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There is an increasing concern regarding the mental health of healthcare workers during the COVID-19 pandemic. This study aimed to assess the psychological impact of the COVID-19 exposure among Paraguayan healthcare workers. A cross-sectional descriptive study has been carried out in five hospitals of Paraguay. Demographic and occupational exposure to COVID-19 were collected through a short questionnaire. Mental health status was assessed with the GAD-7, the PHQ-9, and the PCL-C. Logistic regression was used to determine psychological risk factors. 432 participants were surveyed. 218 (50.46%) were physicians. The prevalence of symptoms of anxiety, depression and PTSD was 48.15, 41.90, and 5.79%, respectively. There were no significant differences in anxiety (128 [29.63%] vs. 80 [18.52%]; p = 0.3303), depression (102 [23.61%] vs. 79 [18.29%]; p = 0.6703), or PTSD (14 [3.24%] vs. 11 [2.55%]; p = 0.8074) between frontline versus second-line workers. Main risk factors associated with psychological distress included work experience <5 years for depression and a COVID-19 positive diagnosis or having family/friends with a COVID-19 positive diagnosis for PTSD. Paraguayan healthcare workers reported high prevalence of anxiety, depression, and a low prevalence of PTSD. A positive diagnosis of COVID-19 and work experience <5 years are important psychological risk factors. [ABSTRACT FROM AUTHOR]

An editorial is presented on the distinctions between "Addiction Medicine" and "Addiction Psychiatry" in treating Substance Use Disorders (SUDs). It emphasizes the physiological aspects of addiction medicine, as opposed to addiction psychiatry, it focuses on psychological therapies. It emphasizes the treatment of intoxications, withdrawal syndromes, and medical problems in Addiction Medicine.

People with severe mental disorders have a higher mortality rate due to preventable conditions like cardiovascular diseases and respiratory diseases. Nicotine addiction is a preventable risk factor, with tobacco use being twice as high in people with mental disorders. An integrative model that divides mental disorders into externalising, internalising, and thought disorders could be useful for identifying common causalities and risk factors. This review aims to examine the interface between smoking and internalising disorders, specifically schizophrenia, depressive disorders, and anxiety disorders. The review finds that there is a clear association between smoking behaviour and these disorders. Schizophrenia is associated with polymorphisms that result in an imbalance between glutamate and GABA release and abnormalities of dopaminergic pathways. Nicotine improves dopaminergic signalling and balances glutamatergic and GABAergic pathways, improving symptoms and increasing the risk of nicotine dependence. In depressive disorders, smoking is associated with functional changes in brain regions affected by smoking and self-medication. In anxiety disorders, there is a bidirectional relationship with smoking, involving the amygdala and changes in dopaminergic pathways and cortisol production. Smoking poses a threat to people living with psychiatric disorders and calls for further research to assess the interactions between nicotine dependence and internalising and thought disorders. [ABSTRACT FROM AUTHOR]

The adverse effects of smoking cessation in individuals with mental health disorders have been a point of concern, and progress in the development of treatment has been slow. The primary first-line treatments for smoking cessation are Nicotine Replacement Therapy, Bupropion, Varenicline, and behavioural support. Nortriptyline and Clonidine are second-line treatments used when the first-line treatments are not effective or are contraindicated. Smoking cessation medications have been shown to be effective in reducing nicotine cravings and withdrawal symptoms and promoting smoking cessation among patients living with mental disorders. However, these medications may have implications for patients' mental health and need to be monitored closely. The efficacy and side effects of these medications may vary depending on the patient's psychiatric condition, medication regimen, substance use, or medical comorbidities. The purpose of this review is to synthesise the pharmacokinetics, pharmacodynamics, therapeutic effects, adverse effects, and pharmacological interactions of first- and second-line smoking cessation drugs, with an emphasis on patients suffering from mental illnesses. Careful consideration of the risks and benefits of using smoking cessation medications is necessary, and treatment plans must be tailored to individual patients' needs. Monitoring symptoms and medication regimens is essential to ensure optimal treatment outcomes. [ABSTRACT FROM AUTHOR]

Substance use disorder (SUD) assessment and measurement in Brazil, as well as in many other countries, face significant shortcomings. The Measurement in the Addictions for Triage and Evaluation (MATE) was developed as a public domain tool, drawing from validated scales and incorporating World Health Organization International Classification of Functioning, Disability, and Health (ICF) framework. The Brazilian version of the MATE (MATE-pt-BR) was evaluated for its reliability and validity, with a total of 239 subjects participating in the study, and data collected between 11/01/2021 and 09/01/2022. The majority were male (79.2%), with diverse racial backgrounds. The substances most prevalently used in the last 30 days were. Alcohol (73.2%), nicotine (63.6%), and cocaine (44.2%). The mean scores for MATE modules showed variations, with Module Q2 assessing psychological well-being having high internal consistency (Cronbach's alpha = 0.92). MATE-pt-BR demonstrated robust internal consistency, with Module 6 (personality) and Module 2 (medical and psychiatric consultation indicators) being exceptions. MATE-pt-BR exhibited significant correlations among its sections and strong discriminant validity. Moreover, the paper compares MATE-pt-BR with the Addiction Severity Index (ASI-6), which is considered the gold-standard measure for SUD assessments. MATE-pt-BR offers a valuable tool for assessing substance use and related functional impairments in the Brazilian context. [ABSTRACT FROM AUTHOR]

This study delves into the construct validity of Food Addiction (FA) as evaluated by the modified Yale Food Addiction Scale 2.0 (mYFAS 2.0) within the context of post-bariatric surgery patients in Brazil. Understanding the prevalence, characteristics, and construct validity of FA among individuals who have undergone bariatric surgery is crucial for enhancing patient care and advancing research in this field. Our findings are based on a convenience-based sample of 100 individuals who had undergone bariatric surgery at Hospital Estadual Mário Covas (HEMC) in Brazil. Using mYFAS 2.0, we found that 51% of the participants met the criteria for FA, with 31% classified as severely affected. In our investigation of construct validity, we confirmed a one-dimensional model, in line with prior research using the YFAS and its modified versions. Item Response Theory (IRT) analyses further confirmed the appropriateness of the mYFAS 2.0 items, with all criteria contributing to the latent structure, most exhibiting discrimination values exceeding 0.5, and the majority having values greater than 2. These results provide substantial support for the construct validity of mYFAS 2.0 in our Brazilian subpopulation of post-bariatric surgery patients. Comparative analyses with previous studies revealed a notably higher prevalence of FA in our population, suggesting potential differences between pre- and post-bariatric surgery groups. This study contributes unique insights into the assessment of FA among post-surgery patients and highlights the importance of early detection and intervention in this population. While this study advances our understanding of FA in post-bariatric surgery patients, certain limitations, such as the relatively small sample size and cross-sectional design, warrant consideration. Nevertheless, our findings hold valuable implications for healthcare providers, researchers, and patients in the field of bariatric surgery and FA management. Future research can build upon these foundations to explore long-term FA effects post-surgery and potential interventions to address this issue effectively. [ABSTRACT FROM AUTHOR]

This systematic review explores the prevalence and impact of Drinking Games (DG) among college students. DGs involve social drinking with the goal of heavy alcohol consumption and are associated with risky behaviours. The review aims to quantify the relationship between DG participation, alcohol consumption, and negative outcomes. It also investigates gender moderation and unexplored motivational factors for DG engagement. Following PRISMA guidelines, 34 studies were included after screening 317 records. The studies comprised n = 34,197 participants and were analysed for various variables, including gender dynamics, motivations, and associated negative consequences. Gender convergence in DG participation was noted, emphasizing the importance of gender-specific interventions. Participants were aware of risks but often perceived negative outcomes as a badge of honour. Motivations for DGs were linked to social interaction and a sense of belonging. Personality traits like sensation seeking and identification with college drinking culture played significant roles in DG engagement and outcomes. The review underscores the need for targeted interventions to address shifting perceptions of negative consequences and consider personality traits when designing preventive measures. It also highlights the significance of gender-specific strategies. However, variations in DG measurement and possible selection bias among heavy drinkers participating in DGs remain limitations. This systematic review provides insights into DG prevalence and its link to negative outcomes among college students. The findings stress the importance of tailored interventions and further research to mitigate risk factors and promote healthier drinking behaviours in this demographic. [ABSTRACT FROM AUTHOR]

Substance-induced psychosis is a secondary psychotic disorder resulting from drug abuse, characterized by one or more psychotic episodes. Drug-induced psychosis is expected to resolve after a 30-day period of sobriety, however, individuals with this condition are more likely to develop severe drug addiction. Compared to primary psychosis, participants with drug-induced psychosis exhibit poorer family history of psychotic diseases, higher insight, fewer positive and negative symptoms, more depressive symptoms, and greater anxiety. Substance-induced psychosis is strongly associated with the emergence of bipolar illness or schizophrenia spectrum disorder, with an increased chance of developing schizophrenia at a younger age. Episodes of self-harm after substance-induced psychosis are strongly linked to an elevated likelihood of developing schizophrenia or bipolar disorder. Effective treatment involves ruling out emergencies, investigating underlying causes, and addressing acute intoxication and withdrawal. Management includes dynamic assessment, intervention, and vigilant monitoring in cases of suicidal behaviour. Antipsychotics may be used for short term, with gradual discontinuation when a person is in a stable condition. Relapse prevention strategies, both medication and non-medication-based, are crucial in long-term management. Conversion rates to schizophrenia or bipolar disorder can be as high as one in three individuals, with cannabis users and those with early-onset substance abuse at the highest risk. [ABSTRACT FROM AUTHOR]

This comprehensive review delves into the intricate interplay between gender/sex and MDMA use, drawing upon recent evidence. It explores how girls, as a means of coping with negative emotions, often resort to drug use, while boys primarily initiate drug use due to peer pressure or sensation-seeking tendencies. Women, frequently having endured traumatic life events, may turn to MDMA as a form of self-medication. Notably, women face an elevated risk of contracting sexually transmitted infections due to their altered mental states and diminished condom use during MDMA consumption. Additionally, females exhibit heightened sensitivity to the subjective effects of MDMA, consistently reporting heightened anxiety, adverse effects, and negative side effects. While women may have a higher susceptibility to hyponatremia, intriguingly, they appear to be less vulnerable to MDMA-induced hyperthermia. Although limited, available data suggest that prenatal MDMA exposure could lead to motor delays in infants, necessitating further research to unravel the potential cognitive effects. Furthermore, MDMA-assisted psychotherapy holds immense promise for addressing post-traumatic stress disorder (PTSD) among female subgroups. These pronounced gender and sex disparities in MDMA use and its effects underscore the pressing need for additional research to develop tailored, effective, and safe treatment approaches that account for these fundamental factors. [ABSTRACT FROM AUTHOR]

Smoking rates among individuals with mental disorders are higher compared to general population. We aimed to investigate the effectiveness of a smoking cessation treatment among individuals with and without mental disorders. Self-report 7-day point prevalence was used to assess abstinence status among 'intention to treat' (n = 1,213) and 'completers-only' (n = 578) samples. Participants were distributed in (1) ND-only; (2) ND and other substance use disorder (ND-SUD); (3) ND associated with mental disorder but no other SUD (ND-MD); and (4) co-morbid ND, SUD and MD (ND-SUMD). The treatment program was composed by six weeks of group Cognitive Behavioral Therapy (CBT) and medical consultations. Multivariate logistic regression models were applied. Rates of abstinence between ND-only and both ND-MD and ND-SUMD differed in the 'intention-to-treat' sample, with the former group showing the best rate (62.5%, 48% and 45.4% respectively). ND-SUD had the second-best rate of abstinence (56.1%). Differences between groups were not observed among 'completers-only'. Self-report 7-day point prevalence abstinence is economical and reliable to be used in low to middle-income countries. In this study, it showed that the 6-week smoking cessation treatment had a positive effect among completers, which supports the importance of investing in treatment to decrease smoking prevalence in this population. [ABSTRACT FROM AUTHOR]

Alcohol consumption has a key role in more than 200 diseases and health injuries, being an important factor for social and public health costs. Studies with clinical populations show an association between alcohol use disorders (AUD) and bipolar disorder. In this meta-analysis we included studies, reports, or summaries identified in Google Scholar, Lilacs, Medline, and MedCaribe that reported original data published up to 31 January 2023. We included cross-sectional and longitudinal observational studies that investigated the prevalence of AUD in patients with bipolar disorder. We calculated the prevalence rates and conducted a meta-analysis using a random effects model. The meta-analysis included 20 unique studies conducted in 12 countries, with a total sample of 32,886 individuals with bipolar disorder, comprising 17,923 women and 13,963 men, all aged 18 years or older. The prevalence of AUD in individuals with bipolar disorder was found to be 29.12%, while the prevalence of Alcohol Dependence (AD) was 15.87% and the prevalence of Alcohol Abuse (AA) was 18.74%. The high prevalence of AUD individuals with bipolar disorder is important because it highlights the need for targeted interventions to prevent and address comorbid conditions, which may improve treatment outcomes, reduce harm, and promote public health. [ABSTRACT FROM AUTHOR]

Currently, few treatments are available for craving in general, and none of them have received approval for cannabis craving. The objective of this review is to evaluate existing studies analysing treatments for cannabis craving and explore novel treatment possibilities for these patients. The study followed PRISMA guidelines and conducted an extensive database search. Inclusion criteria included human randomised controlled trials examining drug effects on craving symptoms. Exclusion criteria involved studies unrelated to craving, non-pharmacological treatments, duplicates, and non-English/Spanish/Portuguese articles. Our included 22 studies that investigated a wide range of compounds used for cravings related to other drugs, as well as interventions based on healthcare professionals' empirical knowledge. The current pharmacological treatments largely involve off-label drug use and the utilisation of cannabinoid-based medications, such as combinations of THC and lofexidine, oxytocin, progesterone, and N-acetylcysteine. These emerging treatments show promise and have the potential to revolutionise current clinical practices, but further investigation is needed to establish their efficacy. In this context, it is essential to consider non-pharmacological interventions, such as psychotherapy and behavioural treatments. These approaches play a crucial role in complementing pharmacological interventions and addressing the complex nature of the disorder. [ABSTRACT FROM AUTHOR]

Given the legislative heterogeneity about involuntary treatment and psychoactive substance users, we opted to perform a systematic review and meta-analysis of the correlates of involuntary substance use disorders (SUD) treatment across different countries. We conducted research on the Pubmed database, searching for involuntary SUD treatment data worldwide. The systematic review analysed a total of 36 articles and included a sample of 47,739 patients. Our review highlights the elevated risk of involuntary treatment among male, unmarried individuals with alcohol and/or opioid use disorders. Targeted preventive and therapeutic interventions should focus on addressing the underlying factors contributing to involuntary treatment, such as psychosis, aggressiveness, suicidal ideation, legal problems, and severe social exposure. By targeting these factors and providing comprehensive care, we can strive to improve outcomes and reduce the burden of substance use disorders in this vulnerable population. It is essential to critically examine and understand the factors contributing to the selection of patients for compulsory treatment. By doing so, we can identify potential gaps or inconsistencies in the current processes and work towards ensuring that decisions regarding compulsory treatment are based on sound clinical and ethical principles. [ABSTRACT FROM AUTHOR]

Through new publications on the subject, the main goal of this article is to seek a change in the pattern of alcohol use before and after bariatric surgery. We searched the National Library of Medicine, CINAHL, and PsycINFO databases. We included original articles regarding alcohol consumption before and after bariatric surgery to conduct the systematic review. Our systematic review, which included 18 articles, yielded mixed results. Meta-analysis of six articles did not reveal statistically significant differences in alcohol use behaviours before and one year after bariatric surgery. However, throughout the perspective of follow-up after bariatric surgery, nine out of the twelve articles showed improvement in the pattern of alcohol consumption when evaluated up to two years after the end of the surgical period, and four out of the five articles with monitoring beyond two years showed worsening in consumption, compared to pre-surgery alcohol use behaviours. Conclusions about the relationship between alcohol consumption and bariatric surgery are challenging primarily because of the variety of the methods used and the alcohol consumption measures. Despite that, our research pointed to an increased risk of alcohol use disorders two years after bariatric surgery. [ABSTRACT FROM AUTHOR]

Racism and racial discrimination heavily impact on health and mental health of ethnic minorities. In this conceptual paper and narrative review, we aim to report on relevant evidence from the international literature describing the prevalence and the qualitative aspects of mental illness due to racism and ethnic- discrimination in different settings and populations. Some variables related to racism, such as cultural, institutional, interpersonal factors, as well as the concepts of perceived and internalised racism will be described and discussed. These are relevant characteristics in the explanatory model of the relationship between racism and mental health. Epidemiological data on the prevalence of depressive and psychotic symptoms as well as substance abuse/misuse among ethnic minorities in large catchment areas, such as United States and United Kingdom, will be represented. We conclude that anti-racism policies are essential in order to address racism and racial discrimination around the world. Pluralistic societies should be promoted in order to understand mental illnesses among ethnic and cultural minorities. Also, anti-racism programs should be delivered in the educational and health-care settings and their impact evaluated. [ABSTRACT FROM AUTHOR]

Stigma and discrimination are a major ongoing problem in the field of mental health as these impact on patient outcomes, access to and acceptability of therapeutic interventions, their quality of life, general wellbeing, social inclusion and opportunities. Social stereotypes, culture and prejudices all contribute to continuing discrimination in mental health. Different settings where people function may also be sources of discrimination such as work and educational environments. The lack of knowledge and understanding of mental health/illness by individuals, their families, carers and policymakers as well as the social media reporting also impact on social attitudes to discrimination. It has been also described a relevant impact of stigma among specific social minorities reporting poor mental health such as elderly people, youths, sexual variants, persons with disability. Educational programs, raising awareness trainings and proper public policies may be developed in order to reduce stigma at social level with favourable outcomes for people with mental illness. [ABSTRACT FROM AUTHOR]

Mental health of social minorities is a challenge of modern psychiatry. It is largely described that people reporting sexual, cultural, religious variations are exposed to an amount of social stress deriving from the contrast between their minority status and the dominant societal norms and values. Minority stress leads to higher level of psychosocial distress and mental illness among these vulnerable populations. This conceptual research paper reports on evidences regarding the mental health issues related to the minority social condition and proposes a set of actions to address these challenges in a global perspective. Specifically, political, social and educational interventions are discussed in order to contrast stigma, discrimination, promote integration and health services for vulnerable populations. Policymakers are invited to deliver ad-hoc policies on minorities and homeless people with specific funding to address related public mental health issues. Educational programs are encouraged in the school setting as well as in the training of health care professionals in order to improve the level of acceptance and competencies in the treatment of minorities' health needs. We firmly believe there is no healthy society without healthy minorities. [ABSTRACT FROM AUTHOR]

We analyzed rationality, content, and anchoring of the monetary policy interest rate expectations (for 3, 6, 9, and 12 months ahead), taking into account the Brazilian data from January 2003 to July 2020. We consider expectations based on two perspectives: expectations gathered from a Taylor rule and market expectations obtained from the survey carried out by the central bank. The findings point out that, concerning rationality and anchoring, the interest rate expectations based on a Taylor rule performed better than expectations from the Central Bank of Brazil's (CBB) survey, even when we consider the Top 5 forecasters. Moreover, our analysis shows that the content of monetary policy interest rate expectations based on a Taylor rule and CBB's survey (including Top 5 forecasters) is different. Thus, they may be seen as complementary sources of information on the future interest rate. Concerning anchoring of the monetary policy interest rate expectations, the CBB's survey expectations are not anchored, while the result for the expectations based on a Taylor rule shows the opposite for horizons up to 9 months ahead. [ABSTRACT FROM AUTHOR]

Medical students face many challenge in their academic path. The disclosure of their own sexual orientation may be problematic since it impacts negatively on their acceptance in the educational environmental and the course of their career. Mental health issues may also occur among medical students as consequences of their perceived homophobia as well as stigma after the coming out. Research shows that students' attitude to the sexual orientation disclosure may vary across countries and cultures as well as students' homophobic attitudes towards sexual minorities: the latter should be addressed since prejudice might affect the quality of medical care for LGBT+ (Lesbian, Gay, Bisexual, Transgender) patients. We suggest that more education and training on LGBT + health issues is needed in the medical students' core-curricula: this would improve the health care of sexual minorities and LGBT + students' acceptance in the academic milieu. [ABSTRACT FROM AUTHOR]

This paper aimed to review the literature regarding the impact of discrimination on substance use disorders among Sexual Minorities (SM), with a focus on alcohol, opioids, stimulants, polydrug use, chemsex, cannabis and tobacco, as well as inequalities in the access to health care services. It is alarmingly clear that SM report higher rates of morbidity if compared to the general population. Health care delivery inequalities have also been reported in this special population. Also, the lack of data from low- and middle-income countries on substance use among SM is a major concern. Certainly, discrimination play a key-role among leading factors to substance abuse, continued use, disorders, and lower levels of preventive and treatment interventions. However, it may be difficult to estimate the impact of discrimination because of the lack of research data and different methodologies of literature studies. Moreover, SM are differently categorized and defined and evidences may be not comparable between studies. There is an urgent need of strategic guidelines and research investments aimed at prioritizing these populations disproportionately impacted by substance use. Equity-oriented policies and programs can facilitate opportunities and decrease substance use in these vulnerable subgroups, including community- and peer-led initiatives and nonjudgmental and inclusive health services. [ABSTRACT FROM AUTHOR]

This report presents the prevalence of mental and substance use disorders around the world discussing the impact of geographical, sociodemographic, and income characteristics on national epidemiological differences. We analysed data from the Institute of Health Metrics and Evaluation database published in 2019. The global prevalence of mental disorders was 13.0%, with higher prevalence of anxiety disorders rate (4.1%), followed by depressive disorders (3.8%, including major depressive disorder 2.49% and dysthymia 1.35%), intellectual disability (1.5%), ADHD (1.1%), conduct disorders (0.5%), bipolar disorders (0.5%), autism spectrum disorder s (0.4%), schizophrenia (0.3%), and eating disorders (0.2%, including bulimia nervosa 0.13% and anorexia nervosa 0.05%). The worldwide prevalence of substance-use disorders was 2.2%, not surprisingly, with higher prevalence of alcohol-use disorders (1.5%) than other drug-use disorders (0.8% total including: cannabis 0.32%; opioid 0.29%, amphetamine 0.10%; cocaine 0.06%). In general, high-income countries reported higher levels of mental and substance use disorders, with the exceptions of conduct and depressive disorders (no significant differences were found among low- and high-income countries), and intellectual disability (with higher prevalence in low-income countries). In regions of the America's prevalence rates of mental and substance use disorders were higher than in Europe. Western Pacific countries reported high levels of schizophrenia, and depressive disorders were highly prevalent in Africa as well as in the Americas. Intellectual disability reported higher rates in Eastern Mediterranean and South-East Asia. We discuss the cross-cultural variations in mental health expenditure and literacy as well as stigma-related factors and some of the environmental risk factors possibly related to these prevalence differences. [ABSTRACT FROM AUTHOR]

Social exclusion and poverty are associated with increased mental health issues. In addition, the current political and civil conflicts worldwide are also considered as leading factors to mental disorders and substance use disorders. The Compassion, Assertive action, Pragmatism and Evidence (CAPE) index comprises nine country-level measures and highlights the need for assistance in countries with a high degree of vulnerability. Several findings from previous studies reported a broad relationship between CAPE indices and increased levels of mental disorders and substance use. In this paper, we identified the prevalence of mental disorders and substance use disorders among those countries reporting higher (i.e., highest CAPE Index scores) as well as lower (i.e., highest Quality of Life Index scores) vulnerability. We extracted prevalence data from the Institute for Health Metrics and Evaluation global database in 2019. There was a lower prevalence of mental (12.5%) and substance use (1.7%) disorders in highly vulnerable countries than less vulnerable ones (15.1% and 3.5%, respectively). These findings suggest an urgent need for early detection of mental and substance use disorders in vulnerable countries: increasing mental health literacy among non-specialized health professionals in these regions may greatly improve the level of detection and treatment. [ABSTRACT FROM AUTHOR]

Immigration typically occurs from low- to high-income countries and regions. Unfortunately, these wealthier areas also have higher rates of cannabis use (e.g. European Union and the US). This systematic review aimed to summarize available studies on cannabis use among immigrants, refugees, and asylum seekers. In addition, evidence on the association between immigration and cannabis use was reviewed. The rates of cannabis use were lower among immigrants than natives. The risk and protective factors to cannabis use were quite similar to those of the native populations. The population at greatest risk for cannabis use were refugees, males, singles, non-religious, those with lower educational level, living in urban areas, with friends that use cannabis and/or other drugs. Cannabis use tend to increase over generations, and acculturation seems to play a pivotal role. First generation migrants report equal or lower consumption of cannabis when compared with the majority population with a subsequent increase in following generations, with a clear association with acculturation factors. A higher cannabis use was found among migrants with lower cultural congruity as well as a higher level of culture assimilation. This use seems to be unrelated to alcohol or illicit drugs consumption, but possibly associated with tobacco smoking. [ABSTRACT FROM AUTHOR]

Tobacco use is associated with an annual global economic cost of two trillion dollars and mortality of half of its regular users. Tobacco leaf cultivation is the starting point of the tobacco cycle. Tobacco farming employs millions of small-scale tobacco farmers around the globe, most of whom are out growers who rely on the tobacco industry. This paper aims to map the regions of greatest tobacco production globally (i.e., the US, Brazil, China, Indonesia, India, and Zambia) and tobacco use rates in these locations. Smoking rates were higher in those areas, except for India, where important population subgroups reported an upward trend for tobacco smoking. In general, there was a relationship between tobacco farming and tobacco smoking. Tobacco farming may lead to a higher risk of tobacco use and lower adherence to tobacco control policies. Therefore, promoting viable alternative livelihoods for tobacco farmers must have dual benefits. Additionally, specific health prevention policies might be necessary for those populations reporting higher tobacco use and lower perception of tobacco-related health risks. [ABSTRACT FROM AUTHOR]

Mental health symptoms and disorders amongst elite athletes have attracted a great deal of discussion recently. Current epidemiological evidence illustrates that mental health symptoms and disorders in elite athletes are prevalent and a concern for athletes, coaches, and sport organizations. Recently, seven consensus, expert, or position statements have been written on the topic of mental health in elite sport. A strategy suggested by each of the seven statements – aimed at preventing and treating mental health symptoms and disorders in elite athletes, both individually and systemically – is to employ education interventions, specifically those based on increasing mental health literacy. Mental health literacy has come to include concepts related to knowledge of effective self-management strategies, challenging mental disorder stigma, awareness and use of mental health first-aid to assist others, and the facilitation of help seeking behaviors. In elite sport, questions remain about how mental health literacy can address the unique needs of the individual athlete, but also factor in their culture and their environment to identify how to prevent and treat mental health symptoms and disorders. The purpose of this commentary is twofold: 1) to explore the evolving concept of mental health literacy within elite sport which addresses individuals, their culture, and their environment, and 2) to propose strategies for best practice and research in mental health literacy within elite sport relying on collaboration between sports psychiatry, sport psychology, and clinical psychology. Lay summary: Expert statements on mental health in elite sport have suggested the use of educational strategies to address poor mental health in elite athletes. This commentary explores the concept of mental health literacy within elite sport which addresses individuals, their culture, and their environment, and proposes strategies for best practice. Mental health literacy interventions should be based on detailed knowledge of developmental, cultural, and social issues related to sport participation and systemic issues within sport settings and organizations. Mental health literacy interventions should be designed in a manner which takes due account of cultural issues and contexts, where sport organizational goals are considered while helping organizations recognize and address mental health symptoms and disorders and also create sport environments where individuals can thrive. Mental health literacy interventions should have measurable impact on both organizations and individuals. [ABSTRACT FROM AUTHOR]

There is considerable evidence to suggest that individuals with mental illness as well as their carers and families are discriminated against across a number of domains. It is also well recognized that people with mental illness are likely to die younger than their counterparts who do not have mental illness. We propose that a Magna Carta is urgently needed to protect the rights of people with mental illness and help reduce discrimination. In this paper a background and rationale for this is offered alongside suggestions for reducing discrimination. The simple message is this; progress in health, economic, environmental and global development will not be made without improvements in mental health. The reasons are equally straightforward as mental illnesses cause more disability than any other health condition and bring enormous pain and suffering to individuals, their families and communities. These impacts lead to early death, damage to the economy and restrain individual progress. Every country needs to take urgent responsibility for defending the rights of individuals with mental illness. [ABSTRACT FROM AUTHOR]

The Compassion, Assertive action, Pragmatism and Evidence (CAPE) Vulnerability Index is a global foreign policy index which has been used to identify countries which require foreign aid and how that can be prioritized. The Index offers an evidenced, structured, and reasoned approach to using aid in bi-lateral agreements with mental health as a foundation. This study used 26 internationally available and validated indicators to explore and perform the analysis leading to the development of the Index. As with many summary statistics used to describe matters across the globe there has to be a fundamental reliance on national reporting or gathering of the underlying information used in their derivation, although their reliability may be in question and, in addition, such an exercise can be refined and repeated every year. It is concluded that the countries which score worse on the Index are likely to be failed states or fragile states: countries where the governments do not have complete control or authority. Such governments can often be repressive and corrupt, may participate in serious human rights abuses, and are characterized by conflict of various forms. These governments are also likely to suffer disadvantage as a result of extremes of climate changes, extreme poverty, inequality, social and ethnic divisions, the inability to provide basic services, and suffer from pockets of insurgency in the form of terrorism, which are often violent and brutal. [ABSTRACT FROM AUTHOR]

High levels of stress, burnout, and symptoms of poor mental health have been well known among practicing doctors for a number of years. Indeed, many health systems have formal and informal mechanisms to offer support and treatment where needed, though this varies tremendously across cultures. There is increasing evidence that current medical students, our doctors of the future, also report very high levels of distress, burnout, and substance misuse. We sampled large groups of medical students in 12 countries at the same time and with exactly the same method in order to aid direct comparison. 3766 students responded to our survey across five continents in what we believe is a global first. Our results show that students in all 12 countries report very high levels of 'caseness' on validated measures of psychiatric symptoms and burnout. Rates of substance misuse, often a cause of or coping mechanism for this distress, and identified sources of stress also varied across cultures. Variations are strongly influenced by cultural factors. Further quantitative and qualitative research is required to confirm our results and further delineate the causes for high rates of psychiatric symptoms and burnout. Studies should also focus on the implementation of strategies to safeguard and identify those most at risk. [ABSTRACT FROM AUTHOR]

Herein, an extended Hoshen-Kopelman algorithm to non-lattice environments has been used to create a algorithm suitable for cluster detecting/labelling in molecular simulations. This algorithm is useful to study many systems of particles which undergo aggregating phenomena, such as clustering or gelation. Particle positions are input in this code, which verifies connections between molecules based on a cutoff distance. We show two examples to better illustrate the proposed algorithm: the aggregation of Lennard-Jones particles under Brownian motion at gelation condition and aggregation of asphaltene molecules in heptane. Results showed that the number of clusters diminishes because each molecule/particle initially corresponds to one cluster, which aggregates over time. Consequently, the number of links (the mean size of the cluster) increases until reaching a constant value, which means that the system achieved equilibrium. This new algorithm is compared to the previously existing one and proved to be faster, while showing to be very useful in counting the number of clusters. [ABSTRACT FROM AUTHOR]

Soldier's Heart (SH) is a former medical diagnosis, rarely mentioned nowadays, presented under several other names. Considering the controversy regarding the removal of Soldier's Heart diagnosis from DSM-5, this study aimed to conduct a systematic review to evaluate its usage in the clinical practice. Information on diagnosis, military stress, heart rate variability, treatment, and prognosis were collected from 19 studies included after a systematic literature search. Considering the lack of adequate use of Soldier's Heart diagnosis and the diagnostic overlapping with other conditions, the present systematic review supports the inclusion of Soldier's Heart under the umbrella of posttraumatic stress disorders (PTSDs). This proposal is also in line with the conception that physical symptoms are relevant features often associated with generalized anxiety disorder and PTSD. Also, it will be described the higher prevalence of cardiological comorbidities in SH and possible cardiological consequences. Pharmacotherapy based on benzodiazepines and beta-blockers, as well as biofeedback and mindfulness techniques are considered to be useful treatment options. Further studies are needed to better define psychopathological domains of this syndrome and possible novel treatment targets. [ABSTRACT FROM AUTHOR]

Kleptomania is an impulse control disorder characterized by the irresistible urge to steal not for monetary gain. Since its conceptualization, this categorical diagnosis has been conflated with common beliefs regarding the social class and gender such as the idea that women are intrinsically fragile and that people in the middle class were unlikely to commit theft. Also, its use has been controversial in the medical and forensic fields. This review of the literature will provide a historical excursus through the definitions of the syndrome and summarize the available pharmacological and psychotherapeutic options for its treatment. Currently, there is a lack of systematic studies regarding the clinical characteristics of kleptomania and its treatment options for practical standardized approaches. [ABSTRACT FROM AUTHOR]

Capgras and Fregoli syndromes are two psychotic and complex conditions also known as Delusional Misidentification Syndromes (DMSs). Their description dates back to the beginning of XX century, and many explanatory models have been formulated through myths, psychoanalytical and psychological hypotheses, as well as neurobiological proposals. Even if DMSs are not fully considered in the modern diagnostic manuals, they still remain intriguing phenomena to be clinically observed and explained. Also, the employment of psychotropics and physical techniques in the treatment of such conditions is not supported by robust evidences and this may encourage further studies. We conclude that it would be of great interest to brush up the neglected MDSs in order to improve our knowledge on the underlying mechanisms of delusion and brain functioning. [ABSTRACT FROM AUTHOR]

The aim of this review is to present a brief historical perspective, the current status of psychiatric education in Brazil, discuss its role in Latin America, and its challenges ahead. The history of psychiatry in Brazil is intertwined with the history of medical assistance in Brazil. Psychiatric education in Brazil started in the asylum-centric era during the second half of the 19th century and evolved to occupy university teaching-hospital in the 20th century. The medical residency in psychiatry has shown considerable growth since its implementation 70 years ago. Undoubtedly, it currently occupies a prominent place in Brazilian medicine. However, there is a need to create and expand it in the less developed regions of the country. Brazilian psychiatric journals also have a leading position in developing evidence-based psychiatry in Latin America. [ABSTRACT FROM AUTHOR]

In line with studies from around the world, several studies have shown equal or higher rates of anxiety, depression, alcohol and other drug use, and burnout in medical students in Brazil. The aim of the present study was to identify difficulties Brazilian medical students face regarding stressors, psychological distress, and psychiatric morbidity using standardized reliable and valid instruments. In addition, this study also investigated differences associated with sex. Students (n = 129) were asked to complete a one-off survey from January to June 2019, including demographics, previous mental health issues, CAGE, GHQ-12, and OLBI. A higher prevalence of previous mental disorders was found in comparison to during the medical course. This may suggest that perhaps students are under more stress or that they form a more vulnerable sub-population in medical school in comparison with the general population. However, the types of mental disorders before and during the undergraduate course appear to vary. During the course, they show higher levels of anxiety rather than that of depression. Before commencing the course, they showed higher levels of depression rather than anxiety. Cannabis and ecstasy experimentation levels were higher than those of students from other courses in previous studies. The opposite was true for stimulants. Just over a quarter reported alcohol abuse above the CAGE cut-off point. The levels of psychological distress and burnout were extremely high, and women had even higher levels. Male respondents were more likely to have a history of mental ill-health, but female subjects scored higher on burnout. Overall over 80% students reported burnout. These findings are discussed in the context of Brazilian culture. [ABSTRACT FROM AUTHOR]

This review aims to summarize neuroimaging studies in order to better understand the neural correlates of depressive symptoms in tobacco smokers. Using the keywords “depressive OR depression” AND “tobacco OR nicotine OR smok*OR cigarette” AND “neuroimage OR magnetic resonance OR smri OR structural magnetic resonance OR fmri OR functional magnetic resonance OR pet OR positron emission tomography”, literature search was conducted in PubMed, Web of Science and PsycINFO databases. The first and the last author read the abstracts of all the studies found in the search (n= 179). The inclusion and exclusion criteria were applied and 150 articles were excluded. Then, both authors assessed the remaining 29 studies for eligibility and 16 studies were included in the present review. In the phase of active/chronic smoking, depressive symptoms are characterized as comorbidity related to an enhancement of dopamine release, and smokers have decreased Monoamine oxidase A (MAO-A). Stimuli-related functional magnetic resonance imaging (Stimuli-fMRI) studies also show that there is a positive correlation between the level of depressive symptoms and a greater response to general negative stimuli in active/chronic smokers. In the withdrawal phase, depressive symptoms are related to the withdrawal syndrome and increased MAO-A. Stimuli-fMRI studies show that there is a negative correlation between level of depressive symptoms and reactivity to negative stimuli in recent abstinent smokers. Major areas of the reward system such as the striatum and areas related to impulse control are activated to a greater extent in depressive smokers compared to non-depressed smokers. [ABSTRACT FROM PUBLISHER]

Objectives: The aim of this study was to investigate smoking treatment effectiveness and retention in a population with and without mental disorders (MD). Participants received cognitive behavioral therapy (CBT) plus nicotine patch alone or in combination with other medications (i.e., gum, bupropion, or nortriptyline) for smoking cessation treatment in a Brazilian Psychosocial Care Center unit (CAPS), taking into account sociodemographics and smoking profile covariates. Methods: The study involved comparison of treatment success (seven-day point prevalence abstinence at the end of the treatment) and retention (presence of the individual in all of the four medical consultations and six group sessions) in two subsamples of patients with MD (n = 267) and without MD (n = 397) who were included in a six-week treatment provided by a CAPS from 2007 to 2013. The treatment protocol comprised group CBT and pharmacotherapy (nicotine patches, nicotine gums, and bupropion and nortriptyline available, prescribed by psychiatrists). Results: Within patients with MD, CBT plus nicotine patch plus bupropion (aOR = 2.00, 95% CI [1.14, 3.50], p =.015) and CBT plus nicotine patch plus gum (aOR = 2.10, 95% CI [1.04, 4.23], p =.036) were associated with treatment success. Within patients without MD, female gender (aOR = 0.60, 95% CI [0.37, 0.95], p =.031) and lower Heaviness of Smoking Index score (aOR = 0.80, 95% CI [0.65, 0.99], p =.048) were associated with treatment success. No variable was associated with dropout or retention within patients with or without MD. Conclusion: Our findings support the use of CBT plus nicotine patch plus bupropion as well as CBT plus nicotine patch plus gum in samples with high rates of medical, psychiatric, and addiction disorders. These findings support those of previous studies in the general population. Pharmacological treatment associated with group CBT based on cognitive-behavioral concepts and combined with ongoing MD treatment seems to be the best option for smoking cessation treatment among patients with MD. Units that deal with patients with MD, such as CAPS in Brazil, should be encouraged to treat smoking addiction in this population. Future studies should investigate retention rates in other samples of patients with MD. [ABSTRACT FROM AUTHOR]

The consumption of alcohol, tobacco, and other drugs has become a concern in high-performance athletes. Professional athletes are more exposed to drugs than the general population. Although some drugs are unquestionably detrimental to performance, several studies have nevertheless shown evidence of increased consumption of these substances within this subpopulation. This review aimed to elucidate alcohol, tobacco, cocaine, cannabis, and opioid use among high-performance athletes, discussing the prevalence of substance use, its impacts, and alternatives to treatment in this special population. Unfortunately, no clinical trials for the treatment of substance use disorders were carried out with this specific sub-population. Therefore, the strategies adopted for the general population should be adapted to high-performance athletes. Psychological, psychosocial, psychoeducational, cognitive-behavioural, motivational interviewing approaches can be implemented. As regards pharmacological treatment, medications used in the treatment of alcohol and tobacco dependence, such as naltrexone, disulfiram, acamprosate, varenicline, bupropion, and nicotine replacement treatment can be used without problems. However, some medications used in cocaine and opioid dependence treatment, such as moldafinil and methadone, are prohibited by doping enforcement agencies. Professionals involved with athletes should be aware of the signs and symptoms of the acute effects of substances so as to enable an early identification of substance abuse problems, especially during training periods. [ABSTRACT FROM AUTHOR]

The authors reflect on geopsychiatry as a new area of psychiatry that studies the relationship between geography and psychiatry. Geopsychiatry is mainly involved on the effects of factors like disasters, globalisation and climate change in the mental health-mental illness processes, and the possible psychological symptoms that could occur after natural disasters like substance abuse, grief, and uncontrollable stress.

The article provides information on dimensional classification of personality disorders mentioned in periodical "the Diagnostic and Statistical Manual of Mental Disorders (DSM)" on the basis of film "Rachel Getting Married." Personality domains discussed include detachment, disinhibition, and antagonism.

The right to vote is an important right signifying freedom of thought as well as full citizenship in any setting. Right to vote is enshrined and protected by international human rights treaties. The right of ‘everyone’ to take part in the political process and elections is based on universal and equal suffrage. Although these International Conventions have been ratified by the large majority of United Nations Member States, their application across the globe is by no means universal. This study sets out to examine the domestic laws of UN Member States in order to explore whether individuals with mental health problems have the right to vote in actuality and, thu,s can participate in political life. Through various searches, electoral laws and Constitutions of 193 Member States of the United Nations were studied. The authors were able to find legislation and/or Constitutional provisions in 167 of the 193 Member States. Twenty-one countries (11%) only placed no restrictions on the right to vote by persons with mental health problems. Over one third of the countries (36%) deny all persons with any mental health problems a right to vote without any qualifier. Some of these discriminatory attitudes are reflected in the multiplicity of terms used to describe persons with mental health problems. Another 21 countries (11%) denied the right to vote to detained persons; of these, nine Member States specifically denied the right to vote to persons who were detained under the mental health law, while the remainder denied the right to vote to all those who were interdicted or judicially interdicted. It would appear that in many countries the denial of voting rights is attributed to a lack of ability to consent by the individuals with mental illness. Further exploration of explanation is required to understand these variations, which exist in spite of international treaties. [ABSTRACT FROM PUBLISHER]

The right to work and employment is indispensable for social integration of persons with mental health problems. This study examined whether existing laws pose structural barriers in the realization of right to work and employment of persons with mental health problems across the world. It reviewed disability-specific, human rights legislation, and labour laws of all UN Member States in the context of Article 27 of the UN Convention on the Rights of Persons with Disabilities (CRPD). It wes found that laws in 62% of countries explicitly mention mental disability/impairment/illness in the definition of disability. In 64% of countries, laws prohibit discrimination against persons with mental health during recruitment; in one-third of countries laws prohibit discontinuation of employment. More than half (56%) the countries have laws in place which offer access to reasonable accommodation in the workplace. In 59% of countries laws promote employment of persons with mental health problems through different affirmative actions. Nearly 50 years after the adoption of the International Covenant on Economic, Social, and Cultural Rights and 10 years after the adoption of CRPD by the UN General Assembly, legal discrimination against persons with mental health problems continues to exist globally. Countries and policy-makers need to implement legislative measures to ensure non-discrimination of persons with mental health problems during employment. [ABSTRACT FROM PUBLISHER]

Background: There has been considerable debate regarding what typically occurs after experimentation with drugs throughout the life of young people who used various drugs. Aims: To evaluate the clinical importance of the most common sequence for the first use of a drug by two models (the 'gateway model' and the 'alternative model', which is the most popular sequence for Brazilian university students according to a previous study) regarding the problematic use of alcohol, tobacco, cannabis and other illegal drugs, assessed by ASSIST. Method: People who had already experimented with three or more drugs across different stages of the two models were selected from a representative sample of university students from 27 Brazilian capitals ( n = 12 711). Findings: There were no differences regarding the problematic use of the most consumed drugs in Brazil (alcohol, tobacco and cannabis) between the models. Multiple drug seekers and violators had more problematic use of illegal drugs other than cannabis than individuals in the model sequence. However, in the case of violators, this was only evident in the alternative model. Conclusions: Multiple drug seekers and violators deserve special attention due to their increased risk of problematic use of other illegal drugs. [ABSTRACT FROM AUTHOR]

Psychosocial units in Brazil (CAPS) provide access to mental health and addiction patients, who are not routinely treated for nicotine dependence. The present study analysed predictors of retention of a 6-week treatment provided by a CAPS unit to 367 smokers with a high rate of psychiatric disorders and addictions for the period 2007-2010. Several baseline variables were collected. Retention was defined as the presence of the individual in all four medical consultations and six group sessions. Multivariate discrete time Cox survival regression models were used to test for the outcome of interest. Timetables were used to explore in which moment of the treatment each predictor was important. Time to smoking the first cigarette (TTFC) 5 min or later after waking and nicotine patch use (nicotine replacement therapy, NRT) were associated with retention. The present study supports the importance of the variables TTFC and NRT when used in treatment retention for a sample with a high rate of psychiatric and alcohol disorders. NRT seems to be very important in the beginning of the treatment, probably because of withdrawal symptoms. Individuals currently undergoing psychiatric treatment and with alcohol problems had good retention rates comparable to the other individuals. [ABSTRACT FROM AUTHOR]

The present study investigated the predictors of an increased number of visits from individuals with some of the diagnoses noted in chapter F14 of ICD-10, from calls to the emergency psychiatric unit of a general hospital in São Paulo state, Brazil, in the period 2011-2012. Poisson regression models were carried out for the outcome variable, accounting for number of subsequent visits to the psychiatric emergency unit. For the analysis of this outcome we took into account the exposure time of each individual in the study. Our findings point to a population at risk for frequent psychiatric emergency service visits: individuals over 25 years. This population should be targeted for interventions on entry into public healthcare due to increased psychiatric morbidity and greater clinical morbidity already confirmed by previous studies. We discussed the need of these individuals for special attention during the clinical or psychiatric emergency consultation which, unfortunately, may be the access point for the public health system. None of the other variables were related to the outcome of interest, such as those related to the level of individual entry into the care network before and after treatment, and other variables related to medical acts during the visit. [ABSTRACT FROM AUTHOR]

Religious values are part of cultures, but spirituality is an internal dimension which may be present in varying degrees across all nations. As both cultural and spiritual factors are important in determining the pattern of alcohol consumption by individuals, it is important to study the relationships between them. The present systematic review aims to summarize the knowledge on the relationship between alcohol use and misuse, religiousness/spirituality and culture drawn from medical studies. Data from the medical literature to date indicate that for some racial and ethnic minorities a return to the traditional culture linked with concepts of spiritual or religious factors can produce a major degree of support for people trying to maintain abstinence from alcohol. This can be seen even in the worst environments. On the other hand, among the general population, religion and/or spirituality can play a positive role in the maintenance of abstinence, but a local heavy drinking culture is a strong risk factor for relapse. These factors are important and can be used for interventions and prevention strategies. However, possible mediating effects need to be explored further. It is likely that both types of intervention (classical medical treatment plus spiritual-based treatment) may work in individuals. [ABSTRACT FROM AUTHOR]

AbstractThis study aimed to explore the perception of barriers to accessing mental health services within the general population of Paraguay using the Barriers to Access to Care Evaluation (BACE) scale. The barriers were categorized into three types: attitudinal, instrumental, and stigma-related. The sample comprised 321 participants, the majority of whom were women (82.9%). Among the participants, 62.9% reported experiencing mental ill-health, with the most common disorders being anxiety (37.4%), depression (30.5%), and sleep disorders (20.6%). Of the participants, 157 (48.9%) reported significant attitudinal barriers, which include beliefs and perceptions about mental health treatment, among others; 87 (27.1%) reported significant stigma-related barriers, which involve prejudices and stereotypes associated with mental disorders; and 189 (58.9%) experienced significant instrumental barriers, including financial constraints and limited availability of services. Mental ill-health was significantly associated with all types of barriers. In conclusion, significant barriers to accessing mental health services persist among the Paraguayan population. These barriers must be addressed through evidence-based public policies to improve the quality-of-life of both individuals with mental ill-health and the broader general population. [ABSTRACT FROM AUTHOR]

AbstractModern psychiatry aims to adopt precision models and promote personalized treatment within mental health care. However, the complexity of factors underpinning mental disorders and the variety of expressions of clinical conditions make this task arduous for clinicians. Globally, major depression is a common mental disorder and encompasses a constellation of clinical manifestations and a variety of etiological factors. In this context, the use of Artificial Intelligence might help clinicians in the screening and diagnosis of depression on a wider scale and could also facilitate their task in predicting disease outcomes by considering complex interactions between prodromal and clinical symptoms, neuroimaging data, genetics, or biomarkers. In this narrative review, we report on the most significant evidence from current international literature regarding the use of Artificial Intelligence in the diagnosis and treatment of major depression, specifically focusing on the use of Natural Language Processing, Chatbots, Machine Learning, and Deep Learning. [ABSTRACT FROM AUTHOR]

An introduction is presented in which the authors discuss various reports within the issue on topics including sports psychiatry, history and evolution of sports, and performance enhancing drugs (PEDs).