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O jogo patológico se caracteriza pela perda do controle de apostar em jogos de azar e pelo comportamento persistente apesar dos prejuízos causados. Uma das características centrais do comportamento de jogadores patológicos é a fissura de jogar para evitar estados emocionais desfavoráveis e sintomas de ansiedade e de depressão estão significativamente associados à intensidade da fissura em jogadores patológicos. Assim, é possível que o tratamento da depressão e da ansiedade esteja associado indiretamente à melhora do comportamento de jogar, através da redução da fissura. Sabemos que a saúde mental pode ser influenciada positivamente pela prática de atividade física. Diversos estudos sugerem que a prática de exercícios tem efeito positivo sobre o humor, se associa à redução da ansiedade e da depressão, possibilitando melhor controle do estresse. O objetivo principal deste trabalho foi examinar o impacto de um programa de atividade física sobre a sintomatologia ansiosa e depressiva e sobre a fissura por jogo em uma amostra de 33 jogadores patológicos em início de tratamento ambulatorial. Adicionalmente, analisamos a associação entre a fissura e níveis dos hormônios relacionados ao estresse. O tratamento consistiu em terapia cognitivocomportamental ou psicoterapia psicodinâmica em grupo e tratamento psiquiátrico das comorbidades associadas. O programa de atividade física variou de 4 a 8 semanas e consistiu em 8 sessões de 50 minutos cada de exercícios aeróbios de intensidade moderada (60-75% da freqüência cardíaca máxima). A fissura durante o exercício foi avaliada imediatamente antes e depois de cada sessão de atividade física. Também foi avaliada a fissura por jogo nas 24 horas anteriores e nos 7 dias anteriores. Os pacientes foram investigados no início e ao final do programa de atividade física quanto a comportamento de jogo, intensidade de sintomas depressivos e ansiosos e níveis plasmáticos dos hormônios adrenocorticotrófico (ACTH), cortisol e prolactina. Os resultados mostram que houve redução significativa da fissura por jogo após cada sessão de atividade física e ao final da intervenção. Houve melhora nos sintomas de ansiedade, depressão e do comportamento de jogo. A redução da fissura por jogo durante o exercício físico se relaciona com a redução da fissura e da ansiedade ao final do programa, mas não à sintomatologia depressiva. Ainda, se associa à variação da prolactina, mas não à variação de cortisol e ACTH / Pathological gambling is characterized by loss of control over gambling and this behavior persists despite losses caused by this activity. One of the central features of the behavior of pathological gamblers is craving for gambling in order to avoid adverse emotional states, and symptoms of anxiety and depression are significantly associated with the intensity of craving among pathological gamblers. Thus, it is possible that the treatment of depression and anxiety is indirectly associated with improvement of gambling behavior by reducing the craving. We know that mental health can be positively influenced by physical activity. Several studies suggest that exercise has a positive effect on mood, is associated with reduced anxiety and depression, enabling better control of stress. The main objective of this study was to examine the impact of a program of physical activity on depressive and anxiety symptoms and the craving for gambling in a sample of 33 pathological gamblers in early outpatient treatment. Additionally, we analyzed the association between craving and levels of hormones related to stress. The treatment consisted of cognitive-behavioral or psychodynamic therapy group and treatment of psychiatric comorbidities. The physical activity program included 8 sessions ranging from 4 to 8 weeks. The proposed activity consisted of 50 minute sessions, aiming at 60-75% of maximum heart rate. Craving during exercise was assessed immediately before and after each session. We also analyzed the gambling craving in the previous 24 hour and 7 day period. Patients were investigated at the beginning and at the end of the program of physical activity regarding gambling behavior, intensity of depressive and anxiety symptoms, and plasma levels of adrenocorticotropic hormone (ACTH), cortisol and prolactin. The results show a significant reduction in gambling craving following each session of physical activity and at the end of the program. There was improvement in symptoms of anxiety, depression, and gambling behavior. The reduction in craving after each session is associated with the reduction of craving and anxiety at the end of the program but not with depressive symptomatology. Still, craving reduction is associated with variation in prolactin levels, but not in cortisol and ACTH levels

Submitted by Aline Batista (alinehb.ufpel@gmail.com) on 2018-03-29T13:57:15Z No. of bitstreams: 2 license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Dissertacao_Karine_Langmantel_Silveira.pdf: 1571849 bytes, checksum: 8d4b68bc011f5a12b9b2739bb807541e (MD5) / Made available in DSpace on 2018-04-03T18:41:32Z (GMT). No. of bitstreams: 2 Dissertacao_Karine_Langmantel_Silveira.pdf: 1571849 bytes, checksum: 8d4b68bc011f5a12b9b2739bb807541e (MD5) license_rdf: 0 bytes, checksum: d41d8cd98f00b204e9800998ecf8427e (MD5) Previous issue date: 2017-02-07 / Sem bolsa / O craving ou fissura por crack é caracterizado por um estado motivacional, orientador para o consumo da substância, que pode ser influenciado pelas expectativas positivas deste consumo, a diminuição dos efeitos negativos, bem como os sintomas relacionados à abstinência. Elevados níveis de fissura, ocasionados pelo consumo abusivo do crack, podem colocar o usuário em situações de risco biopsicossocial. A literatura consultada indica que a influência da fissura pelo crack no organismo pode estar relacionada às alterações que ocorrem no humor, no comportamento e no pensamento e que aspectos relacionados com a vulnerabilidade social podem estar associados ao início do consumo do crack. Este estudo teve como objetivo analisar a influência dos Determinantes Sociais de Saúde na variação do nível de fissura em usuários de crack de dois serviços de saúde do município de Pelotas-RS. Trata-se de um estudo quantitativo de corte transversal, exploratório e analítico, parte integrativa da pesquisa “Perfil dos Usuários de Crack e Padrões de Uso” com amostra de 133 participantes. A pesquisa foi aprovada pelo Comitê de Ética em Pesquisa recebendo o parecer nº 301/2011 e foi desenvolvida no período de outubro de 2011 a outubro de 2012. As entrevistas ocorreram através de um questionário estruturado e, para o presente estudo, além de questões relacionadas ao perfil socioeconômico e demográfico, relacionamento familiar, padrão de uso de substâncias psicoativas, eventos na vida, estratégias de redução de danos e condições de saúde dos entrevistados, foi utilizada a escala Cocaine Craving Questionnaire que mede o nível de fissura. Os resultados deste estudo demonstraram que a maioria dos entrevistados apresentou nível de fissura de moderado a grave. Entre os fatores individuais, observaram-se maiores níveis de fissura entre mulheres, adultos jovens, cor de pele parda, baixa escolaridade e baixa renda, desempregados, autoavaliação de saúde regular e com presença de transtornos psiquiátricos menores. E em relação aos fatores comportamentais, os níveis de fissura foram maiores entre os usuários que no último ano se divorciaram/separaram, que tiveram problemas com a justiça e que praticaram atos de violência. Ainda, em relação aos fatores comportamentais, os níveis de fissura foram maiores entre os entrevistados que relataram utilizar concomitantemente com o crack o tabaco e mais que quatro substâncias. Portanto, com o desenvolvimento deste estudo, pode-se identificar que a maioria dos usuários de crack apresentam questões de vulnerabilidade social e que são necessárias intervenções a partir de um planejamento conjunto de políticas públicas ancoradas nas necessidades dos usuários, procurando a melhoria das condições de vida. / The craving or craving for crack is characterized for a motivational state for substance consumption, that may be influenced by positive expectations of the consumption, the decrease of negative effects, as well as the symptoms related to abstinence. High levels of craving, caused by abusive crack consumption can put the crack user in situations of biopsychosocial risk. The reviewed literature indicates that the influence of crack craving in the organism could be related with humor changes, on behavior, and thinking. The aspects related with the social vulnerability can be associated with the beginning of crack consumption. This study aimed to analyze the influence of Social Determinants of Health in the variation of level of craving in crack users from two health services in Pelotas-RS. It is a cross sectional, exploratory and analytic study. It is a part of a bigger research titled “Profile of crack users and use patterns” with a sample of 133 participants. The research was approved by the Research Ethics Committee under the nº301/2011 and it was conducted from October 2011 to October 2012. The interviews were conducted by a structured questionnaire, and to achieve the study objective, were included issues related to the socioeconomic and demographic profile, family relationship, patterns of use of psychoactive substances, events in life, strategies of harm reduction, health conditions and the Cocaine Craving Questionnaire(CCQ–Brief) scale that measure the level of craving. The results evidenced that the majority of interviewers presented moderate and severe levels of craving. Among the individual factories, were noticed high levels of craving in women, young adults, brown skin color, low schooling and low income, unemployed, regular self-health evaluation and with presence of minor psychiatric disorders. Regarding of the behavioral factories, the level of craving was lower among in users that the past year divorced/separated, that had justice problems and that practiced action of violence. Still in relation to the behavioral factories, the level of craving was bigger among the users that reported using concomitantly with crack the tobacco and more than four substances. Therefore, with the development of this study we can identify that the majority of crack users presented social vulnerabilities issues and are necessary interventions from a joint planning of public policies supporting the user’s needs, searching for improving living conditions.

Craving is thought to play a predominant role in the persistence of alcohol dependence, which seems to bear a substantial genetic component. Based on previous results highlighting the influence of serotonergic and dopaminergic nerotransmissions in both dependence and craving for alcohol, we investigated the impact of three specific polymorphisms on craving in male abstinent alcohol dependent patients. Our results show that alcohol craving may be influenced by genetic differences in alcohol dependent patients. There seems to be a dual serotonergic and dopaminergic modulation of craving. During acute withdrawal, desire to drink is predominantly influenced by the C1019 allele of the 5-HT1A receptor. Conversely, carrying the A1 allele of the DRD2 increases craving only when patients are no longer hospitalized and protected from drinking cues. Furthermore, we showed that craving partially influenced relapse and that the S allele of the 5-HTTpro, responsible for a 5-HT hypo-functioning, was significantly associated with relapse in abstinent alcohol dependent patients, possibly through intermediate phenotypes such as personality features or lack of behavioral inhibition. Our results may be useful in evaluating and developing novel pharmacogenetic approaches to treat alcohol dependence and one of its core symptoms, namely craving. Le craving semble jouer un rôle prédominant dans la persistance des comportements dalcoolisation et de rechute chez les sujets alcoolo-dépendants. Cette pathologie semble par ailleurs très nettement influencée par des facteurs dordre génétique. Sur base détudes préliminaires illustrant linfluence des neurotransmissions dopaminergique et sérotoninergique dans lalcoolo-dépendance et le craving pour lalcool, notre objectif a été dévaluer limpact de trois polymorphismes génétiques spécifiques sur le craving chez des patients masculins alcoolo-dépendant sevrés. Nos résultats montrent que le craving est bien influencé par des différences génétiques interindividuelles et quune modulation bimodale sérotoninergique et dopaminergique semble sexercer sur le craving pour lalcool. Pendant la phase aiguë du sevrage, lenvie de boire est nettement influencée par la présence de lallèle C du polymorphisme C-1019G du récepteur sérotoninergique 5-HT1A. A linverse, la présence de lallèle A1 du récepteur dopaminergique D2 ninfluence le craving quà distance du sevrage, lorsque les patients sont à nouveau dans leur milieu habituel et soumis à des stimuli déclanchant une envie de boire. De plus, nous avons pu montrer que le craving influençait partiellement la survenue dune rechute et que lallèle court du polymorphisme du promoteur du transporteur de la sérotonine (5-HTTpro) exerçait une influence significative sur la rechute, peut-être au travers de phénotypes intermédiaires de type traits de personnalité ou carence dinhibition comportementale. Ces résultats pourraient savérer utiles dans lévaluation et le développement de stratégies pharmacogénétiques destinées à traiter lalcoolo-dépendance et lun de symptômes les principaux : le craving.

Preference for palatable and energy-dense foods may be a risk factor for body weight gain and has both genetic and environmental components. Once obesity develops in an individual, weight loss is difficult to achieve. Indeed, obesity is often characterized by repeated attempts to reduce the overconsumption of energy-dense foods, followed by food craving and relapse to overconsumption. Relapse and loss of control over intake are observed also in drug addicts, and it has been shown that obesity and drug addiction not only share behavioural features but also neural circuitry, e.g. the mesolimbic dopamine pathway. In this thesis, we sought to investigate the mechanisms related to food preferences and craving using animal models previously used in addiction research. The risk of gaining weight may implicate behavioural traits and emotional states. We showed in rats that a risk-taking behavioural profile was associated both with increased preference for a high-fat (HF) diet and with increased motivational response to a palatable high-sucrose (HS) diet. Hypothalamic urocortin 2 expression was associated with the preference for the HF diet. We also tested the hypothesis that consumption of HS and HF diets separately or provided simultaneously (HFHS) affect anxiety-like behaviour and locomotion. Furthermore, we showed that withdrawal from HFHS food affects diet-induced obesity-prone (OP) and obesity-resistant (OR) animals differently. OP animals had increased motivation (craving) for HS food pellets as measured by the operant self-administration technique during withdrawal. Dopamine receptor expression in the striatum differed between OP and OR animals both at access to HFHS and during withdrawal. This strongly implicates dopaminergic signaling in the OP phenotype. In humans, food preferences may be monitored using questionnaires. We analyzed food preference data from parents of preschool children, and identified an inverse association of parental preference for high-fat high-protein food and overweight in children. In conclusion, we have employed animal models previously used in the addiction field to identify molecular mechanisms related both to food preference and vulnerability to obesity, and to food craving associated with withdrawal from palatable food. These findings add to our current understanding of obesity.

The development and persistence of cocaine dependence are greatly influenced by emotional affect and cocaine associative learning. Cocaine is known to enhance nucleus accumbens (NAcc) dopamine, serve as a positive reinforcer and produce negative effects, such as anxiety that may influence cocaine intake behavior. In the first study, I investigated the effects of the anxiolytic, diazepam on NAcc dopamine levels and cocaine self-administration behavior. These are two factors associated with cocaine rewarding effects. Diazepam has no effect on NAcc dopamine, but affects cocaine self-administration. This supports the notion that decreasing the anxiogenic effects of cocaine increases the rewarding value in a dopamine independent manner. Therefore, increasing the aversive effects of cocaine might be a novel approach to fight cocaine dependence. In the second study, I studied cocaine-induced associative learning and changes in affect during cocaine conditioning and extinction. 50-kHz ultrasonic vocalizations (USVs) in rats are thought to reflect positive affect and occur upon appetitive stimuli and with cocaine delivery. First, I explored whether USVs might be elicited in anticipation of impending drug delivery. Shortly into conditioning, rats elicited USVs when placed in the cocaine-associated environment. USVs progressively increased, indicating a growing learned association between cocaine intake and cocaine-associated cues. This suggests that USVs may be a useful model for investigating cocaine craving and serve as a pharmacological target for interventions aimed to reduce cocaine craving and relapse. I then examined the effects of short-term deprivation of cocaine and cocaine cues on cocaine-conditioned USVs, which were both exaggerated after abstinence. The results may have clinical implications, in that intermittently avoiding cues or context may enhance drug cue salience and increase the probability of relapse. Motivational aspects of cocaine were assessed comparing commonly measured lever response rate and locomotion with cocaine-induced USVs during cocaine administration and extinction. In agreement with prevailing findings, lever responding for cocaine and cocaine-induced locomotor activity increased across conditioning sessions. However, the number of USVs evoked in response to cocaine infusion decreased with cocaine experience. These findings suggest growing tolerance to the rewarding properties of cocaine. These studies underscore the value of USV assessment during drug dependence studies. / text

Tobacco smoking has been associated with the development, protraction, and exacerbation of chronically painful conditions. Conversely, there is reason to believe that smokers may be motivated to use tobacco as a means of coping with their pain. To date, no controlled, experimental studies have tested for a causal relationship between pain and smoking motivation. The primary aim of the current study was to test the hypothesis that laboratory-induced cold-pressor pain would enhance smoking motivation, as measured by self-reported urge to smoke and observation of immediate smoking behavior. The effect of a smoking cue was also tested. Smokers (n = 132) were randomly assigned to one of four conditions in this 2 (Pain Manipulation) X 2 (Smoking Cue Manipulation) crossed factorial between-subjects design. Results indicated that both pain induction and the presence of smoking cues increased urge ratings, and pain induction also produced a shorter latency to smoke. The relationship between pain and increased urge to smoke was partially mediated by pain-induced negative affect. This study provides the first experimental evidence that situational pain can be a potent motivator of smoking.

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<p>Substance use disorders are one of the most common psychiatric diagnoses among adolescents; marijuana is the illicit drug used most frequently by youth. Treatment dropout and relapse following treatment are common; innovative strategies are needed to improve treatment outcomes for youth substance abusers. The aim of this study was to develop and evaluate the feasibility of a virtual reality (VR) cue reactivity paradigm for adolescent cannabis abusers and to compare it to a video cue reactivity paradigm. Forty-two treatment-seeking youth with a cannabis use disorder completed the study, which incorporated three parts. During Part 1, drug and neutral video clips were shown to 11 youth and five substance-abuse experts who provided craving/usefulness ratings for each video clip. During Part 2, five youth met in a focus group and then individually to provide input on the development of the VR paradigm. During Part 3, 26 youth completed a laboratory procedure involving neutral and drug-related video clips and VR presentations. Heart rate, skin conductance, and skin temperature were measured as well as craving. Higher levels of craving and skin conductance were observed during drug-related presentations. The presentations did not significantly differ in their ability to elicit craving and arousal. Results suggest that youth can experience subjective and physiological reactivity to VR drug cues warranting further study with a larger, more diverse sample. Implications are discussed.</p> / Dissertation

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