Misuse of prescription anxiolytic and sedative medication is a widespread phenomenon in Canada and a topic of increasing concern among health care providers. While anxiolytics and sedatives have important therapeutic uses in the treatment of anxiety and insomnia, these substances have psychoactive properties that render them vulnerable to misuse. Understanding the correlates and contexts of misuse is essential for developing targeted treatment and prevention strategies. This dissertation is comprised of a series of four studies conducted with adults in the Halifax Regional Municipality, recruited from the community and from a local substance use disorder treatment program. Study 1 investigated misuse of anxiolytics and sedatives among currently prescribed users of these medications in the general community. Misuse and diversion were associated with a more extensive history of other substance use and with personality dimensions, including hopelessness and impulsivity. Study 2 investigated motives for misuse among non-prescribed anxiolytic and sedative users recruited from the community. This study also included non-prescribed stimulant medication users to facilitate comparisons across differing classes of psychiatric medications. Non-therapeutic motives were associated with substance use history and, for anxiolytics and sedatives, with the personality dimension sensation-seeking. Study 3 involved an analysis of prescription regimens and misuse among all participants of Studies 1 and 2 who had ever held a prescription for an anxiolytic or sedative. Misuse of benzodiazepine anxiolytics and sedatives was more frequent than that of non-benzodiazepines, but was unrelated to prescription regimen. Study 4 examined the misuse of quetiapine, an atypical antipsychotic medication with anxiolytic and sedative effects, among clients of a methadone maintenance program. Misuse of quetiapine was widespread, but was typically associated with therapeutic motives. Quetiapine misuse was linked with a history of misusing other anxiolytic and sedative drugs. Collectively, these studies provide evidence that anxiolytic and sedative misuse is a heterogeneous phenomenon encompassing varying patterns of use and motives for misuse. Furthermore, these investigations suggest that anxiolytic and sedative misuse is linked to individual-level and medication-related variables. By providing a more comprehensive characterization of this important public health issue, these findings have practical implications in both clinical and research contexts.

Background and Objectives: To characterize the impact of pregabalin on sleep in patients with generalized anxiety disorder (GAD) and to determine whether the impact is a direct or an indirect effect, mediated through the reduction of anxiety symptoms. Methods: A post-hoc analysis of data from a randomized, double-blind, placebo- and active-controlled study in patients with GAD was conducted. Patients received pregabalin 300 mg/day, venlafaxine XR 75 mg/day or placebo for a week, followed by pregabalin 300-600 mg/day, venlafaxine XR 75-225 mg/day, or placebo for 7 weeks. Treatment effect on sleep was evaluated using the Medical Outcomes Study Sleep Scale. Anxiety symptoms were assessed with the Hamilton Anxiety Rating Scale. A mediation model was used to estimate separately for both treatment arms the direct and indirect treatment effects on sleep disturbance. Results: Compared with placebo (n = 128), treatment with pregabalin (n = 121) significantly reduced scores on the sleep disturbance subscale and Sleep Problems Index II at both week 4 and week 8, and the sleep adequacy subscale at week 8. Venlafaxine XR (n = 125) had no significant effect on these measures. The mediation model indicated that 53% of the total pregabalin effect on sleep disturbance was direct (p < 0.01) and 47% indirect, mediated through anxiety symptoms (p < 0.05). Conclusions: Pregabalin decreased sleep disturbance in patients with GAD both directly, and indirectly by reducing anxiety symptoms. Given the drug specificity of the results, this study provides evidence of an additional important pathway of action for pregabalin and its efficacy in GAD.

Submitted by MARCIA ROVADOSCHI (marciar@unifra.br) on 2018-08-17T11:31:21Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_PedroCelsoAlvesdaSilva.pdf: 2769821 bytes, checksum: 1e142f1afcd58116ec385de5c17ba4cc (MD5) / Made available in DSpace on 2018-08-17T11:31:21Z (GMT). No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_PedroCelsoAlvesdaSilva.pdf: 2769821 bytes, checksum: 1e142f1afcd58116ec385de5c17ba4cc (MD5) Previous issue date: 2016-03-31 / The exaggerated use of anxiolytic drugs can cause environmental problems if there is no destination and treatment, leading to contamination of water resources and biological tissues and aquatic organisms. In addition, some microorganisms develop resistance to these drugs affect the ecosystem with its toxicity and remain in the environment, which justifies the growing concern about these environmental pollutants that were found in various parts of the world. There are some studies in the literature of the use of graphene as a filter for the removal of metals such as Na, Mg, K, Ca and Ni environment. Other studies show that graphene can be used to remove drugs such as aspirin, caffeine, acetaminophen and ciprofloxacin the aqueous media. The objective of this study was to evaluate, through computer simulations based on Density Functional Theory (DFT), the structural and electronic properties of anxiolytic drugs interacting with pure graphene, because until now few methods of treating wastewater for removal anxiolytic drugs are not effective, and in other cases the methods are expensive. In this study, we analyzed the interaction of pure graphene with anxiolytics (alprazolam, clonazepam, clobazam, diazepam and the nordiazepam) commonly found in the environment and highly resistant to photobleaching. The results show that the interaction of graphene with diazepam stabilized with binding energy ranging between -0.29 eV and -0.35 eV and load transfers between -0.002 e- and +0.036 e-. As for the nordiazepam interacting with graphene, the binding energy remained between -0.23 eV and -0.31 eV and cargo transfers between -0.002 e- and +0.069 e-. For alprazolam the binding energy remained between -0.19 eV and -0.86 eV and cargo transfers between -0.004 and +0.041 e-. For clobazam the binding energy varied between -0.23 eV and -0.76 eV and load transfers between -0.005 e- and +0.040 e- and clonazepam remained between -0.52 eV and -0, 75 eV and load transfer between -0.005 e- and +0.070 e-. For every interaction was observed which can occur graphene load transfer to the drug (indicated by positive values) or drug for graphene (indicated by negative values). There was a physical adsorption for all pure graphene interactions with anxiolytic drugs with binding energy ranging between -0.19 eV and -0.86 eV and a charge transfer between -0.018 e- and +0.070 e-, and that the electronic properties of the systems were not changed significantly. The results for the interaction of graphene with anxiolytics, are important to contribute to the development of filters to remove these drugs from aqueous media and sewage treatment plants, since there are no reports in the literature on the interaction of graphene with anxiolytic agents for through computer simulation. / O uso exagerado de fármacos ansiolíticos pode acarretar problemas ambientais, caso não haja destino e tratamento adequado, ocasionando a contaminação dos recursos hídricos e de tecidos biológicos e de organismos aquáticos. Além disso, alguns micro-organismos criam resistência a esses fármacos afetando o ecossistema com sua toxicidade e permanência no meio ambiente, justificando a crescente preocupação sobre estes poluentes ambientais que foram encontrados em várias partes do mundo. Já existem na literatura alguns estudos do uso do grafeno como filtro para remoção de metais como: Na, Mg, Ca, K e Ni do meio ambiente. Outros estudos mostram que o grafeno pode ser utilizado para remoção de fármacos como: aspirina, cafeína, acetaminofeno e ciprofloxacina dos meios aquosos. O objetivo deste trabalho é avaliar, por meio de simulações computacionais baseadas na Teoria do Funcional da Densidade (DFT), as propriedades estruturais e eletrônicas de fármacos ansiolíticos interagindo com o grafeno puro, pois até o presente momento alguns métodos de tratamento dos efluentes para remoção de ansiolíticos não são eficazes e em outros casos os métodos são caros. Neste estudo, foi analisada a interação do grafeno puro com os ansiolíticos (alprazolam, clobazam, clonazepam, diazepam e o metabólito nordiazepam) frequentemente detectados no meio ambiente e altamente resistentes a fotodegradação. Os resultados mostram que a interação do grafeno com o diazepam se estabilizou com energia de ligação variando entre -0,29 eV e -0,35 eV e as transferências de carga entre -0,002 e- e +0,036 e-. Já para o nordiazepam interagindo com o grafeno, a energia de ligação se manteve entre -0,23 eV e -0,31 eV e as transferências de carga entre -0,002 e- e +0,069 e-. Para o alprazolam a energia de ligação permaneceu entre -0,19 eV e -0,86 eV e as transferências de carga entre -0,004 e- e +0,041 e-. Para o clobazam a energia de ligação variou entre -0,23 eV e -0,76 eV e as transferências de carga entre -0,005 e- e +0,040 e- e para o clonazepam manteve-se entre -0,52 eV e -0,75 eV e a transferência de carga entre -0,005 e- e +0,070 e-. Para todas as interações observou-se que pode ocorrer transferência de carga do grafeno para o fármaco (indicados pelos valores positivos) ou do fármaco para o grafeno (indicados pelos valores negativos). Ocorreu uma adsorção física para todas as interações do grafeno puro com os fármacos ansiolíticos, com energia de ligação variando entre -0,19 eV e -0,86 eV e uma transferência de carga entre -0,018 e- e +0,070 e-, sendo que, as propriedades eletrônicas dos sistemas não foram alteradas significativamente. Os resultados obtidos para a interação do grafeno com ansiolíticos, são importantes para contribuir com o desenvolvimento de filtros para remoção destes fármacos dos meios aquosos e estações de tratamento de esgotos, já que não há relatos na literatura sobre a interação do grafeno com agentes ansiolíticos por meio de simulação computacional.

nÃo hà / Os transtornos de ansiedade possuem alta prevalÃncia na populaÃÃo com graus de severidade variÃveis, podendo chegar à incapacitaÃÃo. Deakin & Graeff conceberam um modelo teÃrico relacionando defesa distal, amÃgdala e ansiedade generalizada, de um lado, e defesa proximal, substÃncia cinzenta periaqueductal e pÃnico, de outro. Nesta proposta, a serotonina facilita a ansiedade, porÃm inibe o pÃnico. O modelo do Labirinto em T Elevado (LTE) seria entÃo mais efetivo para distinguir estes dois padrÃes de ansiedade, ao contrario do Labirinto em Cruz Elevado (LCE), um dos modelos mais utilizados para avaliar efeitos ansiolÃticos das drogas. O modelo foi validado para ratos, havendo pouca descriÃÃo sobre o uso em camundongos. No primeiro experimento os animais (camundongos Swiss; 10 em cada grupo) foram tratados com salina (10 ml/kg; i.p.), imipramina (30mg/kg; i.p.), diazepam (1mg/kg; i.p.), paroxetina (5mg/kg; i.p.), paroxetina (10mg/kg; i.p.) e paroxetina (20mg/kg; i.p.) e avaliados no Teste do Nado ForÃado (TNF). No segundo experimento os camundongos foram separados em cinco grupos (n=10) e tratados com salina (10 ml/kg; i.p.), imipramina (30mg/kg; i.p.), diazepam (2mg/kg; i.p.), paroxetina (10mg/kg; i.p.), buspirona (10mg/kg; i.p) diariamente por uma semana (subcronicamente) e depois avaliados no TNF. No terceiro experimento camundongos foram tratados subcronicamnete com salina, imipramina (30mg/kg; IP), paroxetina (10mg/kg; IP), diazepam (2mg/kg; IP) e buspirona (10mg/kg; IP) e depois testados no LCE. No quarto experimento foram utilizados ratos Wistar que recebiam diariamente por gavagem salina, imipramina (10mg/kg), paroxetina (10mg/kg), diazepam (1mg/kg) ou buspirona (10mg/kg) por 24 dias consecutivos (volume constante 1 ml/kg de peso) e depois foram avaliados no LTE e Campo Aberto (CA). O quinto experimento foi semelhante ao quarto, sendo utilizado camundongos e um aparelho para LTE adaptado. Os resultados foram: imipramina e as trÃs dose de paroxetina apresentaram efeito antidepressivo, enquanto diazepam mostrou efeito depressivo no TNF agudo. Jà no TNF subcrÃnico apenas imipramina apresentou efeito antidepressivo. No LCE imipramina apresentou efeito ansiolÃtico enquanto paroxetina apresentou efeito ansiogÃnico. No LTE com ratos tratados cronicamente, paroxetina, diazepam e buspirona apresentaram efeito anti-ansiedade-generalizada enquanto imipramina, diazepam e paroxetina apresentaram efeito anti-pÃnico. No LTE com camundongos tratados cronicamente, imipramina, diazepam, buspirona e paroxetina apresentaram respostas anti-ansiedade-generalizada e apenas a paroxetina demonstrou efeito anti-pÃnico. Assim, imipramina, uma droga eficaz nos transtornos depressivos, ansiedade generalizada e pÃnico, foi responsÃvel por respostas semelhantes nos modelos animais (com exceÃÃo do LTE para camundongos). Diazepam, uma droga utilizada para ansiedade generalizada e com alguns efeitos no pÃnico, apresentou comportamento semelhante nos modelos, tendo efeito antipÃnico no LTE para ratos e nÃo para camundongos. Buspirona, uma droga utilizada na clinica apenas para ansiedade generalizada, nÃo apresentou efeitos antidepressivos ou antipÃnico em nenhum experimento. Paroxetina, inibidor seletivo da recaptaÃÃo da serotonina, antidepressivo, ansiolÃtico e antipÃnico, apresentou atividade ansiogÃnica no LCE (demonstrando este aparelho como inadequado para avaliar esta classe de droga) e efeito anti-ansiedade-generalizada e anti-pÃnico tanto em LTE para ratos quanto para camundongos. Conclui-se que o LTE para camundongos à um modelo adequado para detectar efeitos ansiolÃticos e anti-pÃnico das drogas, este Ãltimo em especial para drogas serotonÃrgicas / The disorders of anxiety use to have high levels of prevalence among population, with varying degrees of severity, eventually causing disability. Deakin & Graeff have conceived a theoretical model, relating distal defence, amygdala and generalized anxiety, on the one hand, and proximal defence, periaqueductal grey substance and panic, on the other. In this proposal, serotonin eases anxiety, but inhibits the panic. The format of the Elevated T Maze (ETM) would be more effective to distinguish these two patterns of anxiety, in contrast to Elevated plus maze (EPM), one of the models most frequently used to evaluate anxiolytic effects of drugs. The model was validated for rats, with little description about the use in mice. In the first experiment, the animals (Swiss mice, 10 in each group) were treated with saline (10 ml / kg, ip), imipramine (30mg/kg; ip), diazepan (1mg/kg; ip), paroxetine (5mg/kg ; Ip), paroxetine (10mg/kg; ip) and paroxetine (20mg/kg; ip) and evaluated in the Forced Swim Test (FST). In the second experiment the mice were divided into five groups (n = 10) and treated with saline (10 ml/kg, ip), imipramine (30mg/kg; ip), diazepan (2mg/kg; ip), paroxetine (10mg / kg, ip), buspirone (10mg/kg; ip), daily for one week (subchronic), and after that they were evaluated in the FST. In the third experiment mice were treated subcronic with saline, imipramine (30mg/kg; IP), paroxetine (10mg/kg; IP), diazepam (2mg/kg; IP) and buspirone (10mg/kg; IP) and then tested in EPM. In the fourth experiment, were used Wistar rats that received daily, by gavage, saline, imipramine (10mg/kg), paroxetine (10mg/kg), diazepam (1mg/kg) or buspirone (10mg/kg) for 24 consecutive days (in volume 1 ml per kg) and then were evaluated in ETM and Open Field Test (OFT). The fifth experiment was similar to the fourth, being used mice and adapted device for ETM. The results were: imipramine and three doses of paroxetine presented antidepressant effect, as diazepam showed depressive effect on acute FST. In subchronic FST, only imipramine presented antidepressant effect. In the EPM, imipramine presented anxiolytic effect as paroxetine presented anxiogenic effect. In ETM with rats chronically treated, paroxetine, diazepan and buspirone showed anti-generalized-anxiety-like effect, as imipramine, diazepan and paroxetine showed anti-panic-like effect. In ETM with mice chronically treated with imipramine, diazepan, buspirone and paroxetine presented responses anti-generalized-anxiety-like and only paroxetine showed anti-panic-like effect. Thus, imipramine, a drug effective in depressive disorders, generalized anxiety and panic, was responsible for similar responses in animal models (except for the ETM for mice). Diazepam, a drug used to generalized anxiety and with some effects in panic, presented similar behavior in the models, with antipanic-like effect in ETM for rats and not for the mice. Buspirone, a drug used in clinic only to generalized anxiety, did not present antidepressant or antipanic effects in any experiment. Paroxetine, a selective serotonin reuptake inhibitor (SSRI), antidepressant, anxiolytic and antipanic, presented anxiogenic activity in EPM (demonstrating this device as inadequate to evaluate this class of drugs) and anti-generalized-anxiety and anti-panic both in ETM for rats and for mice. We concludes that the ETM for mice is an appropriate model to detect anxiolytic and anti-panic effects of drugs, the latter especially for 5-HT drugs

京都大学 / 新制・課程博士 / 博士(医学) / 甲第23408号 / 医博第4753号 / 新制||医||1052(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 中山 健夫, 教授 古川 壽亮, 教授 村井 俊哉 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

L’analyse de donnée textuelle est facilitée par l’utilisation du text mining (TM) permettant l’automatisation de l’analyse de contenu et possède de nombreuses applications en santé. L’une d’entre elles est l’utilisation du TM pour explorer le contenu des messages échangés sur Internet.Nous avons effectué une revue de la littérature systématique afin d’identifier les applications du TM en santé mentale. De plus, le TM a permis d’explorer les préoccupations des utilisateurs du forum Doctissimo.com au sujet des antidépresseurs et anxiolytiques entre 2013 et 2015 via l’analyse des fréquences des mots, des cooccurrences, de la modélisation thématique (LDA) et de la popularité des thèmes.Les quatre applications du TM en santé mentale sont l’analyse des récits des patients (psychopathologie), le ressenti exprimé sur Internet, le contenu des dossiers médicaux, et les thèmes de la littérature médicale. Quatre grands thèmes ont été identifiés sur le forum: le sevrage (le plus fréquent), l’escitalopram, l’anxiété de l’effet du traitement et les effets secondaires. Alors que les effets indésirables des traitements est un sujet qui a tendance à décroitre, les interrogations sur les effets du sevrage et le changement de traitement sont grandissantes et associées aux antidépresseurs.L’analyse du contenu d’Internet permet de comprendre les préoccupations des patients et le soutien, et améliorer l’adhérence au traitement. / Analysis of textual data is facilitated by the use of text mining (TM) allowing to automate content analysis, and is implemented in several application in healthcare. These include the use of TM to explore the content of posts shared online.We performed a systematique literature review to identify the application of TM in psychiatry. In addition, we used TM to explore users’ concerns of an online forum dedicated to antidepressants and anxiolytics between 2013 and 2015 analysing words frequency, cooccurences, topic models (LDA) and popularity of topics.The four TM applications in psychiatry retrieved are the analysis of patients' narratives (psychopathology), feelings expressed online, content of medical records, and biomedical literature screening. Four topics are identified on the forum: withdrawals (most frequent), escitalopram, anxiety related to treatment effect and secondary effects. While concerns around secondary effects of treatment declined, questions about withdrawals effects and changing medication increased related to several antidepressants.Content analysis of online textual data allow us to better understand major concerns of patients, support provided, and to improve the adherence of treatment.

Background and Objectives: To characterize the impact of pregabalin on sleep in patients with generalized anxiety disorder (GAD) and to determine whether the impact is a direct or an indirect effect, mediated through the reduction of anxiety symptoms. Methods: A post-hoc analysis of data from a randomized, double-blind, placebo- and active-controlled study in patients with GAD was conducted. Patients received pregabalin 300 mg/day, venlafaxine XR 75 mg/day or placebo for a week, followed by pregabalin 300-600 mg/day, venlafaxine XR 75-225 mg/day, or placebo for 7 weeks. Treatment effect on sleep was evaluated using the Medical Outcomes Study Sleep Scale. Anxiety symptoms were assessed with the Hamilton Anxiety Rating Scale. A mediation model was used to estimate separately for both treatment arms the direct and indirect treatment effects on sleep disturbance. Results: Compared with placebo (n = 128), treatment with pregabalin (n = 121) significantly reduced scores on the sleep disturbance subscale and Sleep Problems Index II at both week 4 and week 8, and the sleep adequacy subscale at week 8. Venlafaxine XR (n = 125) had no significant effect on these measures. The mediation model indicated that 53% of the total pregabalin effect on sleep disturbance was direct (p < 0.01) and 47% indirect, mediated through anxiety symptoms (p < 0.05). Conclusions: Pregabalin decreased sleep disturbance in patients with GAD both directly, and indirectly by reducing anxiety symptoms. Given the drug specificity of the results, this study provides evidence of an additional important pathway of action for pregabalin and its efficacy in GAD.

Esta pesquisa retrata uma experiência etnográfica sobre o consumo de medicamentos antidepressivos e ansiolíticos fornecidos por uma farmácia pública aos moradores de uma área formada por três bairros da cidade de Ribeirão Preto-SP. Esta área era formada por casas populares, casas luxuosas e por uma favela, sendo coberta pela Estratégia de Saúde da Família, com a exceção de uma parte das casas populares, a qual era formado pelas casas COHAB (Companhia Habitacional). O bairro com as casas luxuosas foi incluído somente na observação participante e na fotografia. Os motivos do consumo destes medicamentos, investigados com entrevistas abertas, observação participante, diário de campo e fotografia, são justificados através de uma remodelação e reorganização de espaços entre os moradores destes bairros, marcados por desigualdades sociais, de gênero e pela busca de diferenciação, numa hierarquia classificada entre o ideal e o indesejado através do curso de vida dos moradores. A seleção dos entrevistados foi realizada a partir dos dados da dispensação dos medicamentos psicoativos pela farmácia pública fornecedora, a qual também estava incluída na experiência etnográfica, tendo sido a dispensação dos medicamentos incluída na observação participante. O consumo de medicamentos psicoativos foi analisado a partir da ótica de seus consumidores, revelando que estariam contribuindo para perpetuar os papéis sociais frente à dinâmica social, como os relacionados ao gênero e à classe social. A pesquisa revela uma associação entre vida cotidiana e consumo de medicamentos psicoativos, destoante de um produzir saúde, esperado da relação entre serviços de saúde e população, e de uma associação entre doença e uso de medicamentos. Aprofundar questões sociais sobre o consumo de medicamentos em grupos populares poderá evitar seu uso abusivo com a função de produzir um corpo explorado quimicamente por se estender seus limites de produção, aprofundando e silenciando desigualdades sociais. O consumo de medicamentos psicoativos deve ser analisado com cautela, devendo seu consumo ser problematizado. / This research shows an ethnographic experience on the use of antidepressant and anxiolytic medicines provided by a public pharmacy to the residents of an area formed by three sectors of the city of Ribeirão Preto-SP. This area was formed by popular houses, luxury houses and a shantytown, and covered by the Family Health Strategy, with the exception of part of the popular houses, wich was formed by COHAB houses (Housing Company). The neighborhood with luxury houses was included only in a participant observation and in the photograph. The reasons for the use of the medecines, investigated with open interview, participant oservation, a field diary and photograph, are justified through a remodeling and recognization of space between the residents of these neigborhoods, marked by social inequality, gender and the search for differentiation, in a classified hierarchy between the ideal and unwanted y the life´s course of residents. The selection of interviewees was made from the data of the dispensing of psychoactive medicines by the provider public pharmacy, wich was also included in the etnographic experience, having been dispensing of medicines included in participant observation. The use of psychoactive medicines has been examined from the perspective of their consumers, revealing that they were helping to perpetuate social roles in the social dynamicsrelated to gender and social class. The research shows an association between daily life and use of psychoactive medicines, diverging from the production of health, which is waited in the relashionship between health services and population, and diverging from assocition between illness and medication use. Deepening social issues on the consumption of medecines in popular groups may prevent their abuse with the function of producing a body explored chemically because it has extended their limits of production, deepening and keeping quiet the social inequalities. The consumption of psychoactive medecines should be examined with caution, their consumption should be problematized

INTRODUÇÃO: Os transtornos psiquiátricos são altamente prevalentes e têm sido associados ao maior uso de serviços e de medicamentos. Entretanto resultados do World Health Organization (WHO) World Mental Health (WHM) Surveys, conduzidos em diversos países, têm apresentado baixas prevalências de uso de psicofármacos entre sujeitos com diagnóstico de transtornos psiquiátricos no ano anterior à entrevista. OBJETIVOS: Estimar a prevalência, o padrão, e os fatores associados ao uso de psicofármacos em amostra da população geral e entre sujeitos com diferentes diagnósticos para doenças psiquiátricas, de acordo com DSM-IV. MÉTODOS: Os dados são provenientes do São Paulo Megacity Mental Health Survey (SPMHS), segmento brasileiro do estudo World Mental Health Survey (WMH survey). O WMH survey é uma iniciativa da Organização Mundial da Saúde (OMS), da Universidade de Harvard e Universidade de Michigan, que vem sendo realizada em mais de 28 centros de pesquisa no mundo. O São Paulo Megacity Mental Health Survey é um estudo de corte transversal, de base populacional, desenhado para avaliar a morbidade psiquiátrica em uma amostra representativa da população geral, com 18 anos ou mais, residentes na Região Metropolitana de São Paulo. Uma amostra de 5.037 indivíduos (taxa de resposta: 81,3%) foi entrevistada por leigos treinados, utilizando a versão do Composite International Diagnostic Interview para o World Mental Health Survey, elaborado para gerar diagnósticos de acordo com o DSM-IV. O foco do presente estudo foi uma subamostra de 2.935 entrevistados, os quais foram avaliados com a versão longa da entrevista e que foram questionados sobre psicofármacos prescritos no ano anterior à entrevista para \"problemas com emoções, nervos, saúde mental, uso de substâncias, energia, concentração, sono ou a capacidade de lidar com o estresse\". Os dados foram ponderados para ajustar a subamostragem dos não casos dessa subamostra e para ajustar as discrepâncias residuais entre as distribuições amostrais e populacionais de uma série de variáveis sociodemográficas, garantindo, assim, a representatividade dessa subamostra. RESULTADOS: Apenas 6,13% dos respondentes relataram o uso de psicofármacos no ano anterior à entrevista. Os hipnóticos e sedativos (incluindo os benzodiazepínicos) (3,63%) e os antidepressivos (3,46%) foram os mais comumente relatados, enquanto os estabilizadores de humor (0,64%) e os antipsicóticos (0,61%) foram pouco frequentes. Ser do sexo feminino (OR= 2,55; 95% IC=1,58-4,11), avançar da idade, escolaridade abaixo do nível superior e ter maior renda foram fatores associados ao maior uso de psicofármacos, assim como ter comorbidades e transtornos graves. A prevalência de transtornos psiquiátricos de acordo com os critérios do DSM-IV/WMH-CIDI no ano anterior à entrevista foi 29,49%. Entretanto, somente 13,75% dos sujeitos com diagnóstico de transtorno psiquiátrico no ano anterior à entrevista, 24,93% com transtorno de humor, 14,43% com transtorno de ansiedade e, aproximadamente, 10% com transtorno por uso de substância e com transtorno de controle do impulso relataram uso de psicofármacos no mesmo período. Respondentes sem diagnóstico também reportaram uso de psicofármacos (2,94%). O uso de antidepressivos (9,10%) e de hipnóticos e sedativos (7,81%) foi pouco frequente naqueles com diagnóstico, apresentando a seguinte distribuição, respectivamente: sujeitos com transtorno de humor (17,94% e 14,70%), ansiedade (9,04% e 8,08%), controle de impulso (6,76% e 5,80%) e por uso de substâncias (5,08% e 7,86%). O uso de psicofármacos foi maior entre sujeitos que apresentaram três transtornos ou mais (26,91%) quando comparado aos que apresentaram dois (15,21%) ou um transtorno (8,96%). Entre os sujeitos com transtornos considerados leve, de moderada gravidade e grave, a prevalência de uso de psicofármacos foi 6,60%, 10,68% e 23,77%, respectivamente. Entretanto aproximadamente 75% casos graves e com três ou mais transtornos, permaneceram sem tratamento farmacológico. CONCLUSÃO: Os resultados sugerem que a maioria dos sujeitos com transtornos psiquiátricos ativos não estão recebendo tratamento farmacológico para seus transtornos psiquiátricos na Região Metropolitana de São Paulo. Políticas públicas poderiam aumentar o acesso aos cuidados de saúde adequado, particularmente entre sujeitos com transtornos graves e comorbidades / INTRODUCTION: Mental Disorders are highly prevalent and have been associated with high use of health services and medications. However results of the World Health Organization (WHO) World Mental Health (WHM) Surveys carried out in several countries have found low prevalence rates of psychotropic medication among those with 12-month disorders. OBJECTIVES: To estimate the prevalence, pattern, and associated factors with the use of psychotropic medication in a sample in the general population and, within this sample, among those with different diagnoses for psychiatric disorders, according to DSM-IV. METHODS: Data were from the São Paulo Megacity Mental Health Survey (SPMHS), the Brazilian segment of the World Mental Health (WMH) Survey Initiative, coordinated by the World Health Organization and Harvard University, which has been held in more than 28 research centers in the world. The São Paulo Megacity Mental Health Survey is a cross-sectional population-based study, designed to evaluate psychiatric morbidity in a representative sample in the general population, aged 18 years or more, living in the São Paulo Metropolitan Area. A sample of 5,037 individuals (response rate: 81.3%) was assessed by trained lay interviewers using the World Mental Health version of the Composite International Diagnostic Interview, designed to generate DSM-IV diagnoses. The focus of the current report was a subsample of 2,935 subjects to whom the long version of the interview was applied and were asked about prescription medicines that used in the previous12 months for \"problems with emotions, nerves, mental health, substance use, energy, concentration, sleep or ability to cope with stress\". Data were weighted to adjust the undersampling of long interview respondents non-cases and to adjust residual discrepancies between the sample and population distributions of a range of sociodemographic variables. RESULTS: Only 6.13% of the respondents reported psychotropic medication use in the previous year the interview. Hypnotics and sedatives (including benzodiazepines) (3.63%) and antidepressants (3.46%) were the most commonly reported, while mood stabilizers (0.64%) and antipsychotics (0.61%) were used less frequently. In the general population of the SPMHS, be female gender (OR= 2.55; 95% IC=1.58-4.11), older, education low level high and higher income were associated the higher psychotropic medication use, well as have comorbidity and serious disorders. The 12-month prevalence of DSM-IV/WMH-CIDI disorder was 29.49%. However, only 13.75% of those with 12-month disorders, 24.93% among those with mood disorder, 14.43% in those with anxiety disorder and, approximately 10% impulse-control disorder and substance use disorder reported psychotropic medication use in the same period. Respondents without diagnosis also reported psychotropic medication use (2.94%). Antidepressants (9.10%) and hypnotics and sedatives (7.81%) were commonly reported, with the following distribution, respectively: subjects with mood disorder (17.94% and 14.70%), anxiety (9.04 % and 8.08%), impulse control (6.76% and 5.80%), and substance use (5.08% and 7.86%). Psychotropic medication use was higher among the respondents with three or more disorders (26.91%), when compared with those with two (15.21%) or with one disorder (8.96%). Among the respondents with mild, moderate, or severe disorders, the prevalence of Psychotropic medication use was 6.60%, 10.68%, and 23.77%, respectively. However approximately 75% severe cases and comorbidities, remained without pharmacologic treatment. CONCLUSION: These findings suggest that the majority of individuals diagnosed with an active mental disorder are not being treated with psychotropic medication in the São Paulo Metropolitan Area. Public policies should increase access to appropriate care, particularly among subjects with serious disorders and comorbidities

Esta pesquisa retrata uma experiência etnográfica sobre o consumo de medicamentos antidepressivos e ansiolíticos fornecidos por uma farmácia pública aos moradores de uma área formada por três bairros da cidade de Ribeirão Preto-SP. Esta área era formada por casas populares, casas luxuosas e por uma favela, sendo coberta pela Estratégia de Saúde da Família, com a exceção de uma parte das casas populares, a qual era formado pelas casas COHAB (Companhia Habitacional). O bairro com as casas luxuosas foi incluído somente na observação participante e na fotografia. Os motivos do consumo destes medicamentos, investigados com entrevistas abertas, observação participante, diário de campo e fotografia, são justificados através de uma remodelação e reorganização de espaços entre os moradores destes bairros, marcados por desigualdades sociais, de gênero e pela busca de diferenciação, numa hierarquia classificada entre o ideal e o indesejado através do curso de vida dos moradores. A seleção dos entrevistados foi realizada a partir dos dados da dispensação dos medicamentos psicoativos pela farmácia pública fornecedora, a qual também estava incluída na experiência etnográfica, tendo sido a dispensação dos medicamentos incluída na observação participante. O consumo de medicamentos psicoativos foi analisado a partir da ótica de seus consumidores, revelando que estariam contribuindo para perpetuar os papéis sociais frente à dinâmica social, como os relacionados ao gênero e à classe social. A pesquisa revela uma associação entre vida cotidiana e consumo de medicamentos psicoativos, destoante de um produzir saúde, esperado da relação entre serviços de saúde e população, e de uma associação entre doença e uso de medicamentos. Aprofundar questões sociais sobre o consumo de medicamentos em grupos populares poderá evitar seu uso abusivo com a função de produzir um corpo explorado quimicamente por se estender seus limites de produção, aprofundando e silenciando desigualdades sociais. O consumo de medicamentos psicoativos deve ser analisado com cautela, devendo seu consumo ser problematizado. / This research shows an ethnographic experience on the use of antidepressant and anxiolytic medicines provided by a public pharmacy to the residents of an area formed by three sectors of the city of Ribeirão Preto-SP. This area was formed by popular houses, luxury houses and a shantytown, and covered by the Family Health Strategy, with the exception of part of the popular houses, wich was formed by COHAB houses (Housing Company). The neighborhood with luxury houses was included only in a participant observation and in the photograph. The reasons for the use of the medecines, investigated with open interview, participant oservation, a field diary and photograph, are justified through a remodeling and recognization of space between the residents of these neigborhoods, marked by social inequality, gender and the search for differentiation, in a classified hierarchy between the ideal and unwanted y the life´s course of residents. The selection of interviewees was made from the data of the dispensing of psychoactive medicines by the provider public pharmacy, wich was also included in the etnographic experience, having been dispensing of medicines included in participant observation. The use of psychoactive medicines has been examined from the perspective of their consumers, revealing that they were helping to perpetuate social roles in the social dynamicsrelated to gender and social class. The research shows an association between daily life and use of psychoactive medicines, diverging from the production of health, which is waited in the relashionship between health services and population, and diverging from assocition between illness and medication use. Deepening social issues on the consumption of medecines in popular groups may prevent their abuse with the function of producing a body explored chemically because it has extended their limits of production, deepening and keeping quiet the social inequalities. The consumption of psychoactive medecines should be examined with caution, their consumption should be problematized