Dissertations / Theses on the topic 'Psychotropic drug use'

Aim: The overall aim of this thesis was to study mental distress, health and lifestyle habits, social factors and psychotropic drug use by young people, and how PHNs conceive their roles in relation to this. Methods: Quantitative and qualitative methods were used. Study I included data  from the Norwegian Youth Health Study (NYHS, 11 620 participants, aged 15-16 years) (2000–2003) linked to the Norwegian Prescription Database (NorPD) (2004–2009). Study II included prescription data on psychotropic drugs among 15-16 year olds from the NorPD (2006–2010). Eight young people were interviewed and qualitative content analysis was used to analyse the data (III). Study IV included interviews with 20 Public Health Nurses (PHN), and was analysed using a phenomenographic approach. Main results: Mental distress was reported among 15.5% of the adolescents non-users of psychotropic drugs, 75% of whom were girls. In both genders reporting mental distress, incident psychotropic use was higher one to nine years, up to 27.7% among girls, as compared with the rest of the participants. In addition, health, lifestyle habits and social factors were associated with incident use (I). Psychotropic drug use increased during 2006–2010, hypnotics and melatonin accounted for most of the increase. In total, 16.4% of all incident psychotropic drug users in 2007 were still having prescriptions dispensed in 2010 (II). Young people experience both beneficial and undesired effects from psychotropic drugs. Access to professional support and follow-up was experienced as insufficient. Life with family, friends, school and work was influenced by psychotropic drug use, and they were afraid of being lonely and stigmatized (III). The PHNs conceived their roles in relation to young people as; the discovering PHNs who became aware of psychotropic drug use in the health dialogues and chose either to act or not to act in relation to this. Those PHNs who took action continued to be the cooperating PHNs who cooperated with the young people, their families, schools, and others. If cooperation was established, the supporting PHNs teach and support the young people in relation to psychotropic drug use (IV). Conclusions: Attention must be paid to poor mental health and increasing psychotropic drug use by young people. Advances in knowledge, treatment and follow-up are needed. The prevalence of mental distress among young people, with differences between the genders, as well as between socioeconomic groups, should have consequences for health promotion strategies. PHNs in Norway, working in health centres and schools, have responsibility and opportunity to identify and follow-up young people with mental health problems.
Baksidestext International studies indicate an increase in mental distress and psychotropic drug use among young people. In this thesis mental distress is reported among 15.5 % of the young people. Of those reporting mental distress 75 % were girls. One quarter of the girls reporting mental distress at 15-16 years of age was incident users of psychotropic drugs one to nine years later. Psychotropic drug use, increase among young people, particularly hypnotic drugs. The young people experience beneficial and undesired effects of the psychotropic drugs. They miss out on professional availability and follow-up, and experience negative reactions related to their psychotropic drug use by their significant others. The public health nurse who discovers psychotropic drug use among young people chooses either to act or not to act in relation to this. Those who choose to act continue to cooperate with the young people and others. An established cooperation was followed by a public health nurse who supports and teaches the young people. The prevalence of mental distress, with a high frequency of initiation of psychotropic drug use among young people should have consequences for health promotion in the school health service. Public health nurses, working in health centers and schools, have a responsibility to promote health and prevent health problems. They have the responsibility and opportunity to identify young people struggling with mental health problems and psychotropic drug use as well as teach and support significant others.

Old people in general, and those affected by dementia disorders in particular, are more sensitive to drug side effects than younger people. Despite this, the use of nervous system drugs and analgesics among old people is common, and has increased in recent years. Institutional geriatric care accommodates people who need round-the-clock supervision and care, due to somatic, psychiatric, cognitive or behavioral symptomatology. A majority of those living in institutional geriatric care suffers from dementia disorders. This thesis is based on three different data collections. Two large cross-sectional studies, the AC1982 and AC2000 data collections, including all those living in institutional geriatric care in the county of Västerbotten in May 1982 and 2000 respectively (n=3195 and n=3669) and one study, the GERDA/Umeå 85+ data collection, including a sample of very old people, living at home and in institutions (n=546), in the municipalities of Umeå, Sweden and Vaasa and Mustasaari, Finland, in 2005-2006. The use of psychotropic drugs and analgesics was common among old people living in geriatric care and among very old people in general. A higher proportion of people with dementia received certain nervous system drugs, such as antipsychotic drugs. The use of antipsychotic drugs among people with cognitive impairment living in geriatric care was found to be correlated to several behaviors and symptoms that are not proper indications for antipsychotic drug use, and also factors related more to the staff and the caring situation. Over the course of eighteen years, from 1982 to 2000, there has been a manifold increase in the use of antidepressants, anxiolytics and hypnotics in geriatric care, but the use of antipsychotics had decreased slightly. During the same time, the prevalence of several depressive symptoms decreased significantly, correcting for demographical changes. One analysis of calculated numbers needed to treat, however, indicated poor remission rates, suggesting that even better results might be achievable. The prevalence of depressive symptoms among people with moderate cognitive impairment remained unchanged between 1982 and 2000, despite the fact that about 50% were receiving treatment with antidepressants in 2000. One possible explanation might be that depressive symptoms have different etiologies in different stages of a dementia disorder. Approximately a quarter of the people experiencing pain in geriatric care were not receiving any regular analgesic treatment. One possible reason might be misconceptions among the caring staff regarding whether or not the residents were receiving analgesic treatment. Such misconceptions were found to be common. In conclusion, psychotropic and analgesic drug use among old people in geriatric care, and very old people in general, was found to be common and in many cases possibly inappropriate. The use of antipsychotics among people with dementia deserves particular concern, because of the high risk of severe adverse events and the limited evidence for positive effects. The use of antidepressants, on the other hand, might have contributed to a lower prevalence of depressive symptoms among old people.

The overall aim of this study was to investigate the association between family structure in childhood and mental health problems in young adulthood. A prospective cohort study was conducted with 481,777 individuals with complete follow-up information, which was obtained from national registers in Sweden. Individuals who were living with only one biological parent at age 17 were compared with those who grew up with two parents with regard to retrieval of prescribed psychotropic drugs at age 35. The association was examined by Cox regression analyses with equal survival time for all individuals included in the analyses. The results demonstrated a higher risk for retrieval of psychotropic medicines among the individuals who grew up with only one parent, with hazard ratio of 1,21 (95%CI: 1,19-1,23). The multivariate analyses showed that a part of the association was explained by familial and individual factors, namely parents’ country of origin, area of residence, parents’ and the individual’s educational attainment, receipt of social benefits and parents’ history of psychiatric disorder. The results indicated that the increased risk of mental health problems among individuals who grew up with only one parent might be accounted for by various psychological, social and economic factors associated to parental separation.

Background: There is a widespread and increasing use of psychoactive prescription drugs, such as opioid analgesics, anxiolytics, hypnotics and anti-epileptics, but their use is associated with a risk of drug use disorder, misuse and abuse. Today, these are globally recognized and emerging public health concerns. Aim: The aim of this thesis is to estimate the prevalence of psychoactive prescription drug (PPD) use disorders, misuse and abuse, and to investigate the association with some potential risk factors. Methods: A study using register data from forensic cause of death investigations investigated and described cases of fatal unintentional intoxication with tramadol (Study I). Based on register data on spontaneously reported adverse drug reactions (ADRs) reported cases of tramadol dependence were investigated and summarised (Study II). In a study in suspected drug-impaired drivers with a toxicology analysis confirming the intake of one out of five pre-specified PPDs, the prevalence of non-prescribed use was assessed and associated factors were investigated (Study III). From a cohort of patients initiating prescribed treatment with pregabalin, using data on prescription fills, a study investigated longitudinal utilisation patterns during five years with regards to use of the drug above the maximum approved daily dose (MAD), and factors associated with the utilisation patterns (Study IV). Results: In the first study, 17 cases of unintentional intoxications were identified, of which more concerned men, the median age was 44 years and the majority used multiple psychoactive substances (alcohol, illicit drugs and prescription drugs). The second study identified 104 spontaneously reported cases of tramadol dependence, in which more concerned women, the median age was 45 years, and a third reported a history of substance abuse and 40% of past psychoactive medication use. In the third study, more than half of the individuals suspected of drug-impaired driving used the drug without a recent prescription. Non prescribed use was most frequent in users of benzodiazepines and tramadol, and was more likely in younger individuals and in multiple-substance users. In the last paper five longitudinal utilisation patterns were found in pregabalin users, with two patterns associated with a particularly high risk of doses above the maximum approved dosing recommendation. This pattern of use was associated with male sex, younger age, non-urban residency and a recent prescribed treatment with an antiepileptic or opioid analgesic drug. Conclusions: This thesis shows that psychoactive prescription drug use disorders, misuse and abuse occur and may have serious and even fatal consequences. The prevalence varies between different drugs and populations. Abuse and misuse seem to be more common in young people. Fatal intoxications and misuse of prescribed drugs may be more common in men, while drug use disorders following prescribed treatment may be more common in women and non-prescribed use equally distributed between women and men. Individuals with a history of mental illness, substance use disorder or abuse, or of past use of psychoactive medications are likely important risk groups. In summary, the findings suggest a potential for improvements in the utilisation of psychoactive prescription drugs. The results may be useful in the planning of clinical and regulatory preventive interventions to promote the rational, individualised and safe use of such drugs.

Psychotropic drugs are mind affecting compounds. They range in type from illegal narcotic analgesics such as heroin, to prescribed major tranquillisers used for treatment of psychotic states, to prescribed minor tranquillisers such as the benzodiazepines, Valium and Mogadon, to the freely available, over the counter drugs, Aspirin and Panadol. Overseas and Australian data show the minor tranquilliser group, benzodiazepines, first introduced on the pharmaceutical scene in the early 1960s, to be the most commonly prescribed psychotropic drugs. Their popularity with medical practitioners as prescription drugs for conditions of anxiety, stress, insomnia and some forms of epilepsy, arises from the advertised inference by drug companies that they are free from any side effects in the patient such as dependence, tolerance and on termination of treatment, absence of withdrawal syndrome. Benzodiazepines were first introduced as a substitute for the well known dependence producing barbiturate based sedatives. Overseas and Australian data show women are prescribed psychotropic drugs, particularly benzodiazepines, twice as often as men and in many instances for conditions unrelated to those for which the drugs are recommended. Australian data comes from two sources, official statistics such as the Pharmaceutical Benefits Scheme and from surveys of drug use. Both sources of data are incomplete, inaccurate and in many cases misleading. The true picture of prescribed psychotropic drug use in Australia therefore lacks resolution and in all probability underestimates prevalence and patterns of use in the community. There is no data on the prevalence and patterns of use of prescribed psychotropic drugs in the Australian Capital Territory. It was therefore deemed appropriate to conduct a survey to determine their prevalence and patterns of use. The survey was confined to women for several reasons: Women are a target group in the Commonwealth and State Government 'Drug Offensive'; evidence from studies overseas and in Australia shows that women are prescribed psychotropic drugs, particularly benzodiazepines, twice as often as men; Australian data suggests that this trend is uniform and therefore the Australian Capital Territory should be no different. Data shows that doctors, particularly General Practitioners, are the main source of prescribed psychotropic drugs. The main psychotropic drugs prescribed by general practitioners are benzodiazepines. It was therefore deemed appropriate to conduct a survey of general practitioner's attitudes, knowledge and beliefs about the appropriate use of benzodiazepines as these factors carry weight in a doctor's prescribing habits. The survey of women was conducted using a standardised, structured, telephone survey on a random sample of 120 women in the Australian Capital Territory. The results of the survey show that 40% of the sample had used prescribed psychotropics at some stage in their lives. Most users were older women, married, well educated and working full time. Level of knowledge about the drug was low, compliance with respect to use was high. Most prescribed psychotropic drugs were obtained from a doctor. There appears to be little drug sharing or concurrent drug use. Half of the prescribed psychotropics were benzodiazepines the other half were mostly anti-depressants. Use of over the counter psychotropics was very high. The survey of general practitioners was conducted using a standardised, structured mailed questionnaire distributed to a random sample of 25 general practitioners in the Australian Capital Territory. The results show the majority of doctors prescribe the drugs for common indications (anxiety, stress, insomnia and some forms of epilepsy) in excess of one week. For specific anxiety states however, most prescribe the drugs along with some form of counselling. The majority of doctors (77%) think counselling is not as effective as drug treatment. All doctors surveyed think patients should be advised of the drugs effects on driving and machinery operation; the drugs should not be shared with others; that the drugs should not be terminated abruptly; the drugs should not be used concurrently with alcohol. The majority (92%) believe benzodiazepines are over prescribed and most doctors (77%) believe the drugs produce dependence in patients. The majority (58%) believe women of child bearing age are at risk using benzodiazepines while 50% think pregnant women are at risk. The majority of doctors did not believe that people older than 60 years of age are at risk but most believe children are at risk. The findings of both surveys have implications for health educators and others with a concern for drug education in the community. Recommendations arising from this study have been made. They are presented at the conclusion of this thesis.

Cette thèse vise à clarifier ce que les sociétés contemporaines désignent par « usage de drogue » et les types d’objets, d’expériences et de pratiques sociales référés à ces usages. L’anthropologie ne fournit pas de définition opératoire et ni la sociologie de la déviance qui circonscris l’usage de drogue aux cadres normatifs (Ogien A., 1995 et 2000 ; Becker H., 2001), ni les définitions médico-pharmacologiques qui classent les psychotropes en fonction de leurs propriétés, ne suffisent à rendre compte de l’expérience à la fois individuelle et collective de « l’usage de drogue ». Si nous disposons avec la notion de « fuitage pharmaceutique » (Lovell, 2008) d’un concept pour décrire le processus qui conduit d’un médicament à l’usage de drogue, nous ne disposons pas de cadre épistémologique pour expliquer pourquoi et comment ? Il nous manque le point de vue intérieur de ceux par qui s’opère cette reconfiguration et le contexte anthropologique dans lequel celle-ci s’inscrit. En l’absence d’une compréhension des processus sémiotiques qui tiennent ensemble, les dynamiques neuropharmacologiques, l’expérience singulière du consommateur et l’inscription sociale de l’usage, il est difficile d’en comprendre le sens. L’anthropologie sémiotique (Lassègue, Rosenthal, Visetti, 2009), nous permet de comprendre comment la reconfiguration de l’usage d’un antalgique en drogue apparaît comme forme symbolique au XIXe siècle par le geste littéraire de Thomas De Quincey (Vigarello, 1991). Des outils d’analyse sémiotique, nous permettent de mettre en évidence, dans le cas du Subutex®, les liens entre contexte socio-historique, fabrique de la norme et invention d’une nouvelle drogue. Ils nous permettent d’analyser l’histoire des transformations des formes sémiotiques d’usages de drogue du XVIIIe siècle à nos jours. Dès lors, il est légitime de s’interroger si la transformation de l’usage thérapeutique en usage de drogue est la seule transformation symbolique possible dans le champ sémiotique des usages de psychotropes ? À partir de ce cadre épistémologique appliqué à différents matériaux, nous montrerons que le rapport d’Homo sapiens aux psychotropes s’organise à partir d’opérateurs de diversification sémiotique se déployant dans des activités chamaniques, religieuses, sociales, médicales, scientifiques, technologiques, artistiques, économiques, politiques, médiatiques, etc. Ce point étant acquis, nous proposerons de formaliser le rapport d’Homo sapiens aux psychotropes selon six motifs existentiels d’usages : Proesthésique, Épiphanique, Curatif, Mélioratif et anti-Mélioratif, Affiliatif. Ce système sémiotique dynamique nous fournit les bases pour construire le socle d’une anthropologie sémiotique des psychotropes
This thesis aims to clarify what contemporary societies refer to as "drug use" and the types of objects, experiences and social practices referred to these uses. Anthropology does not provide an operative definition, neither does the sociology of deviance which locates drug use in normative frameworks (Ogien A., 1995 and 2000; Becker H., 2001), nor the medical-pharmacological definitions that classify psychotropic drugs according to their properties : they are not sufficient to account for both individual and collective experience of "drug use". The concept of "pharmaceutical leakage" (Lovell, 2008) makes it possible to describe the process that leads from a medical use to a drug use but it does not provide an epistemological framework which would explain why and how. What is lacking is the inner perspective of the actors themselves in anthropological contexts. Failing to understand the semiotic processes that hold together neuropharmacological dynamics, the singular experience of the user and the social inscription of use, it becomes difficult to understand their meaning. Semiotic anthropology (Lassègue, Rosenthal, Visetti, 2009), allows us to understand the reconfiguration of an analgesic drug into a symbolic form as the literary gesture of Thomas De Quincey (Vigarello, 1991) amply shows. Tools of semiotic analysis allow us to highlight, in the case of Subutex®, the links between the socio-historical context, the construction of the norm and the invention of a new drug. They allow us to analyze the history of transformations in the semiotic forms of drug use from the 18th century to the present day. It is therefore legitimate to ask whether the transformation of a therapeutic use into a drug use is the only possible symbolic transformation in the semiotic field of psychotropic drug use. Applying the epistemological framework of semiotic anthropology to various fields, we will show that the relationship of Homo sapiens to psychotropic drugs is organized into semiotic operators that are instrumental in shamanic, religious, social, medical, scientific, technological, artistic, economic, political, etc. activities. We propose to formalize the relationship of Homo sapiens to psychotropic drugs according to six existential motifs of use : Proesthesic, Epiphanic, Curative, Meliorative and anti-Meliorative, Affiliative. This semiotic system dynamically provides us with the foundation of a semiotic anthropology of psychotropic drugs and their uses

This thesis explores the perceived relationship between spirituality and psychiatric medication use in individuals living with severe mental health problems. The biological approach to mental health treatment is the dominant paradigm of care across the Western world, which justifies the use of psychopharmacology as a first-line therapy. In the last 30 years, the steady rise in the use of prescription medications has generated much debate and controversy. Historically, much of what we know about psychiatric medication comes from professionals and experts. Comparatively little is known about the perspectives of service users. There is also strong evidence to suggest that religion and spirituality are playing a growing role in addressing mental health problems. Both spirituality and psychiatric medication are known to mediate the processes of wellness and recovery, yet it is not well understood how their interactions may impact upon recovery. The intention of this thesis was to explore this unknown area. The methodology used in this thesis was hermeneutic phenomenology. A purposive sample of twenty people who self-identified as spiritual and/or religious, and were or had in the past taken psychiatric medication participated. Data were collected via in-depth, unstructured interviews, and analysed using a modified approach, based on the works of other researchers. The key finding in this study is that people experienced a multiplicity of interactions between spirituality and psychiatric medication which significantly impacted treatment outcomes, in both positive and negative ways. The overall findings of this research highlights the need for greater awareness of spirituality as a nonpharmacological factor which can impact upon drug treatment outcomes.

Abstract The elderly use drugs more commonly than younger persons. Many studies about drug use have concentrated on institutionalized elders. Knowledge of drug use by the oldest old, aged 85 years or over, is scant. Psychotropics are among the drugs most commonly used by the elderly. Psychotropics have many adverse effects, such as balance impairment, sedation, reduced cognition, depression, and extrapyramidal symptoms. We do not know the extent of sedative drug use, including psychotropics and drugs prescribed for somatic disorders that have sedative properties. Withdrawal of unnecessary drugs appears to be beneficial and to improve the functional capacities of the elderly. The aim of this study was to describe the changes in prescription drug use, polypharmacy, and psychotropic use among home-dwelling elderly Finns in the 1990s by using two cross-sectional community surveys. The specific aim was to classify all drugs used in Finland into four groups based on their sedative properties. Drug use, polypharmacy, and, to some extent, psychotropic use increased within a decade. The oldest old used prescription drugs most commonly. Polypharmacy was independently associated with higher age, and in 1998-99, with at least 3 chronic diseases, poor self-perceived health, and the use of home nursing services. Most psychotropic users were on regular medication. The use of hypnotics and antidepressants increased most. Persons with polypharmacy used significantly more commonly psychotropics compared to other people. Over 84-year-olds used psychotropics more commonly than younger persons. Sedative use was common, as 40 % of drug users used them. Sedative use was significantly more common among persons with polypharmacy than others. According to logistic regression models, the use of many sedatives was independently associated with age 80 years or over, female gender, chronic morbidity, smoking, poor self-perceived health/life satisfaction, and the use of home nursing. Both polypharmacy and abundant sedative use were associated with impaired physical functional abilities. Prescribers need to be aware of the increasing polypharmacy and abundant sedative use. Regular assessment of indications is needed to avoid overuse of drugs. Geriatric knowledge is needed to support health centers and specialized units in this demanding task.

Dementia is a major public health problem worldwide. Emerging research indicates that clinical infections and PTSD could be important risk factors for dementia. However, evidence for infections and the risk of dementia primarily examines central nervous system (CNS) infections. Extant epidemiological evidence for systemic bacterial infections and the risk for dementia is limited while that for PTSD and the risk for dementia did not account for psychotropic medications commonly used in management of PTSD and could affect cognitive function. The purpose of this study was to 1) review the evidence for CNS infections as possible causes of Alzheimer’s disease (AD) dementia, and 2) using nationwide Veterans Health Administration databases, conduct original retrospective cohort analyses in nationally representative samples of U.S. veterans aged 56 years and older to determine the associations between systemic bacterial infections, PTSD, and psychotropic PTSD medication use with the risk for developing dementia. Review of the research pertaining to an infectious AD etiology hypothesis including the various mechanisms through which different clinical and subclinical infections could cause or promote the progression of AD, and the concordance between putative infectious agents and the epidemiology of AD showed evidence linking AD to an infectious cause to be largely inconclusive; however, the amount of evidence suggestive of an association is too substantial to ignore. Analysis of the associations between systemic bacterial infections and the risk for dementia showed a significant association between exposure to any systemic bacterial infection and an increased risk for dementia (hazard ratio [HR] = 1.20; 95% confidence interval [CI] = 1.16-1.24) after adjustment for demographic characteristics, and medical and psychiatric comorbidity. In addition, septicemia (HR=1.39; 95%CI=1.16-1.66), bacteremia (HR=1.22; 95%CI=1.0-1.49), osteomyelitis (HR=1.20; 95%CI=1.06-1.37), pneumonia (HR=1.10; 95%CI=1.02-1.19), UTI (HR=1.13; 95%CI=1.08-1.18), and cellulitis (HR=1.14; 95%CI=1.09-1.20) were independently associated with significantly increased risk of developing dementia after adjustment for potential confounders. Analysis of the associations between PTSD and psychotropic PTSD medication use with the risk for dementia showed a significant association between PTSD and the risk for dementia (HR=1.35; 95%CI=1.27-1.43) after adjustment for demographic characteristics, medical and psychiatric comorbidity, and health care utilization. Analysis of the impact of psychotropic PTSD medications including selective serotonin reuptake inhibitors (SSRI), serotonin-norepinephrine reuptake inhibitors (SNRI), benzodiazepines (BZA), novel antidepressants (NA) and atypical antipsychotics (AA) on the association between PTSD and the risk for dementia showed significant interactions between PTSD and use of SSRIs (p<.0001), NAs (p=.0016), and AAs (p<.0001). Multivariate analysis showed a significant association between PTSD and an increased risk for dementia among individuals not using any psychotropic PTSD medications at baseline (HR=1.70; 95%CI=1.58-1.82). PTSD patients using SSRIs (HR=2.10; 95%CI=1.82-2.41), NAs (2.19; 95%CI=1.94-2.48) or AAs (4.56; 95%CI=4.04-5.15) were significantly more likely to develop dementia compared to those without PTSD and not using any psychotropic PTSD medications. PTSD patients using SSRIs (HR=1.24; 95%CI=1.08-1.42), NAs (HR=1.29; 95% CI=1.14-1.46) or AAs (HR=2.69; 95%CI=2.38-3.04) were also significantly more likely to develop dementia compared to those with PTSD and not using any psychotropic PTSD medications. SNRI (HR=1.35; 95%CI=1.26-1.46) and BZA drug use (HR=1.40; 95%CI=1.35-1.45) at baseline was associated with an increased risk for dementia regardless of PTSD diagnosis. These findings indicate; 1) evidence for an infectious AD etiology hypothesis in inconclusive, 2) both severe (e.g. sepsis), and less severe (e.g. cellulitis) systemic bacterial infections are collectively and independently associated with an increased risk of dementia among older U.S. veterans hence prevention of systemic bacterial infections could positively influence the risk for dementia among older adults, and 3) PTSD and psychotropic medication use are associated with an increased risk for dementia among U.S. veterans. Further epidemiologic, clinical, and basic science research is required to elucidate the mechanisms and the associations between infections and the risk for dementia and to determine if the independent and effect modifying impacts of psychotropic PTSD medication use on the risk for dementia are related to differences in PTSD severity, other psychiatric comorbidity, or whether psychotropic PTSD medication use is an independent risk factor for dementia.

Nos últimos anos, o uso dos psicotrópicos em idosos, aumentou expressivamente em decorrência da ampliação das indicações terapêuticas dessa classe, do lançamento de agentes com menor perfil de toxicidade e do reconhecimento de que determinados quadros clínicos, prevalentes nessa faixa etária, podem ser tratados com esses medicamentos. Todavia, o uso de psicotrópicos pode estar relacionado a eventos adversos que causam impacto no perfil de morbi-mortalidade desse grupo de indivíduos. Desse modo, os objetivos do presente estudo foram identificar a prevalência e os fatores associados ao uso de psicotrópicos entre os idosos do Município de São Paulo. Trata-se de um estudo transversal, de base populacional, cujos dados foram obtidos do Estudo Saúde, Bem-estar e Envelhecimento SABE. A amostra foi constituída de 1.115 idosos de 65 anos ou mais, que foram reentrevistados no ano de 2006. Para coleta de informações utilizaram-se as seções do questionário sobre Informações pessoais (A), Avaliação cognitiva (B), Estado de saúde (C), Estado funcional (D), Medicamentos (E) e Uso e acesso a serviços (F). Os psicotrópicos foram classificados de acordo com a Anatomical Therapeutical Chemical Classification System (ATC). Na analise dos dados utilizou-se o pacote estatístico STATA com realização de regressão logística. Considerou-se nível de significância de p<0,05. A prevalência de uso de psicotrópicos de 12,2%, a qual foi representada por antidepressivos (7,2%), benzodiazepínicos (6,1%) e antipsicóticos (1,8%). No grupo que usou psicotrópicos, 15,9% pertenciam ao sexo feminino, 15,1% apresentaram 75 anos ou mais, 21% relataram possuir quatro e mais doenças e 27,5% usar cinco ou mais medicamentos. Os fatores associados ao uso de psicotrópicos foram : sexo feminino (OR = 1,70; IC95% 1,05 - 2,74), limitação de atividade instrumental de vida diária (OR = 1,871; IC95% 1,16 - 3,04), presença de declínio cognitivo (OR = 1,76; IC95% 1,02 - 3,03), depressão (OR = 5,36; IC95% 3,34 - 8,61) e uso de cinco ou mais medicamentos (OR = 1,28; IC95%1,16 - 1,42). Cerca de um em cada dez idosos do SABE utilizou psicotrópicos, principalmente os antidepressivos. O conjunto dos fatores de risco associados ao uso de psicotrópicos pode indicar que os idosos mais vulneráveis foram aqueles com maior grau de dependência, seja em decorrência de comprometimento clínico causado por doenças, seja pelo uso de psicotrópicos inapropriados
Over the last years, the use of psychotropic drugs in the elderly has risen expressively, due to the increasing of the therapeutic indications of this class, the launching of agents with a profile of low level of toxics, and to the acknowledgement that certain clinical conditions, dominant within this age group, can be treated with this medicine. However, the use of psychotropic drugs can be linked to adverse events which cause impact in the profile of morbid-mortality of this age group. Therefore, the aim of the present study has been to identify the prevalence and factors associated to the use of psychotropic drugs among elderly people in São Paulo City. It is a transversal, population based study, obtained from the Estudo Saúde, Bem-estar e Envelhecimento SABE. The sample was constituted of 1.115 elderly people, aging 65 and over, who were re-interviewed in 2006. For the gathering of information, the sections of the questionnaire on Personal Information (A), Cognitive Evaluation (B), Health State (C), Functional State (D), Medicine (E) and Use and Access to Facilities (F) were used. Psychoactive drugs were classified according to the Anatomical Therapeutical Chemical Classification System (ATC). In the data analysis, it was used the statistic component STATA with logistic regression. A level of significance was considered of being p<0,05. The prevalence of the use of psychotropic drugs of 12,2%, which was represented by anti-depressants (7,2%), benzodiazepine (6,1%) and anti-psychotics (1,8%). In the group that used psychotropic drugs, 15,9% were female, 15,1% were 75 years old and older, 21% claimed having four or more different diseases, and 27,5% making use of five or more different sorts of medicine. The factors associated to the use of psychotropic drugs were: female gender (OR = 1,70; IC95% 1,05 - 2,74), limitation of daily life instrumental activity (OR = 1,871; IC95% 1,16 - 3,04), presence of cognitive decreasing (OR = 1,76; IC95% 1,02 - 3,03), depression (OR = 5,36; IC95% 3,34 - 8,61) and use of five or more sorts of medicine (OR = 1,28; IC95%1,16 - 1,42). About one in ten elderly people in SABE used psychotropic drugs, mainly anti-depressants. The range of risk factors associated to the use of psychotropic drugs may indicate that the most vulnerable elderly people were those with higher level of dependency, whether in consequence of a clinical implication caused by diseases, or by the use of inappropriate psychotropic drugs

Even though there are high diagnosis rates of ADHD among young African American men, policy makers and parents have largely viewed the use of Ritalin as a psychotrop ic drug that raises public health concerns. African American parents may be reluctant to treat their children pharmacologically. Very few studies have fully explored the perceptions of African American men about the consequences of their Ritalin use as chi ldren. The purpose of this qualitative study was to explore the experiences of African American men who used Ritalin as children so that policy makers and parents of children with ADHD might better understand the social and public health implications of tr eatment options. The theoretical framework for this study included Anderson's cultural identity theory of drug abuse and Brady and O'Conno r's community organizing theory . Data were collected through semistructured interviews with 9 African American men who were prescribed Ritalin as children. These data were then inductively coded and analyzed using Braun and Clarke's thematic analysis approach. Participants believed that Ritalin helped them with focus in their academic endeavors and did not lead them to dr ug abuse or addiction . By giving voice to the experiences of this population , educators and policy makers can better assist parents who might be reluctant to give their child Ritalin as their fears about Ritalin prescriptions leading to drug abuse and addiction later in life may be less founded than some believe. This presents a social change advantage for all communities, especially those in low income areas.

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A obesidade é um grave problema de saúde pública em nosso país, com sua prevalência crescendo em níveis epidêmicos. O grau de obesidade está diretamente relacionado com o risco de morbimortalidade. O tratamento farmacológico deve ser precedido de uma mudança de hábitos alimentares e prática regular de atividades físicas. Os medicamentos só devem ser utilizados sob supervisão médica e após uma avaliação criteriosa da relação risco-benefício, para cada paciente especificamente. Em 2005, o Brasil foi o maior consumidor mundial per capita de anfetaminas com finalidade emagrecedora. Estudos anteriores sugerem que as farmácias de manipulação são responsáveis pela maior porcentagem de notificações referentes a supressores de apetite. O presente estudo avalia as dispensações de psicotrópicos anorexígenos durante o ano de 2009 em Juiz de Fora, por meio das informações obtidas dos boletins de consumo enviados mensalmente (RMNRB2) à VISA municipal e de dados obtidos no SNGPC (ANVISA). De 7.759 notificações de psicotrópicos anorexígenos, 93,3% foram dispensadas por farmácias de manipulação e somente 6,7% por drogarias. Do total, 55,4% foram da substância anfepramona, seguido de 33,1% referentes à femproporex e 11,5% de mazindol. Dos 189 médicos que emitiram as prescrições analisadas, 57% não tinham especialidade cadastrada no CRM. Sete profissionais foram responsáveis por 6.492 dispensações no ano, correspondendo a 83,7% do total. O profissional com maior número de prescrições teve 3.535 prescrições dispensadas, correspondendo a 45,6% de todas as prescrições do período analisado. Das 3.535 prescrições de substâncias psicotrópicas anorexígenas emitidas por esse profissional, todas foram dispensadas em farmácias, sendo 99,5% em um único estabelecimento. As prescrições desse profissional correspondem a 94,3% de todo o movimento de dispensações de anorexígenos efetuadas no período analisado, nesse estabelecimento. Comparando com o relatório da ANVISA referente ao consumo no país, no mesmo período, as três substâncias apresentam um consumo maior em Juiz de Fora e microrregião, em Dose Diária Definida/mil habitantes/ano. O cenário mostra a dispensação de psicotrópicos anorexígenos como um problema relevante de saúde coletiva e indica a necessidade de reavaliação dos critérios de monitoramento de sua prescrição, dispensação e consumo.
Obesity is a serious public health problem in Brazil, with prevalence figures increasing at epidemic rates. The degree of obesity is directly related to the risk of morbidity and mortality. A pharmacological approach must always be preceded by a change of eating habits along with the regular practice of physical exercises. Drugs should only be used under medical supervision and after a careful assessment of the individualized risk-benefit ratio. In 2005, Brazil had the world´s largest per capita consumption of amphetamines for weight loss. Previous studies have suggested that magistral pharmacies are responsible for the largest percentage of notifications referring to appetite suppressants. This study assesses the dispensations of appetite-suppressant psychotropics during the year 2009, in Juiz de Fora, through information obtained from the municipal sanitary surveillance authority (consisting of monthly consumption bulletins [RMNRB2] and data from the Brazilian sanitary surveillance agency [ANVISA]). Of the 7,759 notifications of drugsuppressant psychotropics, 93.3% were dispensed by magistral pharmacies, while only 6.7% were dispensed by drugstores. Of the total, 55.4% were of amphepramone, followed by 33.1% of fenproporex and 11.5% of mazindol. The large majority of the prescribing physicians did not have their specialty registered with the Regional Medical Council (57%). Seven physicians were responsible for 6,492 dispensed prescriptions, accounting for 83.7% of the total. A single physician had been responsible for 3,535 dispensed prescriptions, corresponding to 45.6% of all prescriptions during the study period. Of the 3,535 prescriptions of appetitesuppressant psychotropics signed by this physician, 99.5% were dispensed by a single magistral pharmacy. The prescriptions signed by this physician corresponded to 94.3% of all appetite-suppressants dispensed by this pharmacy during the study period. Compared with the ANVISA report, referring to the national consumption during the same period, the three substances had a greater consumption in Juiz de Fora (daily defined dose/thousand inhabitants/year). This scenario points to the dispensation of appetite-suppressant psychotropics as a relevant public health issue, indicating the need to reassess the criteria guiding the monitoring of their prescription, dispensation and consumption.

To provide background information about previous findings about the prevalence of use, abuse and dependence of various substances (nicotine, alcohol, prescription and illicit drugs) findings of available epidemiological studies in Germany from the 1980s and 1990s are summarized and critically evaluated. Focusing on findings of substance use surveys in adolescents and young adults the review indicates: (a) a considerable number of large scale questionnaire surveys in general population samples documenting the frequency of use and patterns of use of most substances; (b) indications of increasing rates of drug use particularly in East Germany; (c) high rates of illicit drug use, mainly of cannabinoids, but also stimulants and hallucinogens, among young age groups. No data are available from substance use surveys or from clinical epidemiological studies allowing the determination of how frequent substance abuse and substance dependence diagnoses are in the general population or in adolescents and young adults. Priorities for future research to ameliorate this unsatisfactory situation are outlined with emphasis on research in adolescents and young adults.

Atualmente os benzodiazepínicos constituem o grupo de fármacos de prescrição mais consumidas em todo o mundo. Além da utilização desta classe farmacológica como fármacos de abuso, mais recentemente seu uso está associado a uma nova cultura psicodélica emergente. O termo \"club drugs\" tem sido usado para descrever estes fármacos que levam a efeitos psicodélicos e euforizantes. Acresça-se a isto à preocupante utilização destas substâncias em situações de estupro e/ou assalto, as chamadas \"drug-facilitated sexual assault\", destacando-se o flunitrazepam. Devido às pequenas doses administradas e a extensiva metabolização, a identificação do flunitrazepam e seus metabólitos torna-se dificultada em relação a outros benzodiazepínicos. O presente trabalho constitui validação de metodologia analítica que permita a correta identificação e quantificação de flunitrazepam e seu principal produto de biotransformação, o 7-aminoflunitrazepam, em soro. O método desenvolvido mostrou boa linearidade, precisão, exatidão, rendimento e capacidade de detectar os analitos mesmo em baixas concentrações, permitindo desta forma a inferência sobre a realidade dos casos onde se utiliza este fármaco sem fins terapêuticos.
Currently the benzodiazepines are one of the most consumed groups among the prescripton drugs in the world. Beside this, they have been used as drugs of abuse and more recently their use is associated with the new emerging psychodelic culture. The term \"club drugs\" has been used to describe these drugs that cause psychodelic and euphoric effects. In addition to this, there is a growing concern with the use of these substances related to \"drug-facilitated sexual assault\", among of which Flunitrazepan is pointed out as one of the most important . Due to the small doses involved in the consumption for this purpose and also the extense biotransformation, the identification of this analyte and its metabolites become more difficult than that of other benzodiazeines. This study provides an analytical validation method that enables correct identification and quantification of Flunitrazepam and its main biotransformation product, the 7-aminoflunitrazepam, in serum. The method developed demonstrates good linearity, precision, accuracy, recovery and capacity of detect the analytes, even in low concentration. Thus making possible to makes inferences regarding the reality of cases where it is used as a drug without therapeutic use.

Pharmacological magnetic resonance imaging (phMRI) is the use of functional MRI techniques to elucidate the effects that psychotropic drugs have on neural activity within the brain; it is an emerging field of research that holds great potential for the investigation of drugs that act on the central nervous system by revealing the changes in neural activity that mediate observable changes in behavior, cognition, and perception. However, the realization of this potential is hampered by several unanswered questions: Are the MRI measurements reliable surrogates of changing neural activity in the presence of pharmacological agents? Is it relevant to investigate psychiatric phenomena such as reward or anxiolysis in anesthetized, rather than conscious animals? What are the methods that yield reproducible and meaningful results from phMRI experiments, and are they consistent in the investigations of different drugs? The research presented herein addresses many of these questions with the specific aims of 1) Developing pharmacological MRI methodologies that can be used in the conscious animal, 2) Validating these methodologies with the investigation of a non-stimulant, psychoactive compound, and 3) Applying these methodologies to the investigation of typical and atypical antipsychotic drugs, classes of compounds with unknown mechanisms of therapeutic action Building on recent developments in the field of functional MRI research, we developed new techniques that enable the investigator to measure localized changes in metabolism commensurate with changing neural activity. We tested the hypothesis that metabolic changes are a more reliable surrogate of changes in neural activity in response to a cocaine challenge, than changes observed in the blood-oxygen-level-dependent (BOLD) signal alone. We developed a system capable of multi-modal imaging in the conscious rat, and we tested the hypothesis that the conscious brain exhibits a markedly different response to systemic morphine challenge than the anesthetized brain. We identified and elucidated several fundamental limitations of the imaging and analysis protocols used in phMRI investigations, and developed new tools that enable the investigator to avoid common pitfalls. Finally, we applied these phMRI techniques to the investigation of neuroleptic compounds by asking the question: does treatment with typical or atypical antipsychotic drugs modulate the systems in the brain which are direct or indirect (i.e. downstream) substrates for a dopaminergic agonist? The execution of this research has generated several new tools for the neuroscience and drug discovery communities that can be used in neuropsychiatric investigations into the action of psychotropic drugs, while the results of this research provide evidence that supports several answers to the questions that currently limit the utility of phMRI investigations. Specifically, we observed that metabolic change can be measured to resolve discrepancies between anomalous BOLD signal changes and underlying changes in neural activity in the case of systemically administered cocaine. We found clear differences in the response to systemically administered morphine between conscious and anesthetized rats, and observed that only conscious animals exhibit a phMRI response that can be explained by the pharmacodynamics of morphine and corroborated by behavioral observations. We identified fundamental and drug-dependent limitations in the protocols used to perform phMRI investigations, and designed tools and alternate methods to facilitate protocol development. By applying these techniques to the investigation of neuroleptic compounds, we have gained a new perspective of the alterations in dopaminergic signaling induced by treatment with antipsychotic medications, and have found effects in many nuclei outside of the pathways that act as direct substrates for dopamine. A clearer picture of how neuroleptics alter the intercommunication of brain nuclei would be an invaluable resource for the classification of investigational antipsychotic drugs, and would provide the basis for future studies that examine the neuroplastic changes that confer therapeutic efficacy following chronic treatment with antipsychotic medications.

A importância de algumas abordagens psicoterápicas associadas à farmacoterapia no tratamento do Transtorno Depressivo Maior tem sido bastante destacada, no entanto, existem poucos dados sobre a Psicoterapia Psicodramática. O presente estudo comparou 20 pacientes com diagnóstico de TDM em uso de medicamentos antidepressivos e avaliados pela Escala de Depressão de HAM-D17 (escores entre 7 e 20), divididos em dois grupos: dez pacientes do Grupo Psicoterápico (GP) participaram de 4 sessões individuais de psicoterapia psicodramática e 24 de grupo. Dez pacientes do Grupo Controle (GC) não participaram de sessões psicoterápicas. Os dois grupos foram avaliados pela Escala de HAM-D17 e pela Escala de Adequação Social (EAS) no início e final do processo psicoterápico e o GP também foi avaliado pela Análise Sociométrica, fundamentada no método psicodramático. Em comparação ao GC, o GP apresentou uma melhora significativa quanto aos sintomas depressivos e ao funcionamento social, bem como uma expressiva mudança nos aspectos sociométricos investigados
The importance of several psychotherapic approaches associated to pharmacotherapy on the treatment of Major Depressive Disorder has been quite highlighted, although, there is little information as far as Psychodramatic Psychotherapy is concerned. The present study compared 20 patients diagnosed with MDD in use of antidepressant drugs and evaluated with the Hamilton Depression Scale (scores between 7 and 20), divided into two groups as follows: ten of the patients from the Psychotherapic Group (PG) took part in 4 individual psychodramatic psychotherapy sessions and 24 psychodramatic psychotherapy group sessions. Ten of the patients from the Control Group (CG) did not participate in the psychodramatic psychotherapy sessions. Both groups were evaluated with the HAM-D17 Scale and the Social Adjustment Scale - Self Report (SASSR) at the beginning and at the end of the psychotherapic process, and the PG was also evaluated through Sociometric Analysis, based on the psychodramatic method. In comparison to the CG, the PG presented a significant improvement regarding the symptoms of depression and social functioning, as well as an expressive change on the investigated sociometric aspects

Conselho Nacional de Desenvolvimento Científico e Tecnológico
Introdução: A preocupação em torno do uso irracional de psicofármacos tem sido observada em diversos países, constituindo-se uma questão importante para a saúde pública mundial. No Brasil, a promoção do uso racional de psicofármacos é um desafio para a atenção primária, sendo importante caracterizar sua dimensão psicossocial. Objetivos. O artigo 1, com características descritivas, tem como objetivo caracterizar o uso de psicofármacos em unidades de saúde da família segundo a presença de transtornos mentais comuns (TMC) e segundo as principais características socioeconômicas e demográficas. O artigo 2, com um caráter analítico, tem como objetivo avaliar o papel da rede social no uso de cada um destes psicofármacos segundo a presença de TMC. Métodos O estudo utiliza um delineamento seccional e abarca a primeira fase de coleta de dados de dois estudos em saúde mental na atenção primária. Esta se deu em 2006/2007 para o estudo 1 (Petrópolis, n= 2.104) e em 2009/2010 para o estudo2 (São Paulo, n =410, Rio de Janeiro, n= 703, Fortaleza , n=149 e Porto Alegre, n= 163 participantes). Ambos os estudos possuem o mesmo formato no que se refere à coleta de dados, seu processamento e revisão, resultando em uma amostra de 3.293 mulheres atendidas em unidades de saúde da família de cinco diferentes cidades do país. Um questionário objetivo com perguntas fechadas foi utilizado para a coleta de informações socioeconômicas e demográficas. O uso de psicofármacos foi avaliado através de uma pergunta aberta baseada no auto-relato do uso de medicamentos. A presença de TMC foi investigada através do General Health Questionnaire, em sua versão reduzida (GHQ-12). O nível de integração social foi aferido através do índice de rede social (IRS), calculado a partir de perguntas sobre rede social acrescentado ao questionário geral. No estudo descritivo (artigo 1), a frequência do uso de antidepressivos e o uso de benzodiazepínicos na população de estudo foram calculadas para cada cidade, tal como a frequência do uso destes psicofármacos entre as pacientes com transtornos mentais comuns. A distribuição do uso de cada um destes psicofármacos segundo as principais características socioeconômicas, demográficas e segundo transtornos mentais comuns foi avaliada através do teste de qui-quadrado de Pearson. No estudo analítico (artigo 2), a associação entre o nível de integração social e o uso exclusivo de cada um dos psicofármacos foi analisada através da regressão logística multivariada, com estratificação segundo a presença de TMC. Resultados: A frequência do uso de psicofármacos foi bastante heterogênea entre as cidades, destacando-se, porém, a importância do uso de benzodiazepínicos frente ao uso de antidepressivos em sua maioria. A proporção do uso de psicofármacos, sobretudo antidepressivos, foi predominantemente baixa entre as pacientes com TMC. Entre elas, o uso de antidepressivos mostrou-se positivamente associado ao isolamento social, enquanto o uso de benzodiazepínicos associou-se negativamente a este. Conclusão: Os resultados colaboram para a caracterização do uso de psicofármacos em unidades de saúde da família e para a discussão acerca de sua racionalidade. Destaca-se a importância de avaliar a dimensão psicossocial que envolve o uso destas substâncias com vistas ao desenvolvimento de estratégias de cuidado mais efetivas
Introduction: Concerns about irrational use of psychotropic drugs has been observed in many countries, becoming an important issue for global public health. In Brazil, the promotion of rational use of psychotropic drugs is a challenge for primary care, therefore it is important to characterize its psychosocial dimension. Objectives This dissertation consists of two articles. Article 1, with descriptive characteristics, aims to characterize the use of psychotropic drugs in family health units, according to major socioeconomic and demographic characteristics and according to the presence of common mental disorders (CMD). Article 2, with an analytical character, aims to evaluate the role of social networks in the use of each of these psychotropic drugs, according to the presence of CMD. Methods The study has a cross-sectional design and integrates baseline data from two previous studies on mental health in primary care . Data collection took place in 2006/2007 for the study 1 (Petropolis, n = 2.104) and in 2009/2010 for the study2 (São Paulo, n = 410, Rio de Janeiro, n = 703, Fortaleza - n = 149 and Porto Alegre, n = 163 participants). Although performed in different periods, both studies have the same format as regards data collection, processing and review, resulting in a sample of 3293 women attending family health units from five different cities. An objective questionnaire with closed questions was used to collect socioeconomic and demographic information. Psychotropic use was assessed through an open-ended question based on self-reporting of drug use. The presence of CMD was investigated by the General Health Questionnaire in its reduced version (GHQ-12). The level of social integration was evaluated through the social network index (IRS), calculated from questions about social network added to the general questionnaire. In the descriptive study (Article 1), the frequency of antidepressants and benzodiazepines use in the study population were calculated for each city, such as the frequency of the use of psychotropic drugs among patients with common mental disorders. The distribution of the use of each of these psychoactive drugs according to major socioeconomic and demographic characteristics and according to the presence of common mental disorders was assessed by Pearsons chi-square test. In the analytical study (Article 2), the association between the level of social integration and the exclusive use of each of psychotropic drugs was analyzed by multivariate logistic regression, stratified according to the presence of TMC. Results: The frequency of psychotropic medication use was quite heterogeneous among cities, emphasizing, however, the importance of the use of benzodiazepines against the use of antidepressants in most of the cities. The proportion of use of psychotropic medication, particularly antidepressants, was predominantly low among patients with CMD. Among these, antidepressants use was positively associated with social isolation, while benzodiazepines use was negatively associated. Conclusion: This study collaborates to characterize the use of antidepressants and benzodiazepines in family health units and to discuss about their rationality. The results highlight the importance of assessing the psychosocial dimension that involves the use of these substances in order to develop strategies to promote its rational use in primary care.

To provide background information about previous findings about the prevalence of use, abuse and dependence of various substances (nicotine, alcohol, prescription and illicit drugs) findings of available epidemiological studies in Germany from the 1980s and 1990s are summarized and critically evaluated. Focusing on findings of substance use surveys in adolescents and young adults the review indicates: (a) a considerable number of large scale questionnaire surveys in general population samples documenting the frequency of use and patterns of use of most substances; (b) indications of increasing rates of drug use particularly in East Germany; (c) high rates of illicit drug use, mainly of cannabinoids, but also stimulants and hallucinogens, among young age groups. No data are available from substance use surveys or from clinical epidemiological studies allowing the determination of how frequent substance abuse and substance dependence diagnoses are in the general population or in adolescents and young adults. Priorities for future research to ameliorate this unsatisfactory situation are outlined with emphasis on research in adolescents and young adults.

Les pratiques addictives aux substances psychoactives sont caractérisées par une dépendance révélée par l’impossibilité répétée de contrôler un comportement et la poursuite de ce comportement en dépit de la connaissance des conséquences négatives. Au-delà du problème considérable de santé publique, la question intéresse directement le monde du travail. Curieusement, le sujet reste un tabou, ou alors, n’est abordé que sous un angle moralisateur. Qu’elle soit à l’origine de ces conduites ou uniquement un des lieux d’expression des problèmes en découlant, l’entreprise ne peut plus faire l’impasse sur cette question. Si l’employeur, tenu à des impératifs de production, peut, parfois, tirer des bénéfices secondaires de certaines conduites addictives (« boulimies » au travail), cela peut avoir un impact négatif sur l’efficacité de sa structure (absences, accidents, baisse de productivité …). L’employeur peut également être tenu responsable pénalement dans les cas d’introduction de substances illicites dans l’entreprise. Au surplus, étant responsable des dommages causés par ses salariés, il devra s’assurer que ces derniers ne représentent pas un danger pour les tiers. Enfin, et peut être surtout, l’employeur est responsable de la santé de ses salariés. La consécration prétorienne d’une obligation de sécurité de résultat a d’ailleurs considérablement renforcé l’intensité de cet objectif. Afin de remplir ses obligations, l’employeur dispose de différentes mesures de contrôle, et jouit d’un double pouvoir de répression et de prévention en la matière. Mais les actions de l’employeur dans le domaine des addictions viennent se heurter à l’inaliénable liberté individuelle des salariés. Il est alors nécessaire de savoir jusqu'où la politique de prévention des entreprises du risque addictif en milieu de travail peut-elle aller sans interférer dans la vie privée des salariés
Addictive behaviors related to psychoactive substances are characterized by a dependence revealed by the repeated impossibility to control behavior and the continuation of the said behavior despite the subject being aware of its negative consequences. Over and beyond the significant public health issue, this topic directly concerns the world of work. Surprisingly, it remains taboo or is only approached from a moralizing angle. Should a company be the source of such behaviors or only one of the places where they are exhibited, it cannot ignore the issue. Although employers may sometimes see secondary benefits of some addictive behavior for productivity reasons (e.g. « workaholism »), this may result in a loss of efficiency of their workforce (absenteeism, accidents in the workplace, drop in productivity). Employers may be held criminally liable in the event of illicit substances being brought into the workplace. What is more, being liable for any damage or injuries caused by their employees, they must make sure they do not represent a threat to others. Last, but not least, employers are responsible for the health of their employees. This objective has been considerably strengthened by the definition of the employer’s safety obligation, by the Court of cassation, as an obligation of safety performance. In order to fulfil these obligations, employers have various control measures at their disposal and enjoy dual powers of repression and prevention. However, any action taken by the employer in the field of addiction comes up against the inalienable right to individual freedom of the employees. An employer is not omnipotent: where is the limit between the management of addictive risks in the workplace and an employee’s privacy, taking into account an employer’s obligation of safety performance

INTRODUÇÃO: A dependência de álcool é um grave problema de saúde publica no Brasil. Seu tratamento ainda é um desafio, mesmo para os melhores programas terapêuticos disponíveis. Esta dificuldade ocorre pelo pequeno número de medicamentos aprovados para o uso e também pela elevada taxa de abandono, próximo a 50%. A ondansetrona tem surgido como uma medicação promissora para o tratamento de alcoolistas. A identificação de pacientes com maior risco de desistência do tratamento é uma estratégia para reverter essa taxa. Os objetivos deste estudo são: (a) avaliar a eficácia e segurança da ondansetrona na dose de 16 mg/dia; (b) investigar variáveis clínicas e psicossociais capazes de prever maior aderência ao tratamento; (c) desenvolver uma tipologia para alcoolistas com características presentes no início do tratamento; (d) testar se os diferentes tipos podem prever o abandono ao tratamento. METODOS: Trata-se de estudo realizado em três etapas. Na primeira foi realizado ensaio clinico randomizado duplo-cego placebo controlado, com ondansetrona, por 12 semanas, desenvolvido na Universidade de São Paulo - Brasil. A amostra era composta por 102 dependentes de álcool com idade entre 18 - 60 anos. A análise foi realizada com os dados brutos e com os dados imputados. Na segunda etapa, foi combinado o banco de dados deste estudo com os de outros dois ensaios realizados no mesmo local (acamprosato versus placebo e naltrexona, topiramato versus placebo), com número total de 332 dependentes de álcool. A partir da análise de quatro fatores clínicos (idade de início dos problemas com uso do álcool, alcoolismo familiar, gravidade da dependência do álcool e intensidade de sintomas depressivos) foi realizada a análise de cluster tipo K-Means e, após a identificação dos tipos, foi avaliada a associação destes com a adesão ao tratamento. Na última etapa, analisando apenas os participantes avaliados quanto ao desejo pelo álcool (257 alcoolistas) foi realizada uma regressão logística, com variáveis clínicas e psicossociais, para analisar a influência dessas na retenção ao tratamento. RESULTADO: A ondansetrona foi capaz de retardar o tempo para o primeiro consumo de álcool (54,7 versus 40,9 dias) e, também, o primeiro consumo pesado de álcool (58,4 versus 45,4 dias) quando comparado ao placebo. Essa droga não influenciou a percentagem de dias bebidos durante o estudo, mas esteve associada com menor percentagem de dias com consumo pesado de álcool (7,8% versus 11,7%), quando comparado ao placebo, na análise de dados imputados. Na análise de tipologia foram identificados dois grupos de alcoolistas. O tipo de alcoolista caracterizado pelo início precoce dos problemas com álcool, maior histórico familiar de dependência, elevada gravidade de alcoolismo e poucos sintomas depressivos esteve associado a maior chance de descontinuar o tratamento, independente da medicação usada e da participação nos alcoólicos anônimos (AA). Entre as variáveis clínicas e psicossociais estudadas, ter idade mais elevada, participar do AA e o consumo preferencial pela cerveja foram fatores independentes associados a maior adesão ao tratamento. Maiores escores de depressão aumentaram o risco de abandono. CONCLUSÃO: A ondansetrona mostrou ser segura e bem tolerada na dose de 16mg/dia. Foi mais eficaz que o placebo em retardar o primeiro consumo e primeiro consumo pesado de álcool, deixou dúvida sobre seu efeito na percentagem de dias bebidos e de consumo pesado de álcool. O tipo de alcoolista com idade precoce de problemas com álcool, elevada dependência dessa substância, mais história familiar de alcoolismo e menos sintomas depressivos, esteve associado ao maior risco de abandono. Idade mais elevada, frequentar o AA e ter preferência pela cerveja aumenta a chance de completar o tratamento proposto
INTRODUCTION: Alcohol dependence is a serious public health problem in Brazil. Its treatment remains a challenge, even for the best available treatment programs. This difficulty is due to the small number of drugs approved for use and also the high dropout rates, close to 50%. Ondansetron has emerged as a promising drug for the treatment of alcoholics. The identification of patients with increased risk of treatment discontinuation is a strategy to reverse these rates. The aims of this study are: (a) to evaluate the efficacy and safety of ondansetron in a dose of 16 mg/day; (b) to investigate clinical and psychosocial variables that could predict treatment retention, (c) to develop a typology of alcoholics based on clinical factors present at the beginning of the treatment; and (d) to test if different types of alcoholics could predict the higher withdrawal from treatment. METHODS: This study was conducted in three stages. Firstly, a randomized, double-blind, placebo- controlled clinical trial was conducted with ondansetron for 12 weeks, developed at the University of São Paulo - Brazil. The sample consisted of 102 alcoholics aged between 18 and 60 years old. The analysis was performed by using only the sample of adherents and an imputed sample. Secondly, the database of this study was combined with two other clinical trials that were carried out in the same setting (acamprosate versus placebo, and topiramate, naltrexone versus placebo), with a final sample size of 332 alcohol dependents. From the analysis of four clinical factors (problem drinking onset age, family alcoholism, severity of alcohol dependence and intensity of depressive symptoms) a K-means cluster analysis was performed to identify types of alcoholics. In addition, the association between the resulting types of alcoholics and treatment retention was verified. Thirdly, using only the participants who were evaluated for craving on alcohol (257 alcoholics), a logistic regression analysis was run with clinical and psychosocial variables as independent variables to analyze their influence on treatment retention. RESULTS: Ondansetron was able to delay the first alcohol consumption (54.7 versus 40.9 days) and the first heavy alcohol consumption (58.4 versus 45.4 days) compared to placebo. Ondansetron did not have effect on the percentage of drinking days. However, ondansetron was associated with a lower percentage of days with heavy alcohol consumption (7.8% versus 11.7%) in an imputed sample, when compared to placebo. Two types of alcoholics were identified. The type characterized by earlier problem drinking onset age, more family alcoholism, high severity of alcoholism, and fewer depressive symptoms, was associated with a greater chance of discontinuing treatment regardless of medication used and participation in alcoholic anonymous groups (AA). Out of the clinical and psychosocial variables, older age, AA attendance, and beer preference drinkers were independent factors associated with higher treatment retention. Higher scores on depression also increased the risk of dropout. CONCLUSION: Ondansetron showed to be safe and well tolerated at the dose of 16mg/day. It was more effective than placebo in delaying both the first use and the first heavy alcohol consumption. In addition, ondansetron was not effective in decreasing the percentage of drinking days throughout this study. The type of alcoholics characterized by earlier problem drinking onset age, more family alcoholism, high severity of alcoholism and fewer depressive symptoms, was associated with greater risk of dropout. Separately, the variables higher age, AA attendance, and beer preference increased the chance of completing the proposed treatments

Thesis (M.S.)--University of Wisconsin--Madison, 1988.
Typescript. eContent provider-neutral record in process. Description based on print version record. Includes bibliographical references (leaves 44-46).

The majority of the population in South Africa use traditional health care to treat various mental conditions. This thesis has two main objectives; to bring together a comprehensive and detailed record of psychotropic plants used in southern Africa by indigenous peoples for medicinal or cultural purposes. Secondly, this research attempts to investigate the validity and rationale of the use of these plants by screening them in various biological assays for psychotropic activity. Plants were selected, based on their traditional use and availability, and were screened in four assays, which detect biological activity of a useful nature. A number of in vitro enzymatic and neuronal signal transduction assays were employed in this thesis, the inhibition of the serotonin reuptake transporter protein (SERT); inhibition of catabolic enzymes (e.g. acetylcholinesterase, monoamine oxidase); GABAA- benzodiazepine receptor binding. The influence of legislation, past and present, on the state of traditional medicine is highlighted. Aspects of the philosophies and practises of the various practitioners of South African traditional medicine will be discussed. An annotated list compiled from available ethnobotanical literature of plants traditionally used for central nervous system-related purposes is provided. It contains more than 330 species, from 94 families, which are currently used or have been used for cultural, medicinal and recreational purposes related to the central nervous system (CNS). Where available, information pertaining to plant part used, preparation method, dosage, route of administration, known and potentially active constituents are included. Seventy five extracts from 34 indigenous plant species used in South African traditional medicine or taxonomically related to these were investigated for their affinity to the serotonin reuptake transport protein, making use of an in vitro [3H]-citalopram serotonin reuptake transport protein binding assay. Aqueous and 70% ethanolic extracts of various plant parts were screened and 45 extracts derived from 15 plant species showed affinity. The affinity of 12 extracts from four plants was characterized as high (more than 50% inhibition at 5, 1, and 0.5 mg/ml). Plant species with high affinity to the serotonin reuptake transport protein included Agapanthus campanulatus, Boophone disticha, Datura ferox and Xysmalobium undulatum. Agapanthus campanulatus yielded high activity in aqueous extracts from leaves and flowers. B. disticha showed high activity both in aqueous and ethanolic extracts of leaves and bulbs. D. ferox showed high activity in aqueous extracts from the seeds and X. undulatum showed high activity in the ethanolic extract of the whole plant. Two compounds, buphanadrine and buphanamine, were isolated by bioassay-guided fractionation on vacuum-liquid-chromatography (VLC) and preparative thin-layer-chromatography (TLC) from B. disticha. The structures of the compounds were determined by 1H and 13C NMR. Fractions were tested for affinity to the serotonin transporter in a binding assay using [3H]-citalopram as a ligand. The IC50 values of buphanidrine and buphanamine were 274 ìM (Ki = 132 ìM) and 1799 ìM (Ki = 868 ìM), respectively. The two alkaloids were also tested for affinity to the 5HT1A receptor, but only showed slight affinity. Aqueous and ethanol extracts of 43 plants that are traditionally used to treat against epilepsy and convulsions were initially tested in the GABAA-benzodiazepine receptor binding assay, where the binding of 3H-Ro 15-1788 (flumazenil) to the benzodiazepine site is measured. The GABAA-benzodiazepine receptor complex is involved in epilepsy and convulsions. Out of the 118 extracts tested, one aqueous and 18 ethanol extracts showed activity. The most active extracts were the ethanolic leaf extracts of Searsia tridentata, Searsia rehmanniana and Hoslundia opposita and the ethanolic corm extract of Hypoxis colchicifolia, which all showed good dose-dependent activity. A further forty-six ethanol extracts from another 35 species, both indigenous and exotic that are traditionally used predominantly as sedatives or to treat various CNS-related ailments were tested in the GABAA-benzodiazepine receptor-binding assay. Out of the 46 extracts tested, seven showed good activity and 10 showed moderate activity. The most active extracts were the ethanolic leaf extracts of Arctopus echinatus, Artemisa afra, four Helichrysum species and Mentha aquatica which all showed good dose-dependent activity. Two biflavonoids with activity in the 3H-Ro 15-1788 (flumazenil) binding assay were isolated by high pressure liquid chromatography (HPLC) fractionation of the ethanol extract of the leaves from Searsia pyroides. The structures of the two biflavonoids were elucidated by nuclear magnetic resonance spectroscopy (NMR) to be agathisflavone and amentoflavone. Agathisflavone and amentoflavone competitively inhibited the binding of 3H-Ro 15-1788 with a Ki of 28 and 37 nM, respectively. Extracts of Searsia dentata and Searsia pentheri were not as active as the extract from Searsia pyroides; both were found to contain apigenin and agathisflavone. The monomer apigenin, agathisflavone and amentoflavone were fitted into a pharmacophore model for ligands binding to the GABAA receptor benzodiazepine site. This reflected the affinities of the compounds in the [3H]-flumazenil binding assay. Mentha aquatica, a mint that is found in Europe and Africa, is used in Zulu traditional medicine for spiritual purposes. The ethanolic leaf extract showed a strong affinity to the GABA-benzodiazepine receptor. Viridiflorol from the essential oil and (S)-naringenin from an ethanolic extract was isolated by bioassay-guided fractionation using binding to the GABA-benzodiazepine site. Viridiflorol had an IC50 of 0.19 M and (S)-naringenin of 0.0026 M. Twenty plants used in Zulu traditional medicine for several CNS-related ailments were screened for MAO inhibition and specific MAO-B inhibition activity. MAO-B inhibitors are currently employed in the treatment of neurodegenerative related illnesses such as Parkinson's and Alzheimer's diseases. A photometric peroxidase linked assay was used to determine the inhibition of the oxidative deamination of tyramine by MAO isolated from rat liver. Ruta graveolens exhibited the best MAO inhibitory activity (ethyl acetate leaf extract = IC50 5 ± 1 ìg/ml, petroleum ether extract = 3 ± 1 ìg/ml) and specific MAO-B inhibition (ethyl acetate leaf extract = IC50 7 ± 6 ìg/ml petroleum ether extract = 3 ± 1 ìg/ml). Schotia brachypetala, Mentha aquatica and Gasteria croucheri also exhibited good MAO-B inhibition activity. Six extracts of varying polarity of Mentha aquatica were tested in a photometric peroxidase linked MAO bioassay. The 70% ethanol extract had highest inhibitory activity. (S)-Naringenin was isolated from the extract by bioassay guided fractionation on VLC and preparative TLC. The structure of the compound was determined by 1H, 13C and 13C-DEPT NMR and optical rotation. The IC50 values for MAO inhibition by naringenin were 342 ± 33 ìM for the rat liver mitochondrial fraction, 955 ± 129 ìM for MAO-A and 288 ± 18 ìM for MAO-B respectively. South African traditional medicine clearly utilizes many botanical species with CNS-related activity. Only a small number of the more than 330 southern African plant species reported to treat or alter the CNS have been scientifically evaluated. To date very few of the active compounds have been isolated and identified.
Thesis (Ph.D.)-University of KwaZulu-Natal, Pietermaritzburg, 2009.

Le présent mémoire explore les liens entre les différents types de capitaux (social, familial, délinquant et individuel) et certains actes déviants, soit la consommation de substances psychotropes et l’implication criminelle violente chez un groupe de décrocheurs scolaires canadiens. Dans un premier temps, il s’agit d’établir la prévalence et les habitudes de consommation de cette population aliénée du système éducatif. De plus, cette étude concerne l’implication criminelle violente des décrocheurs. Plus précisément, il s’agit de déterminer la fréquence des manifestations agressives et les types de violence perpétrés par ces jeunes, ainsi que d’examiner les liens qui se tissent entre la consommation de substances psychotropes et la commission d’actes violents. Ensuite, il est question d’étudier l’impact des différents capitaux (social, familial, délinquant et individuel) sur la consommation de substances psychoactives et l’implication criminelle violente des décrocheurs. En outre, dans une perspective davantage clinique, le dernier objectif aura pour but d’identifier différentes typologies de décrocheurs scolaires. Les analyses s’appuient sur un échantillon de 339 jeunes décrocheurs scolaires de Montréal et Toronto. Les informations amassées par rapport à l’usage de substances psychotropes et la commission d’actes violents concernent les douze mois qui ont précédé la passation du questionnaire. Succinctement, les taux de prévalence de consommation des décrocheurs apparaissent plus importants que ceux de la population estudiantine, leur usage est plus inquiétant de même que l’auto-évaluation de leur dépendance. Les résultats révèlent également une implication criminelle violente importante, surtout chez les garçons et les consommateurs de substances psychotropes. Qui plus est, le capital délinquant semble avoir un impact majeur sur l’usage d’alcool et de drogues de même que sur les manifestations de violence perpétrées par les décrocheurs. Enfin, trois typologies de décrocheurs scolaires ont été identifiées, soit les invisibles, les détachés et les rebelles.
This paper explores the links between different types of capital (social, familial, criminal and individual) and some deviant acts, consumption of psychotropic drugs and violent criminal involvement among Canadian school drop-outs. In first place, the prevalence and habits of alcohol and drug consumption of this population alienated from the education system will be established. Moreover, this study concerns violence involvement of school drop-outs. More specifically, in determining the frequency of aggressive events and types of violence perpetrated by these young people, and to examine the relationships between the use of psychotropic substances and the commission of violent acts. Then, there is the impact of various capitals (social, familial, criminal and individual) on the consumption of psychoactive substances and violent criminal involvement of school drop-outs. In a more clinical perspective, the last goal will be to identify different types of school drop-outs. This analysis is based on a sample of 339 young school leavers in Montreal and Toronto. The information collected in relation to the use of psychotropic substances and the commission of violent acts involve the twelve months preceding the award of the questionnaire. Briefly, the prevalence of consumption of drop-outs is more important than the student population; their use is even more disturbing as well as the self-assessment of their dependency. The results also show a significant violent criminal involvement, especially among boys and consumers of psychotropic substances. Moreover, the criminal capital appears to have a major impact on the use of alcohol and drugs as well as the manifestations of violence perpetrated by drop-outs. Finally, three types of school dropouts have been identified: the invisible, the detached and the rebels.