Made available in DSpace on 2014-07-29T15:25:22Z (GMT). No. of bitstreams: 1 tese sergio nascente costa ciencias saude.pdf: 3835674 bytes, checksum: 6034e0701fc67a4a611b07fa22a5df92 (MD5) Previous issue date: 2009-07-01 / Licit drugs like alcohol, and illicit drugs such as marijuana, cocaine, opioids and amphetamines, are used by millions of people worldwide. The damage to health occurring due to the acute or chronic, and also due to psychomotor and behavioral changes that these substances cause the users. A situation that deserves special attention is the use of drugs in the workplace, especially in enterprises and institutions in need of constant concentration and emotional balance in labor activities. Thus the objective of this study was to determine the survey of psychotropic drug use among Military Police members in the state of Goiás, Brazil, and correlate it with the frequency in society in general. This study was done by the application of a questionnaire and toxicological analysis of urine samples collected at the beginning of the work day, for the detection of cannabinoids, cocaine, amphetamines, methamphetamine, opiates and benzodiazepines. Study carried out from March to October 2008 in 12 Military Police units in the municipalities of Goiânia and Aparecida de Goiânia. Voluntary participants (n = 221) were interviewed about drug use employing a questionnaire especially designed by the Centro Brasileiro de Informações sobre Drogas Psicotrópicas (CEBRID). Data were analyzed by descriptive statistics to determine the frequency of licit and illicit drug use. The frequency of use was: lifetime tobacco 39.9%; alcohol 87.8%; cannabis 8.1%; cocaine 1.8%; stimulants 7.2%; solvents 10.0%; sedatives, anxiolytics, antidepressants 6.8%; LSD 0.5%; Bentyl® 0.5%; anabolic steroids 5.4%; last year use tobacco 15.4%; alcohol 72.9%; stimulants 6.3%; solvents 0.5%; sedatives, anxiolytics, antidepressants 3.7%; use in the past 30 days tobacco 14.5%; alcohol 57.5%; stimulants 5.0%; solvents 0.5; sedatives, Abstract xvii anxiolytics, antidepressants 3.7%. The prevalence of psychotropic drug use found for Military Police members in the state of Goiás, Brazil, is similar to the results of national and international surveys with civilians, showing that the former are at similar risk to become users of legal and illegal drugs. Moreover, 299 samples of urine was submitted to toxicological analysis by immunochromatographic screening tests; whose positive results for cannabinoids and amphetamines, were referred for confirmation by GC / MS. Thus, the results were as follows: 0.33% of samples positive for amphetamine, 0.67% of samples positive for cannabinoids, 1.34% for benzodiazepines and 97.66% negative. Thus the total percentage of positive samples were 2.34%. The research carried out by military police with voluntary form showed that military and civil community in general, are subject to similar risks of abuse of licit and illicit drugs and it is an alert to development of testing drugs in the workplace, to avoid the consequences arising from the consumption of psychoactive substances / Drogas lícitas, como o álcool, e ilícitas, como a maconha, a cocaína, os opióides e as anfetaminas são utilizadas por milhões de pessoas no mundo. Os prejuízos à saúde ocorrem em virtude da intoxicação aguda ou crônica, e também devido às alterações comportamentais e psicomotoras que essas substâncias provocam nos usuários. Uma das situações que merecem especial atenção é o uso de drogas no ambiente de trabalho, notadamente em empresas e/ou instituições que necessitam de constante concentração e equilíbrio emocional nas atividades laborais. Desta forma, o objetivo deste trabalho foi realizar um levantamento sobre o uso de drogas psicotrópicas em 12 unidades da Polícia Militar do Estado de Goiás, nos municípios de Goiânia e Aparecida de Goiânia. Este levantamento foi feito por meio da aplicação de um questionário e da realização de análise toxicológica, em amostras de urina coletadas no início da jornada de trabalho, para a pesquisa de canabinóides, cocaína, anfetaminas, metanfetaminas, opiáceos e benzodiazepínicos. Os resultados obtidos a partir da aplicação do questionário em 221 sujeitos foram os seguintes: uso na vida tabaco 39,9%; álcool 87,8%; maconha 8,1%; cocaína 1,8%; estimulantes 7,2%; solventes 10,0%; sedativos, ansiolíticos, antidepressivos 6,8%; LSD 0,5%; Bentyl® 0,5%; anabolic steroids 5,4%; uso no último ano tabaco 15,4%; álcool 72,9%; estimulantes 6,3%; solventes 0.5%; sedativos, ansiolíticos, antidepressivos 3,7%; uso no mês anterior tabaco 14,5%; álcool 57,5%; estimulantes 5,0%; solventes 0,5 %; sedativos, ansiolíticos, antidepressivos 3,7%. Por outro lado, as 299 amostras de urina obtidas para análise toxicológica foram submetidas aos testes de triagem imunocromatográficos, cujos resultados Resumo xv positivos para canabinóides e anfetaminas foram encaminhados para confirmação por GC/MS. Desta forma, os resultados foram os seguintes: 0,33% de amostras positivas para anfetaminas; 0,67% de amostras positivas para canabinóides; 1,34% para benzodiazepínicos; 97,66% foram de resultados negativos. Assim o percentual total de amostras positivas foi de 2,34%. Não foi encontrado nenhum caso de associação de drogas. Em relação aos casos positivos, 57,1% corresponderam ao uso de benzodiazepínicos; 28,6% ao uso de canabinóides e 14,3% ao uso de anfetaminas. A pesquisa realizada de forma inédita, voluntariamente, em policiais militares revela que estes profissionais, como a comunidade civil em geral, estão sujeitos a riscos semelhantes de se tornarem usuários de drogas lícitas e ilícitas, e alerta em relação à necessidade da implantação de testes de drogas no ambiente de trabalho, visando evitar as conseqüências decorrentes do consumo de substâncias psicoativas

A esquizofrenia é um transtorno mental que provoca a desorganização de diversos processos mentais. Trata-se de uma condição crônica com expressivo impacto em termos de sobrecarga pessoal e social. O tratamento medicamentoso contínuo é necessário para evitar recaídas e manter o paciente no melhor nível de funcionamento possível. Este estudo teve como objetivo compreender o significado da terapêutica medicamentosa para a pessoa com esquizofrenia, em sua perspectiva e na de seu familiar, e formular um modelo teórico sobre o fenômeno estudado. Para tanto, foi adotado como referencial teórico o Interacionismo Simbólico e, como referencial metodológico, a Teoria Fundamentada nos Dados. A pesquisa foi desenvolvida em um Serviço Ambulatorial de Clínica Psiquiátrica de um hospital universitário, um Núcleo de Saúde Mental e um CAPS II, localizados no interior do estado de São Paulo - Brasil. Pelo processo de amostragem teórica, foram selecionados para o estudo 36 pessoas com esquizofrenia e 36 familiares. A entrevista e a observação foram as principais estratégias utilizadas para a obtenção dos dados que foram coletados no período de 2008 a 2010. Os dados coletados foram transcritos e, posteriormente, analisados em três etapas: codificação aberta, axial e seletiva. Verificou-se que, ao ser acometido pela esquizofrenia, o paciente percebe-se \"vivendo dias difíceis\" e identifica no medicamento uma possibilidade de melhora. \"Pesando o custo-benefício do medicamento\" e \"identificando obstáculos e incentivos para o tratamento\" o paciente implementa estratégias \"agindo em busca de alívio\" para o sofrimento causado pela esquizofrenia ou pelo tratamento medicamentoso. Entretanto, esse indivíduo se julga \"permanecendo em um labirinto\", pois não encontra uma saída para livrar-se do transtorno e da necessidade da farmacoterapia. A experiência descrita se centraliza no fenômeno \"CONVIVENDO COM UMA AJUDA QUE ATRAPALHA\" que representa o significado da terapêutica medicamentosa para a pessoa com esquizofrenia. A teoria aqui apresentada fornece uma compreensão abrangente, contextualizada, motivacional e empática da realidade vivenciada pelo paciente. Desse modo, o presente estudo oferece subsídios para o planejamento da assistência a essa clientela e aponta elementos a serem investigados. / Schizophrenia is a mental disorder that provokes the disorganization of several mental processes. It is a chronic condition with considerable impact in terms of personal and social burden. Continuous medication treatment is needed to avoid relapses and maintain the patient at the best possible functioning level. This study aimed to understand the meaning of medication therapy for schizophrenia patients, from their own perspective and that of their relative, and to formulate a theoretical model for the study phenomenon. Therefore, Symbolic Interactionism was adopted as the theoretical framework, and Grounded Theory as the methodological framework. The research was developed at a Psychiatric Clinical Outpatient Service of a teaching hospital, a Mental Health Center and a CAPS II located in the interior of São Paulo State - Brazil. Through a theoretical sampling process, 36 schizophrenia patients and 36 relatives were selected for the study. Interview and observation were the main strategies used for data collection, between 2008 and 2010. The collected data were transcribed and later analyzed in three phases: open, axial and selective coding. It was verified that, when the schizophrenia affects them, the patients perceive that they are \"going through difficult times\" and identify the medication as a possibility for improvement. \"Weighing the cost-benefit of the medication\" and \"identifying treatment obstacles and incentives\", the patients put in practice strategies \"acting in search of relief\" for the suffering the schizophrenia or medication treatment causes. These patients, however, consider that they \"continue in a labyrinth\", as they do not find a way out to get rid of the disorder and the need for the drug therapy. The described experience centers on the phenomenon \"LIVING WITH HELP THAT BOTHERS\", which represents the meaning of the medication therapy for schizophrenia patients. The theory presented here provides a broad, contextualized, motivational and empathetic understanding of the reality these patients experience. Thus, this study offers support to plan care for these clients and appoints elements for further research.

No description available.

Ces travaux de thèse présentent une approche de pharmaco-épidémiologie explorant l'exposition médicamenteuse chez des patients atteints de lymphome tout au long de leur parcours de soin. L'utilisation des données du Système National d'Information Inter-régimes de l'Assurance Maladie (SNIIRAM) nous a permis de quantifier cette exposition médicamenteuse et de déterminer les facteurs associés dans le contexte de la vie réelle. Les travaux de recherche réalisés au cours de cette thèse répondaient à 3 objectifs. Dans un premier objectif, nous avons souhaité valider l'utilisation du SNIIRAM à des fins de recherche pour améliorer la robustesse des futures études menées sur le lymphome. Après avoir défini plusieurs algorithmes d'identification des cas incidents de lymphome, nous avons testé leur validité par confrontation aux données cliniques exhaustives du Registre des cancers du Tarn. Les paramètres de performance obtenus permettent de considérer les données disponibles dans le SNIIRAM comme un outil puissant pour mener des études pharmaco-épidémiologiques ou médico-économiques sur le Lymphome. Le second objectif était d'explorer l'existence d'une surconsommation de médicaments psychotropes au cours de la phase active de traitement par rapport à une population témoin, sous l'hypothèse d'une initiation accrue de ces médicaments pour pallier les complications psychologiques associées à la prise en charge du Lymphome. Par ailleurs, la chronicisation fréquemment observée de ce type de consommation peut conduire à terme à des complications potentiellement évitables. Pour répondre à cet objectif, nous avons réalisé une étude selon une approche " new-user design ", à partir d'une cohorte de patients incidents de lymphome identifiés dans les données du SNIIRAM à l'échelon régional. Nous avons observé un taux d'initiation supérieur au taux observé en population générale ou chez des patients atteints d'autres pathologies mettant en jeu le pronostic vital (infarctus du myocarde). En fonction de la classe thérapeutique étudiée, 20 à plus de 50% des patients restaient exposés de façon inappropriée (au-delà des recommandations) à ces médicaments. Le troisième objectif a donc été d'explorer les déterminants associés à une utilisation prolongée de médicaments psychotropes dans la phase de l'après-cancer à partir des données de l'Echantillon généraliste des bénéficiaires (EGB). [...] / This thesis presents a pharmacoepidemiology approach to describe drug utilization in lymphomas during their whole care pathway. The use of the French claims database (Système National d'Informations Inter-Régimes de l'Assurance Maladie (SNIIRAM)) allows to exhaustively quantify this drug utilization in real life conditions. This thesis consists of three mains objectives. First, we aimed to develop validated algorithms for the identification of incident cases of lymphoma. For the validation, we used data from a regional Cancer Registry as the gold standard. The purpose of this validation study was to enhance validity of future studies conducted on lymphomas in the SNIIRAM database. The results of this study associated to strengths of this database demonstrate that this approach is of great interest to conduct pharmacoepidemiological or medico-economic studies in lymphomas. Second, we aimed to estimate the incidence of use of psychotropic drugs during the active treatment phase of lymphoma in comparison with control groups. Indeed, the increased probability of developing anxio-depressive disorders after diagnosis could lead to an increased initiation of psychotropic drugs and a potential inappropriate chronic use of these drugs after initiation. Such inappropriate chronic use can unnecessarily expose patients to adverse event. For this aim, we conducted a new-user cohort study using data from the SNIIRAM database. The results of this study revealed that the initiation rate of these drugs is higher than in the general population or for life-threatening diseases such as myocardial infarction. Moreover, we observed an inappropriate prolonged use for a significant fraction of patients (20% to more than 50% according to therapeutic class). On the basis of these findings, the third objective was to identify factors associated with prolonged use of these drugs during survivorship. This study was conducted using data from the General Sample of Beneficiaries (EGB). [...]

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

Adults with intellectual disability (ID) experience twice the rate of mental health disorders when compared to the general population. Despite increased prevalence of mental health disorders, caregivers supporting adults with ID rarely seek mental health counseling supports, but instead are referred to psychiatric services. There is limited understanding among researchers about the lack of counseling services for adults with ID. The purpose of this study was to explore the lived experiences of mental health counselors who have worked with adults with ID in a counseling relationship. Hermeneutic phenomenology was used to develop thick and rick experiential detail about counselor experiences providing services for adults with ID. The conceptual framework involved the social constructivist and hermeneutic phenomenological lenses. The 8 participants were recruited using a purposive snowball sampling method and provided data through semi-structured interviews. Data analysis involved coding for themes with the help of NVivo software. Findings indicated counselor perceptions of adults with ID as being stigmatized and marginalized within their communities, which aligned with literature. Adults with ID must be prepared for counseling and there must be appropriate adaptations to support meaningful participation and benefit from counseling interventions. Exposure to adults with ID was a factor in counselors being willing to engage with this population, and questions about counselor education and preparedness were a consistent theme. The social implications of exploring this gap will lead to a better understanding of counselor experiences and can inform the professional body about how to increase access to counseling services for adults with ID.

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

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

Thesis (M.A.)--University of Delaware, 2006. / Principal faculty advisor: Nancy Signorielli, Dept. of Communication. Includes bibliographical references.

Prevalence rates of youth prescribed psychotropic medications have risen dramatically over the past decade. Many of these medications are prescribed to treat symptoms of a disorder that occur in the school setting. Some medications have negative side effects that can inhibit academic and social performance. School psychologists have been identified as professionals who are equipped to assist in monitoring both the beneficial and negative effects of medications for youth attending school. This study investigated the practices, training, types of disorders for which medication monitoring occurs, facilitators, and barriers to school psychologists engaging in medication monitoring in the schools. Survey data from 166 members of the Florida Association of School Psychologists were collected and analyzed. Seventy four percent of respondents endorsed medication monitoring as an appropriate role for school psychologists. Approximately half of the respondents in this study reported engaging in medication monitoring over the past school year. Over half the sample reported receiving training related to medication monitoring. Weak relationships were found among demographic and training variables and reported medication monitoring practices. Additionally, none of the interactions between demographic, professional background, and training variables was predictive of medication monitoring practices. Implications of these findings are discussed in relation to developing strategies to promote the medication monitoring practices of school psychologists.