ABSTRACT Objective: To compare lung function between adolescents with and without substance use disorder (SUD). Methods: This was an observational, cross-sectional exploratory study. The sample consisted of 16 adolescents with SUD and 24 age-matched healthy controls. The adolescents in the clinical group were recruited from a psychiatric inpatient unit for detoxification and rehabilitation; their primary diagnosis was SUD related to marijuana, cocaine, or polysubstance use. Questionnaires and pulmonary function tests were applied for clinical evaluation. Results: We found that FVC, FEV1, and their percentages of the predicted values were significantly lower in the adolescents with SUD than in those without. Those differences remained significant after adjustment for BMI and the effects of high levels of physical activity. The largest effect size (Cohen’s d = 1.82) was found for FVC as a percentage of the predicted value (FVC%), which was, on average, 17.95% lower in the SUD group. In addition, the years of regular use of smoked substances (tobacco, marijuana, and crack cocaine) correlated negatively with the FVC%. Conclusions: This exploratory study is innovative in that it demonstrates the early consequences of smoked substance use for the lung health of adolescents with SUD.

RESUMO Objetivo: Comparar a função pulmonar de adolescentes com e sem transtornos relacionados ao uso de substâncias (TUS). Métodos: Trata-se de um estudo exploratório transversal observacional. A amostra foi composta por 16 adolescentes com TUS e 24 controles saudáveis emparelhados pela idade. Os adolescentes do grupo clínico foram recrutados em uma unidade de internação psiquiátrica para desintoxicação e reabilitação; seu diagnóstico primário era o de TUS (maconha, cocaína ou polissubstâncias). Foram aplicados questionários e testes de função pulmonar para a avaliação clínica. Resultados: A CVF, o VEF1 e seus valores em porcentagem do previsto foram significativamente mais baixos nos adolescentes com TUS do que naqueles sem TUS. Essas diferenças permaneceram significativas após os ajustes para levar em conta o IMC e os efeitos de altos níveis de atividade física. O maior tamanho de efeito (d de Cohen = 1,82) foi o observado em relação à CVF em porcentagem do previsto (CVF%), que foi, em média, 17,95% menor no grupo TUS. Além disso, os anos de uso regular de substâncias fumadas (tabaco, maconha e crack) correlacionaram-se negativamente com a CVF%. Conclusões: Este estudo exploratório é inovador na medida em que demonstra as consequências precoces do uso de substâncias fumadas para a saúde pulmonar de adolescentes com TUS.

Abstract Objective: To evaluate sleep characteristics of parents and their children during the COVID-19 pandemic and predictors for sleep disturbances. Methods: Cross-sectional web-based study using an online survey made available for dyads of parents and their children during the 7th week of quarantine in southern Brazil. Parents' and adolescents’ sleep were characterized using the Pittsburgh Sleep Quality Index and the Epworth Sleepiness Scale. For children aged 0-3 years parents completed the Brief Infant Sleep Questionnaire, for those aged 4-12 years the Sleep Disturbance Scale for Children. Parents also informed, subjectively, their perception about sleep habits during social distancing. Multiple regression was run to predict sleep disturbances in adults using independent variables: sex, income, education, children age, and children with sleep disturbances. Results: Data from 577 dyads showed sleep alterations in 69,8% of adults, in 58,6% of children aged 0-3 years, 33,9% in the 4-12 years range (with a predominance of disorders of initiating or maintaining sleep), and 56,6% in adolescents. Sex (female) and children with sleep disturbances were significant predictors of a sleep problem in parents (p < 0.005). Subjective perception revealed complaints related to emotional concerns such as anxiety and fear in adults and due to alterations in routine in children and adolescents. Conclusion: The present study’s data showed an increased rate of sleep problems among families during quarantine both measured by validated instruments and also based on personal perception.

Abstract Objective: This study aimed to review the literature, summarizing the existing evidence on the effects of the pandemic on children, adolescents and parents, with an emphasis on the psychological, emotional, and sleep quality consequences. Source of data: Empirical studies identified in the following databases: MEDLINE, ISI Web of Knowledge/Web of Science, and preprint servers. Synthesis of data: The findings point to a wide range of consequences for children and adolescents resulting from the COVID-19 pandemic, which mainly includes an increase in depressive mood symptoms. There is also an increase in anxiety symptoms, suicidal ideation, as well as potential delays in language and motor development resulting from deprivation of social interaction and the closing of schools. These effects are more severe due to previous neuropsychiatric conditions. For parents, there is an increase in anxiety, depressive and post-traumatic symptoms, which are more accentuated in those who suffered socioeconomic damage due to the pandemic. There was an important increase in situations of violence towards children by parents and caregivers during the pandemic. Also, changes in routine and fear of the pandemic have negatively impacted sleep quality, globally. Conclusions: It is noteworthy that most studies published to date used a cross-sectional design and applied online screening questionnaires. The few studies with a longitudinal design suggest that these changes may have been transitory and more prevalent at the beginning of the pandemic.

Abstract Introduction Delinquent behaviors are risky behaviors that increase during puberty and reach their highest peak in late adolescence. It has been proposed that poor decision-making and theory of mind (ToM) are key cognitive processes implicated with delinquency during adolescence, affecting evaluation of risks and impairing appreciation of social norms. Nevertheless, it is not yet clear whether adolescent offenders who are subjected to provisional deprivation of liberty due to conflict with the law (adolescents in conflict with the law [ACL]) might, in fact, present a specific profile with regard to these cognitive processes. Objectives To assess deliberative decision-making and ToM among adolescents in conflict with the law and adolescents not in conflict with the law. Methods The sample comprised 62 participants: ACL (n = 29) and a control group (CG) (n = 33). ToM was assessed with the Reading the Mind in the Eyes Test (RMET) and decision-making was assessed with the Columbia Card Task (CCT). Substance use, callous-unemotional traits, childhood maltreatment, and intelligence quotient (IQ) were also assessed. Results ACL had more ToM errors for negative mental states in comparison to CG, but not for error rates concerning neutral and positive mental states. With regards to decision-making, our results suggest that ACL group members did not vary their behavior based on the available information and that the risk information had an opposite effect on the number of cards chosen (risk-taking behavior) when compared to CG. Conclusion These findings have important implications for development of interventions for these adolescents, suggesting that they tend to learn little from negative outcomes and have reduced capacity to process negative emotions.

Introdução : Há evidências robustas na literatura indicando que os maus-tratos na infância podem afetar negativamente a saúde física e mental. Além disso, há um crescente interesse em compreender a ocorrência e as consequências dessas experiências. Vários instrumentos vêm sendo desenvolvidos para investigar retrospectivamente experiências de maus-tratos na infância, mas a maioria deles não investiga a experiência de testemunhar violência familiar durante a infância ou a ocorrência de bullying . Além disso, a maioria não identifica quando as experiências ocorreram, quem estava envolvido ou os sentimentos que evocaram, como desespero ou terror. A escala Maltreatment and Abuse Chronology of Exposure (MACE) foi desenvolvida para superar essas limitações. Objetivos : Considerando as vantagens dessa nova escala em relação aos instrumentos de autorrelato existentes e o reduzido número de questionários de autorrelato disponíveis no Brasil para avaliar maus-tratos na infância, este estudo teve como objetivo conduzir a adaptação transcultural da escala MACE para o português brasileiro. Método : Foram realizadas as etapas de tradução, retrotradução, análise de equivalência semântica e correspondência conceitual por um comitê avaliador e teste de aceitabilidade. Resultados : Adaptações semânticas e estruturais foram realizadas na entrevista para a realidade cultural brasileira, e todos os 75 itens incluídos na versão estendida da MACE foram traduzidos. Os resultados do teste de aceitabilidade sugerem que os itens foram adequadamente compreendidos. Conclusões : A escala MACE é uma ferramenta útil para a investigação de maus-tratos na infância, contribuindo para a pesquisa no Brasil. Futuros estudos devem considerar testar a validade e fidedignidade das três versões do instrumento traduzidas para o português do Brasil.

Introduction : There is strong evidence to indicate that childhood maltreatment can negatively affect both physical and mental health and there is increasing interest in understanding the occurrence and consequences of such experiences. While several tools have been developed to retrospectively investigate childhood maltreatment experiences, most of them do not investigate the experience of witnessing family violence during childhood or bullying exposure. Moreover, the majority of scales do not identify when these experiences may have occurred, who was involved or the feelings evoked, such as helplessness or terror. The Maltreatment and Abuse Chronology of Exposure (MACE) scale was developed to overcome these limitations. Objective : In view of the improvements over previous self-report instruments that this new tool offers and of the small number of self-report questionnaires for childhood maltreatment assessment available in Brazil, this study was conducted to conduct cross-cultural adaptation of the MACE scale for Brazilian Portuguese. Method : The following steps were performed: translation, back-translation, committee review for semantic and conceptual evaluation, and acceptability trial for equivalence. Results : Semantic and structural changes were made to the interview to adapt it for the Brazilian culture and all 75 of the items that comprise the longer version of MACE were translated. The results of the acceptability trial suggest that the items are comprehensible. Conclusion : The MACE scales may be useful tools for investigation of childhood maltreatment and make a valuable contribution to research in Brazil. Future studies should consider testing the availability and reliability of the three versions of the instrument translated into Brazilian Portuguese.

Introdução: Tem sido demonstrado que o transtorno bipolar (TB) tem um impacto direto sobre o funcionamento neurocognitivo e o comportamento. Tais achados têm fomentado outros estudos para investigar o efeito de programas de aprimoramento cognitivo como potenciais intervenções no TB, focados principalmente no treino cognitivo e no funcionamento diário e não restrito a psicoeducação e estratégias de enfrentamento de problemas, como os tratamentos psicossociais tradicionais. Objetivo: Este estudo apresenta uma revisão sistemática de ensaios clínicos controlados que avaliaram reabilitação cognitiva (RC) para TB. Nosso objetivo principal é descrever os resultados desses estudos acerca de programas de reabilitação para TB e questões metodológicas relacionadas. Métodos: Foram realizadas pesquisas em bancos de dados (MEDLINE, Web of Science e Embase) para identificar artigos utilizando termos relacionados a RC e TB. A qualidade metodológica de cada artigo foi mensurada usando a escala JADAD de 5 itens. Resultados: Um total de 239 artigos foram identificados inicialmente, dos quais apenas quatro foram analisados nesta revisão após aplicação dos critérios de exclusão. Uma média de 17 horas de sessões de intervenção foram realizadas, com uma distribuição de 0,95 horas por semana. Três dos quatro estudos relataram melhor desempenho na função executiva após intervenções de RC. Conclusões: Não foram encontradas evidências suficientes que sustentem a reabilitação cognitiva como um tratamento efetivo do TB, devido: 1) à variedade de modelos de intervenção; 2) às limitações metodológicas dos estudos; e 3) à escassez de estudos na área.

Introduction: It has been shown that bipolar disorder (BD) has a direct impact on neurocognitive functioning and behavior. This finding has prompted studies to investigate cognitive enhancement programs as potential treatments for BD, primarily focusing on cognitive reinforcement and daily functioning and not restricted to psychoeducation and coping strategies, unlike traditional psychosocial treatments. Objective: This study presents a systematic review of controlled trials of cognitive rehabilitation (CR) for BD. Our main objective is to describe the results of studies of rehabilitation programs for BD and related methodological issues. Method: Electronic database searches (MEDLINE, Web of Science, and Embase) were conducted to identify articles using terms related to BD and CR. The methodological quality of each article was measured using the 5-item Jadad scale. Results: A total of 239 articles were initially identified, but after application of exclusion criteria, only four were retained for this review. An average of 17 hours of intervention sessions were conducted, distributed as 0.95 hours per week and three of the four studies reported better executive function performance after CR interventions. Conclusions: We did not find robust evidence to support cognitive rehabilitation as an effective treatment for BD, because of: 1) the variety of intervention designs; 2) the methodological limitations of the studies; and 3) the lack of studies in the field.

Las funciones ejecutivas constituyen un conjunto de habilidades que incluye la resolución de problemas, la planificación, la iniciación, el autocontrol, la conciencia ante situaciones nuevas y la capacidad de modificar los planes si es necesario. Se trata de funciones de alto nivel cognitivo, que son cruciales para que una persona mantenga sus actividades diarias y para la promoción de una buena calidad de vida. El déficit en estas funciones se conoce como síndrome disejecutivo (SD). Hay muchos modelos teóricos sobre SD; sin embargo, la literatura no es muy clara en relación con los componentes involucrados ni con la forma de investigar y resolver este problema. Varios estudios muestran que la edad, el consumo de sustancias y la psicopatología pueden afectar a algunas de estas funciones a través de daños en los circuitos frontales asociados a ellos. El efecto de este daño puede poner en peligro las actividades rutinarias del día a día, imponer dificultades en la socialización y afectar su vida laboral. Hay un cuerpo creciente de estudios que tratan de determinar las causas, consecuencias y modelos que son capaces de dar cuenta de estos efectos y promover estrategias de tratamiento más eficaces. Este artículo pretende hacer una revisión de la SD, centrándose en los aspectos relacionados más importantes, tales como las comorbilidades, la reserva cerebral, la reserva cognitiva y los programas de rehabilitación.

Executive Functions (EF) concern a range of abilities including problem-solving, planning, initiation, selfmonitoring, conscious attention, cope with new situations and the ability to modify plans if necessary. It's a high cognitive function that is crucial for a person to get engaged and maintain daily activities whilst keeping a good quality of life. Problems in the EF were formerly known as Dysexecutive Syndrome (DS). There are many models concerning DS, although the literature on the subject still remains unclear. Several works appoint the effects brought by elderly life, as well as abuse of drugs and some psychopathologies. These factors are known to increase the distress of the frontal circuits and that could be associated to executive deficits. The effects of DS would compromise individuals in day-to-day routine, academic, social and labor fields. There is a growing body of studies trying to determine the causes, implications, associations and the best way to take care of these effects. This work intends to review DS, focusing on the most important fields related to this area, such as psychopathology associations, cognitive reserve, assessment and cognitive rehabilitation programs.

As funções executivas constituem um conjunto de habilidades que envolvem o planejamento e a resolução de problemas, desde a iniciação, consciência e auto controle de comportamentos frente a novas situações, além da capacidade de modificar tais planos quando necessário. As funções executivas envolvem um alto grau de controle cognitivo e são cruciais para atender as atividades diárias e manter uma qualidade de vida. Os déficits associados a estas funções é denominado Síndrome Disexecutiva (SD). Existem muitos modelos teóricos que procuram elucidar a SD, no entanto, a literatura não é muito clara quanto os componentes envolvidos, formas de investigar e estratégias para resolver estes déficits. Vários estudos apontam que os efeitos da idade, do consumo de substâncias e de psicopatologias podem contribuir para a deterioração de circuitos frontais associados aos déficits executivos, comprometendo ainda mais o funcionamento diário, acadêmico, social e laboral. Existe um vasto campo de estudos visando determinar as causas, implicações, fatores associados e a melhor forma de lidar com estes efeitos. O presente artigo busca revisar estudos acerca da SD, focando em aspectos centrais como psicopatologias, reserva cognitiva e programas de reabilitação cognitiva.

Este estudo investigou como ocorre o processo de tomada de decisão em dependentes de crack pelo instrumento Iowa Gambling Task (IGT). Foram selecionados 30 participantes para o grupo de dependentes de crack - GDC, e 15 controles não usuários - GNU, de ambos os sexos. Para avaliar a intensidade de craving utilizou-se o Cocaine Craving Questionnaire-Brief. Houve diferenças significativas entre os grupos tanto no cálculo total, como no cálculo por blocos. A curva de aprendizagem do GDCmanteve-se constante e negativa na maior parte do jogo, havendo apenas no final um indício de aprendizagem. Em relação à classificação do desempenho na tarefa, as análises evidenciaram que um significativo número de participantes controles obtiveram desempenho não-prejudicado, oposto ao desempenho do GDC. As diferenças entre os grupos investigadas no IGT corroboraram com achado de estudo anterior, que evidenciou prejuízo no processo de tomada de decisão associado à dependência de cocaína e de crack.

This study investigated how decision-making process occurs in crack dependents through the Iowa Gambling Task (IGT). 30 participants were selected to crack dependent group - GDC, and 15 non-users controls - GNU, from both sexes. We used the Cocaine Craving Questionnaire-Brief to assess the craving intensity. There were significant differences between groups both in the total-calculus score and in the blocks scores. The learning curve of the GDC was constant and negative during almost all game, except in the very ending when a suggestion of learning was observed. Regarding the task performance's classification, the analysis showed that a significant number of controls participants achieved a non-impaired performance, opposed to GDC performance. The differences between groups investigated in the IGT corroborate with a previous study finding, about a worse decision-making process associated with cocaine and crack addiction.

OBJETIVO: Verificar a ocorrência de trauma e transtorno de estresse pós-traumático (TEPT) em uma amostra de mulheres dependentes de cocaína tipo crack. MÉTODO: A amostra foi composta por 99 mulheres, entre 18 e 52 anos, internadas em uma unidade de desintoxicação e extensamente avaliadas por meio da SCID-I e a ASI-6. RESULTADOS: Verificou-se uma taxa de exposição a trauma de 86,9% entre mulheres dependentes de cocaína tipo crack. A taxa de TEPT na amostra foi de 15,1%. Os clusters de revivescência e hiperexcitabilidade foram os mais frequentes - 24,4% e 20,9% respectivamente. Entre os tipos de eventos relatados, os mais frequentes foram sofrer agressão/abuso físico e ser testemunha de violência a outros. CONCLUSÃO: Os resultados sugerem uma frequente exposição a eventos traumáticos. Com relação à idade da experiência traumática, sugere-se que as usuárias expostas a trauma durante a infância e adolescência apresentam um início do uso de drogas em idades mais precoces que aquelas cujo trauma ocorreu na vida adulta.

OBJECTIVE: To determine the occurrence of trauma and posttraumatic stress disorder (PTSD) in a sample of women addicted to crack cocaine type. METHOD: The sample comprised 99 women, between 18 and 52 years admitted to a detoxification unit and extensively assessed by SCID-I and ASI-6. RESULTS: There was a trauma exposure rate of 86.9% among women addicted to crack cocaine type. The rate of PTSD in the sample was 15.1%. The clusters of reexperiencing and hyperarousal were the most frequent, 24.4% and 20.9% respectively. Among the types of events reported most frequently were suffering assault/physical abuse and witnessing violence to others. CONCLUSION: The results suggest a frequent exposure to traumatic events. With regard to age of the traumatic experience, it is suggested that users exposed to trauma during childhood and adolescence showed a beginning drug use at earlier ages than those whose trauma occurred in adulthood.

A exposição prolongada a múltiplos eventos traumáticos de natureza interpessoal, sobretudo durante o desenvolvimento, tem demonstrado consequências e sintomas psiquiátricos não considerados pelo atual diagnóstico de transtorno de estresse pós-traumático (TEPT). Essas situações negativas e crônicas durante a infância e adolescência evidenciam a existência de uma síndrome psicopatológica associada a complexas (des)adaptações a efeitos traumáticos diversos. A ausência de um diagnóstico coeso e fidedigno para essas vítimas interfere negativamente na identificação sintomatológica e no método de tratamento. O presente trabalho visa revisar a definição de trauma, apresentando o conceito de trauma complexo, explorando suas implicações clínicas, bem como as categorias diagnósticas derivadas desse constructo. Importantes questões são levantadas acerca das diferenças entre trauma complexo e TEPT, investigando os sintomas e transtornos comórbidos ao diagnóstico de TEPT, assim como as limitações inerentes a esse diagnóstico. Considerando o impacto psicopatológico relacionado ao trauma complexo, discute-se a possível inserção de uma nova categoria diagnóstica na 5ª versão do Manual Diagnóstico e Estatístico dos Transtornos Mentais, adjunta ao espectro de psicopatologias pós-traumáticas.

Prolonged exposure to multiple traumatic events of an interpersonal nature, particularly during development, has shown psychological consequences and symptoms not included among the current diagnostic criteria of post-traumatic stress disorder (PTSD). These negative and chronic situations during childhood and adolescence provide further evidence of the existence of a psychopathological syndrome associated with complex (dis)adaptations to a number of traumatic effects. The absence of a cohesive and reliable diagnosis for these patients negatively affects symptom identification and treatment planning. The aim of the present study was to review the definition of trauma, presenting the concept of complex trauma and investigating its clinical implications and the diagnostic categories deriving from this construct. Important questions are raised about differences between complex trauma and PTSD, followed by an investigation of PTSD symptoms and comorbid disorders, as well as the limitations of PTSD diagnosis. Taking into consideration the psychopathological impact associated with complex trauma, the article discusses the possibility of including a new diagnostic category in the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders is discussed, as part of the spectrum of post-traumatic psychopathologies.