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Síndrome amotivacional e consumo de cannabis : novas perspectivas
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Introdução: O cannabis é a substância ilícita mais consumida em Portugal. A despenalização do seu consumo e eventual utilização para fins terapêuticos torna premente a identificação e caracterização extensiva dos seus efeitos agudos e crónicos, nomeadamente o Síndrome Amotivacional, relacionado com consumos frequentes e essencialmente caracterizado por apatia, anedonia, embotamento afectivo e diminuição da motivação para actividades dirigidas a objectivos. É essencial a exploração desta e de outras consequências do uso desta substância, nomeadamente dos seus efeitos na adolescência - idade em que, geralmente, se iniciam os consumos - para delinear novas estratégias preventivas e terapêuticas eficazes, identificando possíveis diagnósticos diferenciais e evitando prescrição desnecessária.
Objectivo: Esta revisão de leitura teve como principal objectivo a exploração dos efeitos agudos e crónicos do consumo do cannabis, abordando as consequências neurobiológicas do consumo da substância. Focou-se essencialmente na caracterização do Síndrome Amotivacional relacionado com o consumo crónico do cannabis e eventual diagnóstico diferencial com a Perturbação Depressiva Major Induzida por Consumo de Substância/Medicamento.
Métodos: Foi realizada uma pesquisa literária nas bases de dados Pubmed e B-on e introduzidas as palavras-chave: "amotivational syndrome", "depression", "anhedonia", "apathy", "cannabis". Foram também incluídos artigos que constavam da bibliografia de outros, por interessarem ao tema.
Resultados: O Síndrome Amotivacional é genericamente caracterizado por apatia, anedonia, embotamento afectivo e diminuição da motivação para actividades dirigidas a objectivos. A evidência sugere que a administração aguda de cannabis leva a um estado transiente de amotivação, sendo que tanto o consumo agudo como o crónico estão associados a pior performance em actividades dirigidas a objectivos e reduzem a sensibilidade do sistema de recompensa do indivíduo a estímulos não relacionados com substâncias - sistema mesocorticolímbico -, afectando negativamente a transmissão dopaminérgica nas mesmas áreas cerebrais.
Conclusões: Os resultados demonstram que, de facto, o cannabis é uma substância com efeitos a curto e a longo prazo que devem ser considerados no âmbito das políticas de saúde pública. Relativamente ao Síndrome Amotivacional, é claro que se desenvolve nos consumidores frequentes, com consequências importantes para a sua vida social e actividades laborais. É urgente a realização de mais estudos especialmente centrados nos efeitos crónicos desta substância, nomeadamente para eliminar a possível influência de outras variáveis nos seus resultados e investigar se, de facto, o Síndrome Amotivacional é uma consequência do consumo do cannabis ou é um factor pré-mórbido, já presente no indivíduo, que condiciona o início dos consumos.
Background: Cannabis is the most commonly used illicit drug in Portugal. The decriminalization of its use and therapeutic properties make the identification and description of its acute and chronic effects mandatory. The Amotivational Syndrome, related to frequent use of cannabis, is essentially characterized by apathy, anhedonia, flattening of affects and a decrease in motivation for goal-directed behaviour. It is important to explore the consequences of the use of this substance, especially its effects during adolescence - the age at which the drug use usually begins - to design new preventive and therapeutic strategies that allow us to identify diferential diagnosis and avoid unnecessary prescription. Aim: This literature review's aim was to explore the acute and chronic effects of cannabis use, examining the neurobiological consequences of this drug. It mainly focuses on the characterization of the Amotivational Syndrome, usually related to the chronic use of cannabis and possible differential diagnosis, such as Substance Induced Depressive Disorder. Methods: A literature research was performed on the Pubmed and B-on databases, using the following keywords: "amotivational syndrome", "depression", "anhedonia", "apathy", "cannabis". Articles from other bibliographies were also included if they were of interest. Results: The Amotivational Syndrome is generically characterized by apathy, anhedonia, flattening of affects and a decrease in motivation for goal-directed behaviour. Evidence suggests that the acute administration of cannabis leads to a trasient state of amotivation. Meanwhile, both acute and chronic use are associated to a worse performance in goal-directed activities and reduce the individual's reward system's - mecocorticolimbic system - sensibility to non-substance related stimuli, negativelly affecting dopaminergic transmission in the same brain areas. Conclusions: The results show that, in fact, cannabis is a drug with short and long term effects that should be considered in regards to public health policies. It is clear that the Amotivational Syndrome develops in frequent consumers, with important consequences to their social life and work activities. It is urgent that more studies are available, especially if focused in the chronic effects of this drug, to eliminate the influence of other variables in the results and to examine if, in fact, the Amotivational Syndrome is a consequence of cannabis use or just a pre-morbid factor that leads to the beginning of the drug use.
Background: Cannabis is the most commonly used illicit drug in Portugal. The decriminalization of its use and therapeutic properties make the identification and description of its acute and chronic effects mandatory. The Amotivational Syndrome, related to frequent use of cannabis, is essentially characterized by apathy, anhedonia, flattening of affects and a decrease in motivation for goal-directed behaviour. It is important to explore the consequences of the use of this substance, especially its effects during adolescence - the age at which the drug use usually begins - to design new preventive and therapeutic strategies that allow us to identify diferential diagnosis and avoid unnecessary prescription. Aim: This literature review's aim was to explore the acute and chronic effects of cannabis use, examining the neurobiological consequences of this drug. It mainly focuses on the characterization of the Amotivational Syndrome, usually related to the chronic use of cannabis and possible differential diagnosis, such as Substance Induced Depressive Disorder. Methods: A literature research was performed on the Pubmed and B-on databases, using the following keywords: "amotivational syndrome", "depression", "anhedonia", "apathy", "cannabis". Articles from other bibliographies were also included if they were of interest. Results: The Amotivational Syndrome is generically characterized by apathy, anhedonia, flattening of affects and a decrease in motivation for goal-directed behaviour. Evidence suggests that the acute administration of cannabis leads to a trasient state of amotivation. Meanwhile, both acute and chronic use are associated to a worse performance in goal-directed activities and reduce the individual's reward system's - mecocorticolimbic system - sensibility to non-substance related stimuli, negativelly affecting dopaminergic transmission in the same brain areas. Conclusions: The results show that, in fact, cannabis is a drug with short and long term effects that should be considered in regards to public health policies. It is clear that the Amotivational Syndrome develops in frequent consumers, with important consequences to their social life and work activities. It is urgent that more studies are available, especially if focused in the chronic effects of this drug, to eliminate the influence of other variables in the results and to examine if, in fact, the Amotivational Syndrome is a consequence of cannabis use or just a pre-morbid factor that leads to the beginning of the drug use.
Descrição
Trabalho Final do Curso de Mestrado Integrado em Medicina, Faculdade de Medicina, Universidade de Lisboa, 2017
Palavras-chave
Cannabis Síndrome amotivacional Perturbação depressiva major Psiquiatria