacientes. Entretanto, foi observada correlação entre o número de meses durante os quais os pacientes consumiram droga e o grau de comprometimento da perfusão cerebral (coeficiente de correlação de Spearman: r=0,45, p<0,05). CONCLUSÃO: Este estudo documenta a freqüência elevada de alterações funcionais cerebrais em dependentes de cocaína, estabelecendo a influência do tempo de consumo da droga no grau de comprometimento do fluxo cerebral dos pacientes.

OBJECTIVE: To evaluate the relationship between the pattern of cocaine use and cerebral perfusion among cocaine addicts. METHOD: A sample of 30 cocaine addicts was studied using 99 m-Tc-HMPAO SPECT (single photon emission computed tomography with injection of 99 m-Tc-hexametilpropilenoamina-oxime). Their cerebral perfusion pattern was then compared with their pattern of cocaine use. RESULTS: Eighty percent of the sample presented some degree of impairment in brain perfusion, either focal or diffuse. There was no difference between sniffers and crack smokers regarding their perfusion patterns. No relationship could be established between the severity of SPECT abnormalities and the amount of drug consumption or period of abstinence. However, length of cocaine use did correlate with the severity of cerebral perfusion (Spearman correlation coefficient: r=0.45, p<0.05). CONCLUSION: This study documents the high frequency of cerebral functional impairment in cocaine addicts and establishes the relationship between length of cocaine exposure and severity of perfusion abnormalities.

INTRODUÇÃO: Algumas formas de comportamento sexual podem assumir características dos comportamentos aditivos, merecendo a denominação de dependência de sexo. Este artigo descreve a adaptação, a validação e o estudo da confiabilidade de uma escala de 25 questões, desenvolvida nos Estados Unidos por Carnes em 1989, tendo como finalidade a identificação de casos de dependência de sexo. MÉTODO: Foi constituída uma amostra de 71 indivíduos, sendo 33 pacientes e 38 voluntários, que respondeu às questões da escala de rastreamento e aos critérios diagnósticos adaptados a partir do DSM IV para dependência de sexo. RESULTADOS: A versão brasileira da escala apresentou seu melhor desempenho ao se utilizar o ponto de corte 6, para o qual a sensibilidade obtida foi 0,83 e a especificidade 0,75. A consistência interna do instrumento foi de 0,89 (alfa de Cronbach). CONCLUSÃO: O uso desse tipo de instrumento dentro de um contexto cultural diferente daquele no qual o mesmo foi desenvolvido requereu o aprofundamento no estudo das propriedades psicométricas da versão adaptada.

INTRODUCTION: A condition in which individuals engage in some form of sexual behavior in a pattern that fits the definition of an addictive disorder can be considered as sexual addiction. This article describes the aspects of adaptation, validation and reliability of a 25-item instrument devised by Carnes in 1989 to detect cases of sexual addiction in the US. METHOD: To a sample of 71 subjects, 33 patients and 38 volunteers, was administered the screening scale and applied the provisional diagnostic criteria for Sexual Addiction according to DSM IV. RESULTS: The adapted version of the scale to be used in Brazil performed better in identifying potential cases at a cut-off score of 6 (sensibility = 0.83; specificity = 0.75). Internal consistency of the instrument measured by the Cronbach’s alpha was 0.89. CONCLUSION: The use of this instrument in a cultural setting other than the one it was developed for required an in-depth study of its psychometric properties.