Examining predictors of cocaine withdrawal syndrome at the end of detoxification treatment in women with cocaine use disorder

BACKGROUND

Detoxification is frequently recommended as a treatment for moderate to severe Cocaine Use Disorder (CUD). However, the response to detoxification varies among patients, and previous studies have focused mostly on patterns of drug use behavior to test associations with treatment outcomes, overlooking the potential impact of psychosocial factors, other clinical variables, and individual life experiences. In this study we comprehensively examined several variables aiming to find the most relevant predictors to classify patients with severe versus non-severe cocaine withdrawal symptoms at the end of detoxification.

METHODS

Data from 284 women with CUD who enrolled in a 3-week detoxification program was used in this longitudinal study. Psychosocial, clinical, and drug use behavior characteristics were evaluated, generating a dataset with 256 potential predictors. We tested six different machine learning classification algorithms.

RESULTS

The best classification algorithm achieved an average accuracy and ROC-AUC of approximately 70%. The 16 features selected as best predictors were the severity of psychiatric, family, and social problems and the level of exposure to childhood maltreatment. Features associated with drug-use behavior included days consuming drugs and having craving symptoms in the last month before treatment, number of previous drug/alcohol-related treatments, and a composite score of addiction severity. The level of cocaine withdrawal syndrome at the beginning of detoxification was also a key feature for classification. A network analysis revealed the pattern of association between predictors.

CONCLUSION

These variables can be assessed in real-world clinical settings, potentially helping clinicians to identify individuals with severe cocaine withdrawal that is likely to be sustained over the course of detoxification.

Correction: The psychological impact of the COVID-19 pandemic in Portugal: The role of personality traits and emotion regulation strategies

[This corrects the article DOI: 10.1371/journal.pone.0269496.].

To produce or not to produce? Contrasting the effect of substance abuse in social decision-making situations

Substance use disorders (SUD) have been related to high criminal justice costs, expensive healthcare, social impairment, and decision-making deficits. In non-social decision-making tasks, people with SUD tend to take more risks and choose small immediate rewards than controls. However, few studies have explored how people with SUD behave in social decision-making situations where the resources and profits depend directly on participants' real-time interaction, i.e., social foraging situations. To fulfill this gap, we developed a real-time interaction task to (a) compare the proportion of producers (individuals who tend to search for food sources) and scroungers (individuals who tend to steal or join previously discovered food sources) among participants with SUD and controls with respect to the optimal behavior predicted by the Rate Maximization Model, and (b) explore the relationship between social foraging strategies, prosocial behavior, and impulsivity. Here participants with SUD (n = 20) and a non-user control group (n = 20) were exposed to the Guaymas Foraging task (GFT), the Social Discounting task (SD), and the Delay Discounting task (DD). We found that participants in the control group tended to produce more and obtain higher profits in contrast to substance abuser groups. Additionally, SD and DD rates were higher for scroungers than producers regardless of the group. Our results suggest that producers tend to be more altruistic and less impulsive than scroungers. Knowing more about social strategies and producers' characteristics could help develop substance abuse prevention programs.

Non-pharmacological treatment-related changes of molecular biomarkers in major depressive disorder: A systematic review and meta-analysis

Background

Major depressive disorder (MDD) is a serious mood disorder and leading cause of disability. Despite treatment advances, approximately 30% of individuals with MDD do not achieve adequate clinical response. Better understanding the biological mechanism(s) underlying clinical response to specific psychopharmacological interventions may help fine tune treatments in order to further modulate their underlying mechanisms of action. However, little is known regarding the effect of non-pharmacological treatments (NPTs) on candidate molecular biomarker levels in MDD. This review aims to identify molecular biomarkers that may elucidate NPT response for MDD.

Methods

We performed a systematic review and a multilevel linear mixed-effects meta-analyses, and a meta-regression. Searches were performed in PubMed, Scopus, and PsycINFO in October 2020 and July 2021.

Results

From 1387 retrieved articles, 17 and six studies were included in the systematic review and meta-analyses, respectively. Although there was little consensus associating molecular biomarker levels with symptomology and/or treatment response, brain metabolites accessed via molecular biomarker-focused neuroimaging techniques may provide promising information on whether an individual with MDD would respond positively to NPTs. Furthermore, non-invasive brain stimulation interventions significantly increased the expression of neurotrophic factors (NTFs) compared to sham/placebo, regardless of add-on pharmacological treatment.

Conclusions

NTFs are candidate biomarkers to fine-tune NIBS for MDD treatment.

A Longitudinal Investigation of Blood Neurofilament Light Chain Levels in Chronic Cocaine Users

The identification of a blood marker of brain pathology that is sensitive to substance-induced neurotoxicity and dynamically responds to longitudinal changes in substance intake would substantially improve clinical monitoring in the field of substance use and addiction. Here, we explored the hypothesis that plasma levels of neurofilament light chain (NfL), a promising marker of neuroaxonal pathology, are elevated in chronic cocaine users and longitudinally associated with changes in cocaine use. Plasma NfL levels were determined using single molecule array (SIMOA) technology at baseline and at a 4-month follow-up. Substance use was subjectively assessed with an extensive interview and objectively measured via toxicological analysis of urine and 4-month hair samples. In a generalized linear model corrected for sex, age, and body mass index, NfL plasma levels were elevated in cocaine users (n=35) compared to stimulant-naïve healthy controls (n=35). A positive correlation between cocaine hair concentration and NfL levels was also found. Changes in cocaine hair concentration (group analysis of increasers vs. decreasers) over the 4-month interval predicted NfL levels at follow-up, indicating a rise in NfL with increased cocaine use and a reduction with decreased use. No associations between use or change of use of other substances (including the neurotoxic cocaine adulterant levamisole) and NfL levels were found. Our findings demonstrate that NfL is a sensitive marker for assessing cocaine-related neuroaxonal pathology, supporting the utility of blood NfL analysis in addiction research but also suggesting the detailed assessment of substance use in neurological studies and diagnostics.

Decision-making under risk and theory of mind in adolescent offenders in provisional deprivation of liberty

INTRODUCTION

Delinquent behaviors are risky behaviors that increase during puberty and reach their highest peak in late adolescence. It has been proposed that poor decision-making and theory of mind (ToM) are key cognitive processes implicated with delinquency during adolescence, affecting evaluation of risks and impairing appreciation of social norms. Nevertheless, it is not yet clear whether adolescent offenders who are subjected to provisional deprivation of liberty due to conflict with the law (adolescents in conflict with the law [ACL]) might, in fact, present a specific profile with regard to these cognitive processes.

OBJECTIVES

To assess deliberative decision-making and ToM among adolescents in conflict with the law and adolescents not in conflict with the law.

METHODS

The sample comprised 62 participants: ACL (n = 29) and a control group (CG) (n = 33). ToM was assessed with the Reading the Mind in the Eyes Test (RMET) and decision-making was assessed with the Columbia Card Task (CCT). Substance use, callous-unemotional traits, childhood maltreatment, and intelligence quotient (IQ) were also assessed.

RESULTS

ACL had more ToM errors for negative mental states in comparison to CG, but not for error rates concerning neutral and positive mental states. With regards to decision-making, our results suggest that ACL group members did not vary their behavior based on the available information and that the risk information had an opposite effect on the number of cards chosen (risk-taking behavior) when compared to CG.

CONCLUSION

These findings have important implications for development of interventions for these adolescents, suggesting that they tend to learn little from negative outcomes and have reduced capacity to process negative emotions.

Cue-induced cocaine craving enhances psychosocial stress and vice versa in chronic cocaine users

Stress and craving, it has been found, contribute to the development and maintenance of and relapse in cocaine use disorder. Chronic cocaine users (CU), previous research has shown, display altered physiological responses to psychosocial stress and increased vegetative responding to substance-related cues. However, how psychosocial stress and cue-induced craving interact in relation to the CU's physiological responses remains largely unknown. We thus investigated the interaction between acute psychosocial stress and cocaine-cue-related reactivity in 47 CU and 38 controls. In a crossed and balanced design, the participants were randomly exposed to a video-based cocaine-cue paradigm and the Trier Social Stress Test (TSST) or vice versa to investigate possible mutually augmenting effects of both stressors on physiological stress responses. Over the course of the experimental procedure, plasma cortisol, ACTH, noradrenaline, subjective stress, and craving were assessed repeatedly. To estimate the responses during the cocaine-cue paradigm and TSST, growth models and discontinuous growth models were used. Overall, though both groups did not differ in their endocrinological responses to the TSST, CU displayed lower ACTH levels at baseline. The TSST did not elevate craving in CU, but when the cocaine-cue video was shown first, CU displayed an enhanced cortisol response to the subsequent TSST. In CU, cocaine-cues robustly evoked craving but no physiological stress response, while cue-induced craving was intensified after the TSST. Taken together, though CU did not show an altered acute stress response during the TSST, stress and craving together seemed to have mutually augmenting effects on their stress response.

In- and Out-Group Effects on Social Perception and Empathy in Cocaine Use Disorder

Earlier research revealed that cocaine users display impairments in emotional but not necessarily in cognitive empathy. However, no study to date has tested whether empathy is generally altered or whether impairments are restricted to specific social targets. The current investigation addresses this open question. In addition, we examined whether attributions of warmth and competence as well as personal future expectancies differed between cocaine users and substance-naïve controls. Twenty-two chronic cocaine users and 40 stimulant-naïve controls specified their perceived warmth and competence for four social targets [in-group member, opposite consumption out-group member (cocaine user for controls and non-user for cocaine user), opposite consumption out-group member of opposite gender, and elderly person]. They also specified their cognitive and emotional empathy for these four targets facing eight desirable and eight undesirable events. Finally, they rated the likelihood of these scenarios happening to themselves. Both cocaine users and controls attributed lower warmth to cocaine-using than non-using targets. Comparably, no in-group preference was observed in cocaine user's emotional empathy ratings, and greater denigration of the in-group was associated with higher frequency and doses of cocaine consumption. In addition, cocaine users rated both desirable and undesirable events as more likely to happen to themselves than did controls. Results show that substance-naïve individuals stigmatize cocaine users. They further point to compromised self-esteem in cocaine users resulting from such stigmatization. Interventions should address stigmatization processes to break the vicious circle of mutual social distancing and stronger dedication to the drug.

The psychological impact of the COVID-19 pandemic in Portugal: The role of personality traits and emotion regulation strategies

Recent evidence suggests that both personality traits (PT) and emotion regulation (ER) strategies play an important role in the way people cope with the COVID-19 pandemic. The aim of this study was two folded. First, to longitudinally investigate the psychological distress (depression, anxiety, and stress levels) taking in consideration PT and ER strategies in 3 different moments: during the first lockdown period (April/20), at the first deconfinement (May/20) and 1-month after the first deconfinement (Jun/20)-Experiment I. Second, to cross-sectionally evaluate the impact of the pandemic in psychological distress and the correlates with PT and ER 6-months after the first deconfinement November/20 to February/21 -Experiment II. A total of 722 volunteers (Experiment I = 180; Experiment II = 542) aged 18 years or older participated in this online survey. The findings from Experiment I show that psychological distress decreased after the lockdown period, however, neuroticism traits predicted higher levels of depression, anxiety and stress symptoms, while difficulties in ER strategies were identified as a risk factor for depression and stress. For experiment II, neuroticism traits and being infected with COVID-19 were associated to higher levels of symptomatology, while unemployment and the use of emotional suppression strategies to cope with emotional situations were associated to depressive and anxiety symptoms. Although the psychological impact of the COVID-19 outbreak decreased over time in our sample, the current findings suggest that difficulties in emotional regulation and high levels of neuroticism traits might be potential risk factors for psychiatric symptomatology during the COVID-19 pandemic. Thus, people with difficulties in ER and neuroticism traits would benefit from psychological interventions that provide personality-appropriate support and promote emotion regulation skills during stressful events, such as the case of the global pandemic.

The Acute Impact of the Early Stages of COVID-19 Pandemic in People with Pre-Existing Psychiatric Disorders: A Systematic Review

People with pre-pandemic health conditions are more vulnerable and more likely to suffer greater psychosocial impact due to the current COVID-19 pandemic and the lockdown measures. Thus, the objective of this work was to systematically review the impact of the early stages COVID-19 pandemic on people with pre-existing psychiatric disorders. The search was performed between 23 January and 2 September 2021 in PubMed, PsycINFO, and EMBASE. A total of 4167 published results were identified; however, only 49 were included in this review. Results show that there was considerable heterogeneity among studies, which resulted in a low consensus. However, it seems that the impact of the first stage of the COVID-19 pandemic on psychiatric disorders was two-fold: (1) an overall effect, in which people suffering from psychiatric disorders in general experienced more psychological distress and anxiety when compared to people who had no psychiatric diagnosis, and (2) a condition-specific effect, namely in people suffering from eating disorders and obsessive compulsive disorders. Moreover, the current work highlights that there were also some external factors that were related to worsening symptoms. For instance, unemployment or experiencing work and financial difficulties can be a trigger for greater distress during the pandemic for people with mood disorders, and being alone and in social isolation during the COVID-19 pandemic may actually increase substance use and relapse rates. Further studies are needed to prospectively investigate the long-term effects of the current COVID-19 pandemic on people with (pre)-existing psychiatric conditions and on the onset or deterioration of psychiatric-related symptoms in a larger number of participants, as well as exploring the long-term effects of the current pandemic on mental health.

Validation of the Brazilian Portuguese version of the Quick Inventory of Depressive Symptomatology and Self-Report (QIDS-SR16) for the Brazilian population

OBJECTIVES

To evaluate the psychometric properties of the Quick Inventory of Depressive Symptomatology (QID-SR16), a self-report instrument based on the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) criteria that assesses the severity of depression symptoms, in the Brazilian population.

METHODS

Participants were 4,400 Brazilians over the age of 15 years recruited for an online survey assessing depressive symptoms during the early phase of the coronavirus disease 2019 (COVID-19) pandemic in Brazil. The internal consistency, construct validity, and convergent and discriminant validity of the QIDS-SR16 were evaluated.

RESULTS

The model tested was considered an adequate fit to the data (comparative fit index [CFI] = 0.947, Tucker-Lewis index [TLI] = 0.927, and root-mean-square error of approximation [RMSEA] = 0.051) and its internal consistency was good, with a Cronbach's alpha of 0.71 and an average item correlation of 0.23. The correlations between the total QIDS-SR16 score and the total scores of the Patient Health Questionnaire (PHQ-9) instruments (r = 0.67, p < 0.001), the Posttraumatic Symptoms Checklist (PCL-5) (r = 0.61, p < 0.001), and the Patient-Reported Outcomes Measurement Information System (PROMIS) (r = 0.60, p < 0.001) indicate good concurrent and convergent validity.

CONCLUSION

The QIDS-SR16 has robust psychometric properties in terms of its internal consistency, construct validity, and convergent and discriminant validity. The Portuguese version of the QIDS-SR16 is an adequate instrument for assessment of depressive symptoms in the context of an online survey.

Validation of the Brazilian Portuguese version of the Quick Inventory of Depressive Symptomatology and Self-Report (QIDS-SR16) for the Brazilian population

OBJECTIVE

The aim of this study was to evaluate the psychometric properties of the Quick Inventory of Depressive Symptomatology (QID-SR16), a self-report instrument based on the DSM-IV criteria that assesses the severity of depression symptoms, in the Brazilian population.

METHOD

Participants were 4.400 Brazilians over 15 years old recruited from an online survey assessing depressive symptoms during the early phase of COVID-19 pandemic in Brazil. Internal consistency, construct validity and convergent and discriminant validity of the QIDS-SR16 were evaluated.

RESULTS

The tested model was considered adequate to the data (CFI = 0.947, TLI = 0.927 and RMSEA = 0.051) and its internal consistency was good, with a cronbach's alpha of 0.71 and an average item correlation of 0.23. The correlations between the total score of the QIDS-SR16 and the total scores of the PHQ-9 instruments (r = 0.67, p < 0.001), PCL-5 (r = 0.61, p < 0.001) and PROMIS (r = 0.60, p < 0.001) demonstrate good indicators of concurrent and convergent validity.

CONCLUSION

The psychometric properties of the QIDS-SR16 proved to be strong in terms of internal consistency, construct validity, and convergent and discriminant validity. The Portuguese version of QIDS-SR16 is an adequate instrument to assess depressive symptoms in the context of an online survey.

The Perceptions of Women About Their High Experience of Using Crack Cocaine

INTRODUCTION

The aim of this study was to explore the perceptions of women about their experience in using crack cocaine, discussing their motivations for using it and the repercussions in their lives.

OBJECTIVE

To investigate these experiences, a qualitative exploratory study was conducted, using the inductive thematic analyses of the content.

METHODS

Eight female crack cocaine users took part in this study. They were assessed by a semi-structured interview, addressing the crack cocaine use experience. Four main themes emerged in the interviews: (1) crack cocaine "high" experience; (2) symptoms related to crack cocaine use; (3) circumstances of crack cocaine use; and (4) crack cocaine use consequences.

RESULTS

The main perceptions reported by the users were related to a feeling of being disconnected to the world preceded by a pleasant experience, especially during the first moments of use. They revealed that the drug fulfills a key role of coping strategy to handle with negative thoughts, emotions or life experiences. An important influence of social issues was reported in relation to the onset of crack cocaine use. Negative consequences and significant impact on their lives appeared in their reports, regarding the loss of family ties, involvement with prostitution, traumatic experiences and violence.

CONCLUSION

Taking together all women's perceptions suggests that beyond the positive immediate rewarding effect, the maintenance of use might be related to the dissociative experience and self-medication role, acting as negative reward by relieving of negative life experiences that, in turn, are both cause and consequence of the drug use.

Stability and test-retest reliability of different hormonal stress markers upon exposure to psychosocial stress at a 4-month interval

The Trier Social Stress Test (TSST) has been shown to reliably induce physiological stress responses in the hypothalamus-pituitary-adrenal (HPA) and in the sympathetic-adrenal-medullary (SAM) axis in cross-sectional studies. However, it was also reported that repeated exposure to the TSST might be associated with habituation, mainly of the HPA axis responsivity. Thus, in all longitudinal stress studies involving repeated TSST administration, potential habituation of the HPA axis response complicates the interpretation of results. The goal of the present study was therefore to assess stability and test-retest reliability of a number of different endocrinological stress markers as well as subjective stress responses after two exposures to the TSST four months apart. We assessed salivary and plasma cortisol profiles, plasma ACTH and noradrenaline profiles, as well as subjective stress ratings in healthy volunteers before, during, and after the TSST at six time-points both at test-day 1 (TSST_1, n = 42) and test-day 2 (TSST_2, n = 34) 4-months later. Half of the participants received the TSST in the early, the other half in the late afternoon. Discontinuous growth models were applied to model three phases of the stress response (preTSST, reactivity, recovery) for each marker. Subsequently, the stability of these phases was analyzed. Stability and test-retest reliability of standard physiological stress markers such as Area-under-the-Curve (AUC_G, AUC_I), Absolute Peak Change, and Relative Peak Change (RPC) were analyzed as well. We did not observe strong test-retest effects in any of the endocrinological measures. In contrast, test-retest effects in subjective stress were characterized by a faster drop directly after the second TSST, whereas the initial increase before the test period was the same for both test-days. Regarding test-retest-reliability, AUC_G was the most reliable measure across all endocrinological and subjective stress markers (range: r = .606 to .858), while AUC_I and RPC (range: r = - .146 to .548) were least reliable. A 4-month interval is a sufficient time interval between two repeated TSST exposures to largely reinstate the physiological stress response, which was also true for the initial psychological stress response. Thus, the TSST is well applicable in longitudinal studies.

White matter deficits in cocaine use disorder: convergent evidence from in vivo diffusion tensor imaging and ex vivo proteomic analysis

White matter (WM) abnormalities in patients with cocaine use disorder (CUD) have been studied; however, the reported effects on the human brain are heterogenous and most results have been obtained from male participants. In addition, biological data supporting the imaging findings and revealing possible mechanisms underlying the neurotoxic effects of chronic cocaine use (CU) on WM are largely restricted to animal studies. To evaluate the neurotoxic effects of CU in the WM, we performed an in vivo diffusion tensor imaging assessment of male and female cocaine users (n = 75) and healthy controls (HC) (n = 58). Moreover, we performed an ex vivo large-scale proteomic analysis using liquid chromatography-tandem mass spectrometry in postmortem brains of patients with CUD (n = 8) and HC (n = 12). Compared with the HC, the CUD group showed significant reductions in global fractional anisotropy (FA) (p < 0.001), and an increase in global mean (MD) and radial diffusion (RD) (both p < 0.001). The results revealed that FA, RD, and MD alterations in the CUD group were widespread along the major WM tracts, after analysis using the tract-based special statistics approach. Global FA was negatively associated with years of CU (p = 0.0421) and female sex (p < 0.001), but not with years of alcohol or nicotine use. Concerning the fibers connecting the left to the right prefrontal cortex, Brodmann area 9 (BA9), the CUD group presented lower FA (p = 0.006) and higher RD (p < 0.001) values compared with the HC group. A negative association between the duration of CU in life and FA values in this tract was also observed (p = 0.019). Proteomics analyses in BA9 found 11 proteins differentially expressed between cocaine users and controls. Among these, were proteins related to myelination and neuroinflammation. In summary, we demonstrate convergent evidence from in vivo diffusion tensor imaging and ex vivo proteomics analysis of WM disruption in CUD.

Neurotrophic Factor Levels in Preterm Infants: A Systematic Review and Meta-Analysis

Objectives: Through a systematic review and meta-analysis of the literature we aimed to compare the levels of BDNF, NGF, NT-3, NT-4, and GDNF between human term and preterm infants, and investigate factors implicated in the variability of effect size estimates. Methods: The analysis was performed in three online databases, MEDLINE Complete, PsycINFO, and CINAHL. A random effects model was used to calculate the standardized mean difference (SMD) of neurotrophic factor levels in preterm infants vs. term within a 95% confidence interval (CI). To explore sources of heterogeneity meta-regression models were implemented. Results: Sixteen studies were included in this meta-analysis. A combined sample of 1,379 preterm and 1,286 term newborns were evaluated. We identified significant lower BDNF (SMD = -0.32; 95% CI: -0.59, -0.06; p = 0.014) and NT-3 (SMD = -0.31; 95% CI: -0.52, -0.09; p = 0.004) levels in preterm compared to term infants. No significant difference was observed in NGF and NT-4 levels between groups. Given that only two effect sizes were generated for GDNF levels, no meta-analytical model was performed. Meta-regression models revealed sample type (placental tissue, cerebrospinal fluid, peripheral blood, and umbilical cord blood) as a significant moderator of heterogeneity for BDNF meta-analysis. No significant associations were found for gestational week, birth weight, and clinical comorbidity of newborns with effect sizes. Conclusions: Our findings indicated that lower BDNF and NT-3 levels may be associated with preterm birth. Future studies with larger samples sizes should investigate neurodevelopmental manifestations resulting from neurotrophic factor dysregulation among preterm infants.

A behavioral economic risk aversion experiment in the context of the COVID-19 pandemic

We investigated what degree of risk of infection with COVID-19 is necessary so that people intend to stay home, even when doing so means losing their salary. We conducted an online survey across Brazil during the initial outbreak, in which 8,345 participants answered a questionnaire designed to identify the maximum tolerated risk (k') necessary for them to disregard social distancing recommendations and guarantee their salaries. Generalized linear mixed models, path analysis structural equation, and conditional interference classification tree were performed to further understand how sociodemographic factors impact k' and to establish a predictive model for the risk behavior of leaving home during the pandemic. We found that, on average, people tolerate 38% risk of infection to leave home and earn a full salary, but this number decreased to 13% when the individual risk perception of becoming ill from severe acute respiratory syndrome coronavirus-2 is considered. Furthermore, participants who have a medium-to-high household income and who are older than 35 years are more likely to be part of the risk-taking group who leave home regardless of the potential COVID-19 infection level; while participants over 45 years old and with good financial health are more likely to be part of the risk-averse group, who stay home at the expense of any salary offered. Our findings add to the political and public debate concerning lockdown strategies by showing that, contrary to supposition, people with low socioeconomic status are not more likely to ignore social distancing recommendations due to personal economic matters.

Psychiatric symptoms and expression of glucocorticoid receptor gene in cocaine users: A longitudinal study

BACKGROUND

Chronic cocaine users (CU) display reduced peripheral expression of the glucocorticoid receptor gene (NR3C1), which is potentially involved in stress-related psychiatric symptoms frequently occurring in CU. However, it is unknown whether psychiatric symptoms and lower NR3C1 expression are related to each other and whether reduction of drug consumption reverse them.

METHOD

At baseline, NR3C1 mRNA expression was measured in 68 recreational CU, 30 dependent CU, and 68 stimulant-naïve controls. Additionally, the Revised Symptom Checklist (SCL-90R) and the Barratt Impulsiveness Scale (BIS) were assessed. At a one-year follow-up, the association between change in NR3C1 expression and psychiatric symptoms was examined in 48 stimulant-naïve controls, 19 CU who increased and 19 CU who decreased their consumption. At both test sessions, cocaine concentrations in hair samples were determined. Mixed-effects models were used to investigate how changes in drug use intensity affect severity of psychiatric symptoms and NR3C1 expression over time.

RESULTS

At baseline, recreational and dependent CU displayed elevated impulsivity and considerable symptom burden across most of the SCL-90R subscales. Time-group interaction effects were found for several impulsivity scores, SCL-90R Global Severity Index, Paranoid Thoughts, and Depression subscales as well as for NR3C1 expression. Pairwise comparisons showed that decreasing CU specifically improved in these SCL-90R subscales, while their NR3C1 expression was adapted. Finally, changes in NR3C1 expression were negatively correlated with changes in impulsivity but not SCL-90R scores.

CONCLUSION

Our findings suggest that NR3C1 expression changes and some psychiatric symptoms are reversible upon reduction of cocaine intake, thus favouring abstinence-oriented treatment approaches.

Substance related disorders are associated with impaired valuation of delayed gratification and feedback processing: A multilevel meta-analysis and meta-regression

Across numerous studies, individuals with substance use disorders (SUDs) differed from non-using controls regarding valuation of delayed gratification and feedback processing. However, it remains unclear whether the magnitude of the effect sizes is different across these two cognitive processes and how specific SUDs as well as demographic and clinical moderators influence these effects. In this study we thus performed multilevel linear mixed-effects meta-analyses and meta-regressions to examine the effects of SUDs on the Delay Discounting Task (DD) and on the Iowa Gambling Task (IGT). We found a moderate to large effect for SUD on both, the IGT and DD. While the effect on the DD was generalized to all substance classes, a smaller effect for cannabis-related disorder when compared to other SUDs was found with regard to the IGT. Early onset of substance use and psychiatric comorbidities were associated with stronger effects on the DD. Our findings suggest that feedback processing is more vulnerable to specific substance effects, while valuation of delayed gratification depends more on developmental and clinical factors.

Cocaine use disorder in females is associated with altered social decision-making: a study with the prisoner's dilemma and the ultimatum game

BACKGROUND

Chronic cocaine use is associated with cognitive deficits, including poor performance on neuropsychological tasks of memory, executive functions, theory of mind and decision-making. However, the relationship between cocaine use disorder and social decision-making remains unclear. This is particularly relevant given the fact that many cocaine abusers present impairments in social functioning. In this sense, game theory paradigms have been helping to comprehend the behavior of psychiatric patients when they directly engage in social situations, which may better approximate many of their real-life choices.

METHODS

The present study investigated social decision-making in individuals with or without cocaine use disorder, examining their behavior in the Prisoner's Dilemma and in the Ultimatum Game. Thus, 129 females diagnosed with cocaine use disorder and 55 females with no history of substance abuse were recruited and performed both social decision-making tasks. Additional assessments included information about demographics, patterns of substance consumption and executive function performance.

RESULTS

Females with cocaine use disorder opted more often to not defect in the Prisoner's Dilemma, while in the Ultimatum Game they frequently chose to accept the first and unfair offer as responders. These effects were more pronounced within females with long-term history of cocaine use. Associations between cocaine use disorder and altered social decision-making were independent from demographic and executive function variables.

CONCLUSIONS

The influence of cocaine use disorder on social decision-making was detected in both game paradigms, resulting in more cooperative behavior in the Prisoner's Dilemma and higher acceptance rate of unfair offers in the Ultimatum Game. Further studies should focus on investigating these associations to shed light on the putative biopsychosocial factors underlying the observed effects.

Factors underlying risk taking in heroin-dependent individuals: Feedback processing and environmental contingencies

Evidence suggests that factors influencing risk-taking include whether decisions are made based on emotions (affective systems) or cognitions (deliberative systems), the processing of feedback (e.g., deciding to attend a rehabilitation facility for opioid addiction treatment after an intervention held by a family member), and attention to environmental contingencies (e.g., considering the probability of an outcome such as the likelihood of contracting tetanus from a shared needle; or the gains and losses associated with a decision, such as the benefits and costs of taking drugs). Although drug-dependent individuals tend to take more risks than non-drug users, the factors underlying risk-taking are unknown. The current study tested, for the first time, the influences of performance feedback (i.e., whether feedback about performance is integrated into decision-making in heroin-dependent individuals) and attention to environmental contingencies (i.e., the influence of the probability of a loss, the gain amount, and the loss amount associated with a scenario) on risk-taking in heroin-dependent individuals. Heroin-dependent patients undergoing maintenance therapy for opioid addiction (n = 25) and healthy controls (n = 27) completed the feedback and no-feedback conditions of the Columbia Card Task (CCT). Analyses of covariance, controlling for education and task design (the order in which the CCT conditions were completed) as covariates revealed a significant interaction between (a) probability, gain and loss amount, and group, and (b) group and probability. Our findings suggest that heroin-dependent patients pay less attention to environmental contingencies during risk-taking than controls. Addressing these factors may facilitate greater adherence to treatment programs and lower rates of relapse.

Balancing Automatic-Controlled Behaviors and Emotional-Salience States: A Dynamic Executive Functioning Hypothesis

Recently, there has been growing interest in understanding how executive functions are conceptualized in psychopathology. Since several models have been proposed, the major issue lies within the definition of executive functioning itself. Theoretical discussions have emerged, narrowing the boundaries between “hot” and “cold” executive functions or between self-regulation and cognitive control. Nevertheless, the definition of executive functions is far from a consensual proposition and it has been suggested that these models might be outdated. Current efforts indicate that human behavior and cognition are by-products of many brain systems operating and interacting at different levels, and therefore, it is very simplistic to assume a dualistic perspective of information processing. Based upon an adaptive perspective, we discuss how executive functions could emerge from the ability to solve immediate problems and to generalize successful strategies, as well as from the ability to synthesize and to classify environmental information in order to predict context and future. We present an executive functioning perspective that emerges from the dynamic balance between automatic-controlled behaviors and an emotional-salience state. According to our perspective, the adaptive role of executive functioning is to automatize efficient solutions simultaneously with cognitive demand, enabling individuals to engage such processes with increasingly complex problems. Understanding executive functioning as a mediator of stress and cognitive engagement not only fosters discussions concerning individual differences, but also offers an important paradigm to understand executive functioning as a continuum process rather than a categorical and multicomponent structure.

Theory of Mind in Substance Users: A Systematic Minireview

BACKGROUND

Theory of mind concerns the sociocognitive ability to infer others' thoughts. It has been theorized to be impaired in substance use and abuse, as its alterations might explain negative social and interpersonal outcomes noted in the course of disorders. In addition, the brain structures involved in Theory of Mind (ToM) have been found to be disrupted in drug use conditions.

OBJECTIVE

We undertook a systematic review of ToM functioning in drug use conditions.

METHODS

Four electronic databases (MEDLINE, Web of Science, PsycINFO, and Embase) were searched to find studies that have addressed ToM and conditions related to actual or previous drug use.

RESULTS

The search found 147 papers, of which 14 fulfilled our review eligibility criteria. Different methods were used, but overall, results indicated that drugs are related to ToM deficits, particularly related to alcohol and amphetamines use. These impairments correlate with other clinical and cognitive functions.

CONCLUSION

Despite the lack of studies and the methodological limitations of the existing ones Theory of Mind seems to play a role in drug use conditions, which requires further investigation.

Similarities between adult female crack cocaine users and adolescents in risky decision-making scenarios

BACKGROUND

Although previous studies have shown that both adolescence and drug addiction can influence risk-taking and decision-making processes, the underlying mechanisms remain unclear. Specifically, there is a lack of evidence as to whether these conditions could affect deliberative and affective processes involved in risk taking, such as feedback learning and valuation of profits and risk.

OBJECTIVES

The objectives were to compare the role of feedback and the use of information in risk-taking behavior between female crack cocaine users and adolescents. Additionally, we aimed to investigate whether sensation seeking, impulsivity, depressive and anxiety symptoms, executive functioning, and working memory performance could explain differences in risk-taking behavior.

METHOD

This is a quasi-experimental study comparing 27 low-income adult female crack cocaine users (CU) to 18 female adolescents (AD) within two conditions (no-feedback or delayed-feedback) of the Columbia Card Task (CCT). In order to investigate CCT reference values for adult females, we also included 20 female non-drug-users with regular education and income as a reference group (RG).

RESULTS

A similar pattern of risk-taking behavior was found between CU and AD within the CCT no-feedback condition. When delayed feedback was provided, AD exhibited a similar pattern of risk-taking behavior in the no-feedback condition, while CU showed a reduction of risk-taking behavior. Both groups exhibited higher risk taking than the RG within the CCT no-feedback condition, but only the AD group showed higher risk-taking behavior within the CCT feedback condition. Depressive symptom severity and working memory deficits were associated with higher risk-taking behaviors in CU. Executive functioning deficits were associated with higher risk-taking behavior in AD.

CONCLUSIONS

Adult female crack cocaine users and female adolescents took similar risks during risky decision-making scenarios where feedback about their own performance was absent. However, when participants were provided with such feedback, it modulated risk-taking behaviors in crack cocaine users but not in adolescents.

Cross-cultural adaptation of the Maltreatment and Abuse Chronology of Exposure (MACE) scale to Brazilian Portuguese

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

The influence of geographical and economic factors in estimates of childhood abuse and neglect using the Childhood Trauma Questionnaire: A worldwide meta-regression analysis

This multilevel meta-analysis examined the effects of geographical and economic factors on worldwide childhood maltreatment estimates measured by the Childhood Trauma Questionnaire (CTQ) short-form. The primary outcome extracted was continuous scores on the CTQ subscales - emotional abuse, physical abuse, sexual abuse, emotional neglect, and physical neglect - and total score. Geographical, economical and methodological variables were extracted for use as covariates in meta-regression models. A literature search identified 288 studies suitable for the CTQ total score analysis (N=59,692) and 189 studies suitable for maltreatment subtype analysis (N=44,832). We found that Europe and Asia were associated with lower CTQ estimates while South America presented the highest estimates among continents. Specifically, studies from China, Netherlands and United Kingdom presented the lowest maltreatment estimates. Furthermore, high-income countries presented lower CTQ physical neglect estimates in comparison to low- or middle-income countries, while per-capita gross domestic product of countries was negatively associated with childhood physical neglect estimates. Despite the influence of methodological covariates, these findings indicate that geographical and economic factors could influence variations of childhood maltreatment estimates around the world, particularly when assessed by a structured standardized questionnaire.

A systematic review of cognitive rehabilitation for bipolar disorder

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

Propriedades psicométricas da Cocaine Selective Severity Assessment (CSSA) em mulheres usuárias de crack

Objetivo Este estudo teve como objetivo adaptar a Cocaine Selective Severity Assessment (CSSA) para o português do Brasil e verificar as propriedades psicométricas do instrumento em uma amostra de usuárias de crack. Métodos Após as etapas de tradução e adaptação, 125 mulheres usuárias de crack, internadas em uma unidade pública de desintoxicação, foram avaliadas. Para caracterização da amostra e análise das validades concorrente, de construto e preditiva, foram utilizados os seguintes instrumentos: SCID-I, ASI-6, BDI-II e CCQ-B. Resultados A análise fatorial exploratória identificou cinco fatores, com níveis adequados de consistência interna tanto para os fatores quanto para o escore geral da CSSA. Quanto à validade concorrente, a CSSA vai ao encontro de instrumentos já utilizados na clínica e em pesquisas. Em relação à validade de construto e preditiva, a CSSA pode ser sensível ao declínio dos sintomas de abstinência durante o processo de desintoxicação do crack. Conclusões Nossos achados foram além da tradução e adaptação da CSSA, proporcionando testes de validade e sugerindo que a CSSA é um instrumento confiável na avaliação dos sintomas de abstinência do crack.

Brain-Derived Neurotrophic Factor and Delayed Verbal Recall in Crack/Cocaine Dependents

BACKGROUND/AIMS

Considering the role of brain-derived neurotrophic factor (BDNF) in memory processes and its peripheral response during the detoxification of cocaine, the aim of this study was to investigate whether plasma BDNF levels could be related to memory performance in women with crack/cocaine dependence.

METHODS

Twenty-five abstinent female crack/cocaine users (CCD) and 25 unmedicated healthy women (HW), carefully matched for age and years of formal education, were assessed regarding memory performance. Logical Memory was used to assess the immediate verbal recall (IVR), delayed verbal recall (DVR) and memory retention. Plasma BDNF levels were measured by Elisa immunoassay. Beck Depression Inventory was used to assess the severity of depressive symptoms, and the Cocaine Selective Severity Assessment the severity of cocaine abstinence symptoms.

RESULTS

The CCD group had lower DVR scores and higher plasma BDNF levels when compared to HW group. In addition, a linear regression model showed that BDNF levels predicted DVR scores within CCD group independently of depressive symptoms (R = 0.51; R(2) = 0.26; t(22) = 4.025, p = 0.03).

CONCLUSION

Despite higher plasma BDNF levels, crack users exhibited memory impairments when compared to healthy women. Specifically, peripheral BDNF levels predicted better cognitive performance only within individuals who already had cognitive impairment.

Brazilian version of the Structured Interview for Disorders of Extreme Stress - Revised (SIDES-R): adaptation and validation process

BACKGROUND

Posttraumatic stress disorder (PTSD) contemplates the impact of acute traumatic events, but the literature indicates that this is not true for chronic exposure to stress. In this sense, the category disorders of extreme stress not otherwise specified (DESNOS) has been proposed to characterize the behavior and cognitive alterations derived from exposure to continuous early life stress. The Structured Interview for Disorders of Extreme Stress - Revised (SIDES-R) was developed to investigate and measure DESNOS. Considering the lack of instruments designed to assess DESNOS, especially in Brazil, the aim of this study was to translate, adapt, and validate the contents of SIDES-R to Brazilian Portuguese (SIDES-R-BR).

METHOD

The original interview was subjected to translation, back-translation, semantic equivalence and conceptual correspondence analyses by naive and specialized judges, respectively, an acceptability trial, and inter-rater validity analysis.

RESULTS

The interview underwent semantic and structural adaptations considering the Brazilian culture. The final version, SIDES-R-BR, showed a mean understanding score of 4.98 on a 5-point verbal rating scale, in addition to a kappa coefficient of 0.853.

CONCLUSION

SIDES-R-BR may be a useful tool in the investigation of DESNOS and contributes a valuable input to clinical research in Brazil. The availability of the instrument allows to test symptoms with adequate reliability, as verified by the kappa coefficient and translation steps.

Executive functions rehabilitation for schizophrenia: a critical systematic review

BACKGROUND

Consistent evidences suggest that poor functional outcomes in schizophrenia are associated with deficits in executive functions (EF). As result cognitive training, remediation and/or rehabilitation (CR) programs have been developed and many theories, methods and approaches have emerged in support of them. This article presents a systematic review of randomized controlled trials (RCT), including EF rehabilitation interventions, with a focus on methodological issues and evidences of EF improvements.

METHOD

Electronic databases (Medline, Web of Science, PsycINFO and Embase) were searched for articles on schizophrenia, EF and cognitive rehabilitation terms. The methodological quality of each article was measured by 5-point JADAD scale.

RESULTS

A total of 184 articles were initially identified, but after exclusion criteria, 30 RCT remained in this review. A proportion of 23% of studies scored higher than 4 points in JADAD scale, 40% scored 3 points, 33% scored 2 points and one study scored only 1 point. The average length of interventions was approximately 80 h distributed around 3.42 h/week.

CONCLUSION

The reviewed articles corroborate the literature pointing that CR could be a promising therapeutic option for cognitive deficits in schizophrenia. In general, CR could improve cognitive domains and social adjustment either using computerized or paper-and-pencil programs. Additionally, CR combined with cognitive behavioral therapy and/or group sessions is particularly effective. In this paper, we also speculated and discussed optimal doses of treatment and the differences regarding modalities and approaches.