Search

Introduction: Pharmacological treatment of insomnia in patients with addictions has been hardly investigated and there are few researches about it in an inpatient detoxification. The aim of this study was to describe the outcomes of the pharmacological treatment of insomnia in SUD patients admitted to a detoxification unit in Spain, with a focus on the primary substance of abuse and co-occurring mental disorders. Methods: A quasi-experimental study was conducted in 481 addicted in patients, who were admitted for substances detoxification in Vall d´Hebron University Hospital, Barcelona, Spain, from 2010 to 2015. The patients underwent systematic evaluation of axes I and II psychiatric disorders (SCID-I, SCID-II, and CAADID). Insomnia was evaluated using a night time sleep log. Substance-dependent patients, who had insomnia during hospital detoxification, received a psychotropic medication with hypnotic effect, keeping the regular clinical practice without randomization. Results: At discharge, insomnia was considered to have been alleviated in 63.8% (n = 204) of patients while 36.2% (n = 116) of patients remained with insomnia disturbances. Comparing hypnotic treatments it was observed that mirtazapine and clotiapine were the treatment that corrected the insomnia more frequently. Discussion: Since insomnia is not corrected in all patients, it should be further investigated in medications with hypnotic purpose. Based on the results of this work, randomized clinical trials might be proposed. [ABSTRACT FROM AUTHOR]

Background The aim of this study is to describe the features of cocaine-dependent patients who have had cocaine-induced tactile/somatic hallucinations (CITSH), and to analyze the association with addiction-related variables and psychiatric comorbidity, comparing patients with CITSH, patients with cocaine psychotic symptoms (CIP) and no CITSH, and patients without any psychotic symptom. Method A cross-sectional study was conducted in 767 cocaine-dependent patients in an outpatient treatment center for addictions. The following data were obtained: sociodemographic characteristics, CIP information, addiction-related variables and psychiatric comorbidity. A bivariate and multivariate analysis was performed. Results Of the whole sample, 6.6% reported CITSH at some point of their lives, 48.4% had suffered some CIP other than CITSH, and 45% had not experienced any psychotic symptom. According to multivariate analysis, risk of overdose increases by 12.1 (OR) times the probability of having had CITSH compared patients with CIP-no-CITSH. Other variables associated to patients with CITSH were: age of drug use onset, presence of episodes of overdose, prevalence of psychotic disorder induced by cocaine. In general, in all variables studied, patients with CITSH presented worse clinical features (addiction variables and psychiatric comorbidity) than patients with CIP without CITSH and non-CIP group. Conclusion CITSH are usually associated with other psychotic symptoms induced by cocaine. The patients who experienced CITSH are more severe cases compared both with patients with CIP without CITSH and patients without CIP. Increased risk of overdose is an important issue in this type of patients. [ABSTRACT FROM AUTHOR]

Our aim was to investigate differences in immune mechanisms in multiple sclerosis (MS) relapse, after high-dose oral methylprednisolone (oMP) or intravenous methylprednisolone (ivMP). We measured serum cytokines (IL-2, IL-4, IL-6, IL-10, IL-17, TNF-α and IFN-γ) in 39 of 49 MS patients with moderate-severe relapse, whom were treated with ivMP or oMP in a placebo-controlled, non-inferiority clinical trial. We assessed these cytokine levels at baseline and at 1 and 4 weeks post-treatment. The cytokine levels between oMP and ivMP were similar at any time. Proinflammatory cytokines (IL-6 and IFN-γ) were significantly decreased in both groups at week 1 (p = 0.05 / p = 0.03) and at week 4 (p = 0.04 / p = 0.05). This study provides further confirmatory evidence that oMP is not inferior to ivMP.Trial registration: clinicaltrials.gov identifier: NCT00753792 [ABSTRACT FROM AUTHOR]

The article focuses on the study which compares the clinical and radiologic efficacy of intravenous methylprednisolone (ivMP) against oral methylprednisolone (oMP) at equivalent high doses for multiple sclerosis (MS) relapse. It states the main outcome of noninferiority at four weeks for improved expanded disability status scale (EDSS) score. It mentions that oMP is not inferior to ivMP in reducing the score of EDSS.

Background: The identification of major immunogenic peptides in multiple sclerosis (MS) is of great importance for the development of antigen-specific therapies. Cellular reactivity against a selected mix of seven myelin peptides was evaluated in vitro. The evolution of this reactivity over time and its correlation with clinical variables was also analysed. Material and methods: Forty-two patients with MS, 15 with other demyelinating diseases and 40 healthy donors (HD) were studied. Cell proliferation was measured by 3[H] thymidine incorporation into samples obtained at 0, 3, 6 and 12 months of MS patient follow-up. Results: A positive reaction to the peptide mix was detected in 31 of the 42 patients (74%), 12 of the 40 HD (30%) and 6 of the 15 (40%) patients with other demyelinating diseases. Patients with positive proliferation had greater disability (EDSS score, 3 [1-5.5] vs. 1.0[1-2], P = 0.021), higher number of relapses (7 ± 4.1 vs. 3 ± 1.2, P < 0.001) and shorter time since the last relapse (9 ± 7.5 vs. 32 ± 12.3 months, P = 0.036). After 12 months of follow-up, cell reactivity was maintained in 33 patients (78%). Conclusion: A high percentage of patients exhibit a significant and maintained reactivity to myelin peptides over time. Therefore, this mix may be useful as a source of antigen in the development of protocols aimed at inducing specific tolerance in MS. [ABSTRACT FROM AUTHOR]

Abstract: The development of specific therapies for organ-specific autoimmune diseases requires the identification of relevant immunogenic epitopes, recognized by both pathogenic T cells and autoantibodies. Here, we review the most relevant studies focused in the identification of peptides in multiple sclerosis (MS) and the distinct T cell reactivity induced in patients compared to controls. Only a few studies reported significant differences in terms of T cell reactivity to them. The current knowledge on this issue, and the diagnostic and therapeutic possibilities opened by the identification of pathogenic MS epitopes are discussed in this paper. [Copyright &y& Elsevier]

The article presents a case study of a 37-year-old female with a history of epilepsy, epidermoid cyst and focal complex seizures consistent with the diagnosis of neuronal intermediate filament inclusion disease (NIFID). The diagnosis was confirmed after magnetic resonance imaging (MRI) of the brain, neuropsychological and histological examination. The link of NIFID with frontotemporal lobal degeneration (FTD), accumulations of neuronal intermediate filaments and FET proteins is discussed.

Introduction: It's known that adherence to treatment is a key factor in the treatment of addictions. The presence of comorbid substance dependence disorder and other psychiatric disorder is very high. Comorbid psychiatric disorders interfere with adherence to drug treatment and detoxification. Aims: To analyze the percentage of patients who had a voluntary discharge to Hospital Detoxification Unit and to describe sociodemographic, clinical and diagnostic test characteristics. Material and methods: We descriptively studied drug dependents patients admitted to our Detoxification Unit from June 2008 to August 2012. Data was gathered at admission on demographic (age), clinical (main abused drug, psychiatric comorbidities, polydrug users, binge consumption previous intake) and alcoholtest and/or urinalysis. Results from patients with and without voluntary discharge were compared. Results: The study sample included 469 patients (77.7% men, average age 38.3±9). 10.7% of the patients had voluntary discharge. We found significant differences between voluntary discharge and the non-voluntary discharge group on younger people (37,6 vs 40,42,p<0,05), on heroine as main drug of abuse (40% vs 13,4%, p<0,0001) and psychiatric comorbidities (60,8% vs 39,2%,p=0,02), being psychotic disorders (26% vs 13,6%,p<0,02) and borderline personality disorder (56% vs 29,4%,p<0,0001) the most significant. Also patients who had binge consumption previous intake (84% vs 56.6%,p<0.0001) and patients with positive urinalysis(84% vs 58.2%,p<0.0001) had more voluntary discharge. Patients with comorbid depressive disorders had non-voluntary discharge(6% vs 18.4%,p<0.02). Conclusions: Few patients had a voluntary discharge. Younger people, opiate dependence, having psychotic and borderline personality co morbidity, binge consumption previous intake and positive urinalysis might be considered as risk factors for voluntary discharge. [Copyright &y& Elsevier]

Introduction: Cocaine induced psychosis (CIP) is common but not developed in all cases. Many risk factors have been linked with CIP. A lifetime diagnosis of ADHD has been associated with the categorical presence of CIP. Objectives: The objective of this study is to determinate the relationship between impulsivity and impulsivity-realetd disorders (BPD, BN and ADHD) and CIP. Aims: We study the presence of psychotic symptoms using a clinical interview for psychotic symptoms in a large sample of cocaine-dependent patients. Patients suffering from schizophrenia or bipolar disorders were excluded. Finally we included 287 patients in the study. Methods: A structured interview about psychotic symptoms were systematically conducted. The Structured Clinical Interview for DSM IV Axis I and Axis II disorders were used in order to identify the comorbidity. CAADID-II (Conners’ Adult ADHD Diagnostic Interview for DSM-IV) were used in order to identify ADHD comorbidity. Barrat impulsivity scale were used for evaluate impulsivity. Results: BIS total were 63.78. We identify a significant association between CIP and BIS cognitive subscale p<0.003 and BIS total p<0.021. We also identify a significant association between CIP and adult ADHD in cocaine-dependent patients p<.0.002. We fail to identify association between CIP and BPD and BN. Conclusions: CIP is related with BIS cognitive subscale and BIS total scores, and with ADHD comorbidity in cocaine-dependent patients. As well these findings could be useful for a clinical approach to the risks of psychotic states in cocaine-dependent patients. [Copyright &y& Elsevier]

Introduction: Cocaine consumption can induce transient psychotic symptoms. Cocaine induced psychosis (CIP) is common but not developed in all cases. However, prevalence and clinical features are not well known. In psychiatry settings different studies have reported prevalence ranging between 29%–86.5%.There are few samples including more than 150 patients for studding this topic. Objectives: The objective of this study is to determinate the CIP prevalence and the most prevalent psychotic symptoms. Aims: We study presence of psychotic symptoms using a clinical interview for psychotic symptoms in a large sample of 287 cocaine-dependent patients. We study the presence of psychotic symptoms using a clinical interview for psychotic symptoms in a large sample of cocainedependent patients. Patients suffering from schizophrenia or bipolar disorders were excluded. Finally we included 287 patients in the study. (80.8% men and 35.77 yo). Methods: A structured interview were systematically conducted. The Structured Clinical Interview for DSM IV Axis I and Axis II disorders were used in order to identify the comorbidity. Results: Psychotic symptoms were detected in 59.9% of the sample. The most frequent symptoms reported lifetime was suspiciousness 38.6% and paranoid beliefs 27.2% Auditory hallucinations were reported by 23.6%, visual hallucinations by 13.3%, and kinesthetic hallucinations by 7.8%. Motor alterations were not evaluated. Conclusions: Our dates confirm previous study. CIP prevalence is high. Motor alterations were not evaluated, so symptoms could be underestimated. Identifying this kind of symptoms can be useful in order to minimize risks of psychotic states for the patients or others. [Copyright &y& Elsevier]

Introduction: There is no pharmacotherapy with specific indication for psychostimulant detoxification. Few studies have been made about pharmacological strategies in this dependence. In dual patients, literature about this remains limited. Objectives and aims: To describe socio-demographic features, drug-related experiences, primary psychiatric disorders and therapeutical approaches in dual inpatients, and compare them with non dual inpatients. Methods: We present a descriptive and cross-sectional study, based on the description of 300 admitted patients for psychostimulant detoxification from June 2008 to August 2011. Clinical and socio-demographic characteristics were registered using an ad-hoc questionnaire. Structured interviews based on SCID I, SCID II, ASI and CAADID were performed to screen psychiatric co-morbidity. Results: Almost 63% reached criteria for dual diagnosis (72.4% men, mean age 36±7,8 years). The most common diagnostics were psychotic disorders (45.5%) in axis I and Cluster B personality disorders in axis II (31.8%). 44.7% were multiple-drug abusers. 57.9% of dual patients had been previously hospitalized in comparison with 28.1% of non dual patients, being this statistically significant. Dual patients used a higher number of pharmacological treatments at discharging from hospital (3,1±1,5 vs 1,9±1,4, p<0.001). The most frequent approaches were antiepileptics (80,8%), antidepressant (67.7%), antipsychotics (51.3%), interdictors (16.9%), anxiolytics (12.8%) and opioid agonists (10.4%). Conclusions: Dual patients admitted for a psychostimulant detoxification frequently reach criteria for psychotic disorders and cluster B personality disorders. They exhibit a severe condition, requiring numerous admissions and presenting higher prevalence of poly-drug abuse. Similarly, they need additional pharmacological strategies to complete detoxification. [ABSTRACT FROM AUTHOR]

Introduction: Sleep disturbances have been described in drugdependent patients and mainly, in alcoholics. Few studies describe the hypnotic treatment used in this setting. Aims: Describe the prevalence of insomnia in drugdependent inpatients. Describe the hypnotic treatment, according to the substance abuse and the psychiatric comorbidity. Material and methods: Descriptive study performed in drugdependent inpatients between June, 2008 and August, 2011. The Structured Clinical Interview for DSM Disorders was obtained in order to ensure the clinical diagnosis. Hypnotic treatment was dispensed to those patients who complain of insomnia according to the Psychiatric prescription. Demographic data, type of abuse drug and the hypnotic dispensed was obtained. Results: 298 patients fulfilled inclusion criteria (71.8% men, 39.22±10.13 years). The principal substances of consumption were stimulants(36.2%), followed by alcohol(34.9%), heroine(14.4%), cannabis(9.4%) and benzodiazepines(5%). 60.4% of the patients complained of insomnia during the hospital admission. The most used drugs for insomnia were mirtazapine(19.8%), trazodone(14.8%), quetiapine(14.1%), clotiapine(7.4%) and olanzapine(4.4%). Alcohol, cocaine and benzodiazepines addicted patients were treated with antidepressants as mirtazapine(17.3%, 18.5% and 40% respectively); heroin addicts were treated with antipsychotic drugs as quetiapine(27.9%). Cannabis addicts took antidepressant and antipsychotic (mirtazapine (21.4%) and olanzapine(21.4%)) 61.7% of the patients fulfilled diagnostic criteria of dual diagnosis. Patients with psychotic disorder used quetiapine(17.4%); those with depressive and bipolar disorder were treated with trazodone(30.2% and 33.3% respectively), those who complain of anxious disorder and personality disorder took mirtazapine(50% and 17.4% respectively). Conclusions: Sleep disturbances are frequent in drugdependent inpatients. Mirtazapine was the most frequently used drug to treat insomnia. [ABSTRACT FROM AUTHOR]

Introduction: Dual diagnosis patients are characterized by low rates of adherence and treatment compliance. During last years new resources have dedicated to these patients where substance use and mental disorder are treated simultaneously. Objectives: The aim of this study is to describe sociodemographic and psychopatology features of dual diagnosis outpatient. Methods: All subjects in the study were outpatients at dual diagnosis program at Vall d’Hebron University Hospital, Barcelona, Spain during 2007 to 2008. These patients were following up until December 2009. Sociodemographic data, psychiatric diagnosis and substance abuse were assessed by using EuropASI, SCID-I y SCID-II and by reviewing their medical histories. Results: A total of 90 patients were recruited for this study during 2007–2008 and were followed one year. 62,5% of them remain until the end of the treatment. 67,9% were men, medium age was 37 years old (±1.4). Most of them live with their own families (57,1%) and their marital status was single (48,2%). In this sample the most prevalent psychiatric diagnosis was Major Depressive Disorder (36,4%) followed by Psychotic Disorder (36,2%). The most abused substance was cocaine (33,9%) followed by cannabis (26,8%), alcohol (16,1%), heroin (17,9%). More of 60% were polydrug. Conclusions: The patients who maintained inculcation with the outpatient program of dual diagnosis were men with medium level of academic level and good family and social environment. [ABSTRACT FROM AUTHOR]

Introduction: There are few studies about the characteristics of Substance Use Disorder patients that relapse, defined by restart of the substance use that motivated the intake, after discharge from a Detoxification Unit. Objectives: To analyze the percentage of patients who had a relapse in the following 3 months after discharge and to describe their sociodemographic, clinical and therapeutical characteristics. Methods: We prospectively studied drug dependents patients admitted to our Detoxification Unit from June 2008 to August 2009. Data was gathered at admission on demographic (gender, age), clinical (main abused drug, psychiatric comorbidities, polydrug users) and therapeutical variables (hospitalisation duration, prescribed treatment). Patients were followed up for 3 months and assessed for relapse at 1 and 3 months by clinical interview, alcohol screening test and/or urinalysis. Results from patients with and without relapses were compared. Results: The study sample included 103 patients (77,7% men, average age 38,31±9). At month 3, 57,3% of the patients had relapsed. We found significant differences between the relapse and the non-relapse group on the percentage of polydrug users (68,6% vs 31,4%, p=0,05), on heroine as main drug of abuse (76% vs 24%, p=0,05) and psychiatric comorbidities (60,8% vs 39,2%, p=0,04), being psychotic disorders the most frequent. No significant differences were found between the 2 groups concerning therapeutical variables. Conclusions: More than half of the patients that ended the detoxification process relapsed in the first 3 months. Polydrug use, opiate dependence and having a psychiatric comorbidity might be considered as risk factors for relapse. [Copyright &y& Elsevier]

Introduction: Drug substance abuse has been related with chronic insomnia and other sleep disorders that are thought to interfere in detoxification treatment and relapse induction. These disorders can persist after drug detoxification. Objectives: To describe sleep disorders referred by drug dependents patients in an inpatient detoxification unit. Methods: We prospectively studied drug dependents patients admitted to our Detoxification Unit from January 2005 to March 2009. The first night, patients were asked to complete an 11-item questionnaire measure designed to assess the relationship between sleep disorders and drug use. Responses ranged from 1 to 7. The questionnaire measured the following: [a)] insomnia before hospitalization; [b)] patients’ beliefs about the relationship between insomnia and drug use; [c)] insomnia in previous detoxifications; [d)] patients’ worry about insomnia; [e)] treatment of sleep disorder with benzodiazepines. Results: The study sample included 150 patients (75.3% men). 39% of the patients suffered from alcohol abuse, 34.67% from cocaine abuse, 22.67% from opioid abuse, 21% from cannabis abuse, 18% from benzodiazepine abuse, and 12.67% of patients were polydrug users. Lifetime prevalence of sleep disorders was 68.1%. 64% had suffered insomnia the months previous to detoxification. 80.1% of patients’ referred sleep disorders in relationship with substance abuse. 69.4% were worried about insomnia during detoxification. 75.4% of patients took benzodiazepines without prescription. Conclusions: Sleep disorders in patients with drug abuse are frequent. A high prevalence of patients having worries about insomnia during the detoxification treatment and believing in a relationship between their sleep disorders and the drug abuse was found. [Copyright &y& Elsevier]

Introduction: Suicidal behaviors are frequently observed among patients with substance use disorder, including suicidal ideation (SI) (1). Alcohol use disorder (AUD) is one of the most prevalent addictions and may be related to suicidal behaviors (2,3). However, the association between AUD and SI requires a deeper analysis which includes several clinical features observed among AUD patients. Objectives: To analyze the clinical characteristics and features associated with lifetime SI among patients who had AUD. Methods: This is a cross-sectional study performed in an outpatient center for addiction treatment in patients seeking for treatment who met the criteria for AUD between 01/01/2010 and 12/31/2021. Patients were evaluated with an ad-hoc questionnaire and the European Addiction Severity Index (EuropASI), SI was evaluated using the item for SI in EuropASI. Results: From a potential sample of n=3729 patients, only n=1082 (73.8% males; mean age 42.82±12.51) met inclusion criteria and had data for the current analysis. Lifetime SI was present in 50.9% of the AUD patients. Several clinical features were related to SI, including: sex differences, any type of lifetime abuse, polyconsumption, benzodiazepine use disorder, any psychiatric diagnosis aside from SUD, and higher addiction severity according to the EuropASI. Image: Conclusions: SI among AUD patients is related to several clinical features which indicate a higher addiction severity, more polyconsumption, and a higher prevalence of psychiatric comorbidities. These findings may contribute to the understanding of suicidal behaviors in AUD patients but it is required further investigations, including longitudinal studies. REFERENCES 1 Rodríguez-Cintas L, et al. Factors associated with lifetime suicidal ideation and suicide attempts in outpatients with substance use disorders.  Psychiatry Res. 2018;262:440-445. doi:10.1016/j.psychres.2017.09.021 2. MacKillop J, et al. Hazardous drinking and alcohol use disorders.  Nat Rev Dis Primers. 2022;8(1):80. doi:10.1038/s41572-022-00406-1 3.Darvishi N, et al. Alcohol-related risk of suicidal ideation, suicide attempt, and completed suicide: a meta-analysis [published correction appears in PLoS One. 2020;15(10):e0241874].  PLoS One. 2015;10(5):e0126870. doi:10.1371/journal.pone.0126870 Disclosure of Interest: None Declared [ABSTRACT FROM AUTHOR]

Background: The use of tolerogenic DCs is a promising therapeutic strategy for transplantation and autoimmune disorders. Immunomodulatory DCs are primarily generated from monocytes (MDDCs) for in vitro experiments following protocols that fail to fulfil the strict regulatory rules of clinically applicable products. Here, we compared the efficacy of three different tolerance-inducing agents, dexamethasone, rapamycin and vitamin D3, on DC biology using GMP (Good Manufacturing Practice) or clinical grade reagents with the aim of defining their use for human cell therapy.Methods: Tolerogenic MDDCs were generated by adding tolerogenic agents prior to the induction of maturation using TNF-α, IL-β and PGE2. We evaluated the effects of each agent on viability, efficiency of differentiation, phenotype, cytokine secretion and stability, the stimulatory capacity of tol-DCs and the T-cell profiles induced.Results: Differences relevant to therapeutic applicability were observed with the cellular products that were obtained. VitD3-induced tol-DCs exhibited a slightly reduced viability and yield compared to Dexa-and Rapa-tol-DCs. Phenotypically, while Dexa-and VitD3-tol-DCs were similar to immature DCs, Rapa-tol-DCs were not distinguishable from mature DCs. In addition, only Dexa-and moderately VitD3-tol-DCs exhibited IL-10 production. Interestingly, in all cases, the cytokine secretion profiles of tol-DCs were not modified by a subsequent TLR stimulation with LPS, indicating that all products had stable phenotypes. Functionally, clearly reduced alloantigen T cell proliferation was induced by tol-DCs obtained using any of these agent. Also, total interferon-gamma (IFN-γ) secretion by T cells stimulated with allogeneic tol-DCs was reduced in all three cases, but only T cells co-cultured with Rapa-tol-DCs showed impaired intracellular IFN-γ production. In addition, Rapa-DCs promoted CD4+ CD127 low/negative CD25high and Foxp3+ T cells.Conclusions: Our results demonstrate contrasting influences of different clinical-grade pharmacological agents on human tol-DC generation. This should be taken into account for decisions on the use of a specific agent for the appropriate cellular therapy in the context of a particular disease. [ABSTRACT FROM AUTHOR]

The disorders classified as control of the impulses; explosive intermittent disorder, pathological gambling, kleptomania, pyromania, pathological gambling, hair pullers, compulsive purchases, skin picking and onychophagia are a heterogeneous set of clinical entities, most of them with little prevalence. Nevertheless, they cause important personal and social dysfunctions and present great comorbidity with other psychiatric disorders. Antipsychotics, antidepressive agents, serotoninergic agonists, naltrexone, beta blockers antiandrogen, lithium and anticonvulsants have been used in their pharmacological treatment. Currently, interest is growing on the use of the antiepileptics because their possible usefulness has been described in these disorders. However, the neurobiological effects are only partially known in some cases. We have reviewed the literature regarding the treatment of these disorders with mood stabilizers, (lithium, carbamazepine, valproate, phenitoin, oxcarbacepin, topiramate, lamotrigin, leviteracetam) and have described those studies on which the current knowledge and evidence are based. The results must be considered as provisional and must be updated in the future, since they are mostly based on case reports, case series or opened clinical trials, their being little knowledge based on double blind clinical trials. [ABSTRACT FROM AUTHOR]

• Insomnia disorder remission is associated with a significant ADHD severity improvement. • Psychiatric ADHD comorbidity contributes to greater insomnia disorder persistence. • ADHD severity, rather than ADHD presentations, would be related to insomnia disorder persistence. • Insomnia disorder treatment would contribute to improve mental and physical adult ADHD HRQoL. The longitudinal relationship between insomnia disorder and adult attention-deficit/hyperactivity disorder (ADHD) has been scarcely investigated. This study aimed to evaluate the relationship between the remission of insomnia disorder and adult ADHD clinical severity, psychiatric and medical comorbidities, and the health-related quality of life (HRQoL) in a 6-month follow-up. Ninety-two adult patients with ADHD and insomnia disorder (52.2% males; mean age 39.5 ± 11.0 years) were comprehensively assessed at baseline, 3 months, and 6 months of a follow-up period. The evaluation included semi-structured interviews (for ADHD and comorbidity assessment), the Pittsburgh Sleep Quality Index, Insomnia Severity Index, and Epworth Sleepiness Scale. The diagnosis of ADHD and insomnia disorder was performed according to DSM-5 criteria. At baseline and follow-up, psychoeducation/sleep hygiene and, if necessary, pharmacological were prescribed for insomnia. Eighty-seven patients completed the 6-month follow-up. Insomnia disorder remission was reported in 72.4% of cases and was related to a greater improvement in ADHD symptoms and severity throughout the follow-up period. Additionally, an improvement in psychiatric comorbidities and better HRQoL were associated with insomnia disorder remission. The current study highlights that the treatment of insomnia disorder in ADHD adult patients may have an important role in the outcome of ADHD therapeutic approaches by reducing their severity. [ABSTRACT FROM AUTHOR]

Introduction Legal and illegal drugs can cause psychotic symptoms, in cocaine-dependent patients the prevalence of these symptoms may reach 86% (Vorspan, 2012). It is estimated that 13–32% of cocaine-dependent patients have kinaesthetic hallucinations (Siegel, 1978; Mahoney, 2008; Roncero, 2012). Objectives To compare the prevalence of substance-induced psychotic symptoms and compare the use of welfare/social resources and social adjustment among cocaine-dependent patients (CD) and other substances dependences (OtherD). Methods Two hundred and six patients seeking treatment at the Addictions and Dual Diagnosis Unit of the Vall d’Hebron. Patients were assessed by ad hoc questionnaire designed to collect demographic data and psychotic symptoms associated with consumption, a record of the care/social resources used by the patient and the scale of social adaptation (SASS). A descriptive and bivariate analysis of the data was performed. Results CD were 47.1% vs. 52.9% OtherD (66.1% alcohol, 17.4% cannabis, 8.3% opioid, 8.3% benzodiazepines/other drugs). Of cocaine dependent-patients, 65.6% present psychotic symptoms vs. 32.1% for the OtherD. Different exhibiting psychotic symptoms are: self-referential (69.7% vs. 30.7%), delusions of persecution (43.4% vs. 12.2%), hallucinations (49.4% vs. 14.3%), auditory hallucinations (43.5% vs. 11.4%), visual hallucinations (30.4% vs. 5.7%) and kinaesthetic hallucinations (7.2% vs. 2.9%). Cocaine-dependent patients significantly use more health care resources in reference addiction unit (76.3% vs. 62.4%, P :.035) and infectious diseases (22.7% vs. 5.5%, P :.000) and justice-related (50.5% vs. 26 resources 0.6%; P :1.001) and less resources and mental health (25.8% vs. 43.1%; P :.013). Regarding social adaptation, no differences were found in the SASS. Kinaesthetic hallucinations do not appear to be related to a greater use of resources and in social adaptation. References not available. [ABSTRACT FROM AUTHOR]

Introduction Drug use among medical students is partially unknown. However, consumption among medical students may have a similar role if compared with the rest of population. Objectives To study drugs use among medical students comparing gender and evolution on drugs use. Aims Students enrolled in the fifth year of the medical studies at the Universidad Autónoma de Barcelona, from the course 2008-2009 to 2014-2015, were offered the chance to participate voluntarily in the study. Methods The students agreed to participate anonymously in a survey filled in during the beginning days of the psychiatry classes. They were asked about their drug consumption, including legal drugs (alcohol and tobacco) and illegal drugs. During the seven study years, 469 questionnaires were collected (74.1% of women) and mean age was 22.77 (20-35) yearsold. Results The students reported consuming alcohol (66.7%; 65.5% women, 70.4% men), tobacco (18.6%; 18.1% women, 20% men) and illegal drugs (15.1%; 12.4% women, 22.8% men). The female students consumed fewer illegal drugs than the men (p 0.008) as showed above. Comparing 2008/2009 and 2014/2015 courses, the consumption was: alcohol 75.5% and 65.7%, tobacco 24.5% and 13.2% and illegal drugs 22.4% and 14.7%. Conclusions Drug consumption is an important problem among medical students who will become prescribing doctors in a few months after the survey . There is a decreased tendency to use illegal drugs. Due to the gender differences on illegal drug use a special focus must be placed on the male group. [ABSTRACT FROM AUTHOR]

Introduction: Patients with substance use disorders (SUD) have higher alexithymia levels and present frequently suicidal ideation (SI) and suicide (SA) [1,2]. Beside, alexithymia has been related to suicidal behaviors in several psychiatric disorders[3]. Although, there are some studies on alexithymia and suicidality in SUDpatients, to our knowledge there are no studies on this issue in Spanish population. Objectives: To compare the alexithymia levels in SUD patients with and without SI and SA in an outpatient addiction treatment center in Spain. Methods: This is a cross-sectional study performed on 110 patients (74.3%males; mean age 43.6±14.5years old) for whom we had information from the Toronto Alexithymia Scale(TAS-20) and the presence or not of lifetime SI and SA. Results: Lifetime SI and SA were present in 55.5% and 35.5% of the sample respectively. The mean score of TAS-20, difficulties identifying feelings (DIF), difficulties describing feelings (DDT), and externally-oriented thinking(EOT) were 57.2±13.3, 20.0±7.0, 14.7±4.5, and 22.5±4.5 respectively. Conclusions: SI and SA may be related to alexithymia levels. Hence, alexithymia should be further analyzed in SUD patients in longitudinal studies in order to analyze the bilateral association with suicidal spectrum behaviors. REFERENCES Rodríguez-Cintas L, et al. Factors associated with lifetime suicidal ideation and suicide attempts in outpatients with substance use disorders. Psychiatry Res. 2018;262:440-5. Morie KP, et al. Alexithymia and Addiction: A Review and Preliminary Data Suggesting Neurobiological Links to Reward/Loss Processing. Curr Addict Rep. 2016;3 (2):239-48. Hemming L, et al. A systematic review and metaanalysis of the association between alexithymia and suicide ideation and behaviour. J Affect Disord. 2019;254:34-48. [ABSTRACT FROM AUTHOR]

Introduction: Insomnia has been related to a more severe substance use disorder presentation (1). There are few longitudinal studies in outpatients center for SUD treatment that evaluate how insomnia impacts on relapses. Objectives: To analyze how insomnia impacts on the time of the first substance relapse in SUD outpatients after the onset of addiction treatment. Methods: This is a one-year follow-up study performed on 116 patients (73.3% males; mean age 43.4±14.3) for whom we had information frombaseline insomnia and the time for the first relapse. A Kaplan-Meier survival analysis was performed. This is part of a greater research on Alexithymia in SUD in a longitudinal study. Results: The initial sample consisted of 116 patients, information on relapses was available for 113 patients. The main substances used at baseline were alcohol (62.1%), cocaine (56.0%), cannabis (42.2%), and opiates (30.2%). Conclusions: It is important to evaluate insomnia at the onset of addiction treatment because insomnia may be related to earlier relapses. Furthermore, it should be analyzed further on how insomnia treatment impact on substance relapses. [ABSTRACT FROM AUTHOR]

Abstract: Cocaine consumption can induce transient psychotic symptoms, expressed as paranoia or hallucinations. Cocaine induced psychosis (CIP) is common but not developed in all cases. This is the first European study on the relationship between CIP, consumption pattern variables and personality disorders. We evaluated 173 cocaine-dependent patients over 18 years; mostly males, whose average age was 33.6 years (SD=7.8). Patients attending an outpatient addictions department were enrolled in the study and subsequently systematically evaluated using SCID I and SCID II interviews for comorbid disorders, a clinical interview for psychotic symptoms and EuropASI for severity of addiction. A high proportion of cocaine dependent patients reported psychotic symptoms under the influence of cocaine (53.8%), the most frequently reported being paranoid beliefs and suspiciousness (43.9%). A logistic regression analysis was performed, finding that a model consisting of amount of cocaine consumption, presence of an antisocial personality disorder and cannabis dependence history had 66.2% sensitivity 75.8% specificity predicting the presence of CIP. In our conclusions, we discuss the relevance of evaluating CIP in all cocaine dependent-patients, and particularly in those fulfilling the clinical profile derived from our results. These findings could be useful for a clinical approach to the risks of psychotic states in cocaine-dependent patients. [Copyright &y& Elsevier]

Introduction: Until now, no reliable biological markers of risk and relapse in cocaine-dependent patients have been identified. The yawn-inducing Apomorphine test has been proposed as a marker for predicting relapse during cocaine withdrawal. Objectives: Studying the Apomorphine complete Test as a predictor of relapse in intranasal cocaine dependet-patients during abstinence. Aims: 39 (35 men) cocaine addicts were recruited and included in an addiction program involving 2 weeks in-patient setting and a 23 follow-up weeks. Dependence was diagnosed according to DSM-IV-TR criteria and other axis I comorbid main diagnosis were excluded. Methods: We performed the Apomorphine complete Test (including an Apomorphine Test plus a Placebo Test) at the beginning (day 1) and end (day 11 or 12) of a detoxification program. Patient received 0′005mg/kg of apomorphine and 0′005mg/kg of placebo subcutaneously each test. Results: The patients who relapse prematurely (before 4 weeks), yawn more 11′42 (0–31) in the Apomorphine complete Test realized the first day of the detoxification compared with patients that relapse no prematurely (after 4 weeks of follow-up), 6′83 (0–20), Z -2′14 p<0′03. A model can establish, with a point of court of 7 yawns in the first Apomorphine complete Test that has a sensibility of 61 ′ 9% and a specificity of 70 ′ 6%. Conclusions: There an increased number of yawns in relapse-patients The Apomorphine complete Test could be proposed as a biological marker of early relapse. [ABSTRACT FROM AUTHOR]

Introduction: Addictions among physicians and nurses are a cause of serious concern due to their negative impact both on their wellbeing and on their practice safety. Easy access and increased knowledge of legal drugs increases their risk of developing some substance related disorders such as opioid dependence. In the last decades, Physicians Health Programs (PHPs) have accumulated experience on how to prevent and treat those conditions. Objectives: To describe the clinical characteristics of physicians and nurses with opioid dependence (OD) in treatment at the Galatea PHP. Methods: Data from medical records of physicians and nurses consecutively admitted to the Galatea PHP from 2008 to 2018 will be presented. Records formpatientsmeeting DSM-IV-TR criteria for OD will be selected and compared to those with other addictions. A specific analysis of the clinical relationship between drug prescription and physical pain in the OD subsample will be performed. Results: Physicians and nurses with opioid dependence are expected to be different than other addicted health professionals with regards to specialty (OD more frequent among those with access to intravenous drugs), type of referral (OD less likely to be self-referred for treatment), and risk for self or others (higher among OD patients). Some of them may have developed an OD as a strategy to deal with physical complaints without adequate medical supervision. Conclusions: Acknowledging the factors associated with OD among physicians and nurses may help develop more effective preventive and treatment interventions for them. [ABSTRACT FROM AUTHOR]

PMH70 DIRECT HEALTHCARE COSTS FOR THE MANAGEMENT OF PATIENTS WITH OPIOID USE DISORDER TREATED WITH METHADONE AND BUPRENORPHINE/NALOXONE IN REAL-WORLD SETTING IN SPAIN. To evaluate the economic impact in patients with Opioid Use Disorder (OUD) treated with methadone or buprenorphine/naloxone (B/N) in routine clinical practice in Spain. In a real-world setting, treatment of OUD patients with B/N results in direct healthcare cost savings, compared to methadone. [Extracted from the article]

Introduction Accident rate have a high social cost. Cocaine consumption increases the risk of traffic crashes (Monras, 2011; Fierro, 2011). However, there is not extensively studies in addicts. Objective Compare and analyze the history of accidents and risk behaviors while driving in cocaine dependent patients (DC) and of other substances (OtherD). Methods One hundred and eighty-two patients seeking treatment since January 2014 to September 2015. Sociodemographic and accident-related variables were collected, also administered the MDBQ. Descriptive analysis and bivariate analysis using Chi-square test for categorical variables and Student t test was performed for quantitative. Results Of women, 30.3%, and 69.7% men, mean age 43.67 years (SD = 13). 65.6% currently driving or above. 45.2% DC vs. 54.8 DOther (35.6% alcohol, cannabis 8.3%, 5.8% opioid and 5.1% other drugs). Comparing accident rate on the DC is a tendency to have suffered more accidents (χ 2 : 2.62 P =.072). Patients addicted to cocaine referred further potentially dangerous activities both under the influence of consumption (65.9% vs. 33.3%) and abstinence (41.7% vs. 12%). As for the results of MDBQ, it has been detected that cocaine addicts show more errors and traffic violations. No differences in the lapses identified by patients of different groups. Conclusion Patients with cocaine dependence have more accidents, reduced risk perception and recognize more mistakes and traffic violations. Cocaine implies a high risk of road accidents and exposure to high-risk situations compared to the use of other substances. References not available. [ABSTRACT FROM AUTHOR]

Introduction: Alcohol dependence disorder has been widely described. However, differences due to gender remain unknown. Aim: To compare clinical gender differences in an alcohol dependent outpatient sample. Methods: Alcohol dependent outpatients from the centre for addiction treatment of the Vall d’Hebron University Hospital following treatment during 2005 to 2011 were evaluated. We included patients with an alcohol dependence following DSM-IV criteria. Sociodemographic and clinical variables were collected. Simple descriptive statistics were carried out for demographic and clinical data. Bivariate analysis was made to compare the main variables by sex using SPSSvs15.0. Results: 149 patients were included, 83.2% were men. No gender differences were found in the mean age of the sample. Time of first alcohol use to regular consumption was significantly shorter in men (7.9±6.9 year vs 13.95±8.9 years). Significantly more women (68%) compared with men (44.4%) had comorbid psychiatric disorders. 52% of women and 28.2% of men had depressive symptoms. No gender differences were observed for psychotic, anxiety neither personality disorders. Comorbidity with nicotine dependence was high in men and in women (75.4% vs 73.9%). Significantly more women had sedatives dependence (16% vs 5.3%) and opiate dependence (8.3% vs 3.5%) without observing gender differences in the other drugs. The 71.4% of women consume alone compared with the 38.7% of men. Conclusions: Alcoholic women tend to consume alone. They have more comorbid mental disorders, being depression the most prevalent. Besides alcohol dependence, women also had more sedatives and opiate dependence than men. [ABSTRACT FROM AUTHOR]

Introduction: Chronic consumption of cocaine can induce transient psychotic symptoms, expressed as paranoia or hallucinations. The term cocaine induced psychosis (CIP) has been used to describe this syndrome. Cocaine Induce Psichotic Disorder (CIPD) have been used to describe a full psychotic state. CIP and CIPD prevalences are not well described. Objectives: To evaluate risk factors for CIPD, in cocaine-dependents according to DSM-IV criteria. Methods: We evaluated 150 patients (mean age 34 y.o, 81.8% men) of which 143 were included, using The PRISM (Psychiatric Research for Substance and Mental Disorders) interview. Exclusion criteria were: psychotic disorder or bipolar type I disorder, intoxication at interview, severe somatic disease at interview and language barrier. We compared three groups: group I: without any psychotic symptoms (33,33%); group II: with any psychotic symptoms (28,57%) and group III: with CIPD (38,77%). Results: Differences were found in Patients of Group III in the Age at onset of addiction p<.0001*, past history of imprisonment p<0,01, Alcohol Use disorders p=.006, Cannabis use disorders P<.0001* and Hallucinogens use disorders p<0,001.All remaining after Bonferroni corrections. Conclusions: CIPD is common in this population (approximately 40%). Risk factor for suffering CIPD were described, in Cocaine-dependents. Finally, professionals who work with cocaine-dependents patients should incorporate these considerations into an integral approach. [ABSTRACT FROM AUTHOR]

Introduction: Chronic consumption of cocaine can induce transient psychotic symptoms, expressed as paranoia or hallucinations. This is typically prevented by abstinence. The term Cocaine-Induced Psychosis (CIP) has been used to describe this syndrome. Impulsivity has been hypothesised are likked with CIP. Objectives: This study examined the relationship between CIP and substance consumption variables and impulsivity disorders including ADHD (Axis I) and Borderline personality disorders (BPD) (Axis II), and attempted to evaluated their link as a risk factors for CIP. Aims: Trained psychiatrists systematically conducted a structured interview in which the conclusions from the psychotic symptoms were summarized. We used the CADDID to evaluate Adult ADHD, SCID II for axis II disorders, and the Barrat Impulsivity Scale (BIS-11). Methods: We evaluated 163 (34,16 yo, 85,80% men) cocaine-dependent patients, according to DSM-IV criteria. Results: We found statistically significant association between CIP and Early age at onset of cocaine addiction (p=0,04), cocaine use per day 6 months before starting treatment (p=0,03), Barrat cognitive impulsivity subscale (p<0,004), and Adult ADHD (p<0,041). No relationship between BPD and CIP was found. Conclusions: We confirm previous findings that Impulsivity disorders as ADHD or high impulsivity trails are liked to CIP. Coinciding with our previous findings, relationship between early age of onset cocaine dependence or high amounts of cocaine use and CIP was found. CIP are related with impulsivity disorders spectrum. [ABSTRACT FROM AUTHOR]

Introduction: Cocaine consumption can induce transient psychotic symptoms, expressed as paranoia or hallucinations. Cocaine induced psychosis (CIP) is common but not developed in all cases. Objectives: To describe the Risk Factors for developing cocaine-induced psychosis in cocaine dependent patients, according DSM-IV-TR criteria. Methods: This is the first European study about the relationship of CIP with consumption pattern variables and personality disorders, we evaluated 220 cocaine dependents over 18 years, 80''5% males, mean age 33.9 years (SD = 7.6). Patients were recluted from an outpatient clinic department and subsequently systematically evaluated using SCID I and SCID II interviews for comorbidity disorders, and a clinical-based systematic psychotic symptoms form. Results: A high proportion of cocaine dependent patients reported psychotic symptoms (51.8%) under influence of cocaine. The most frequent reported psychotic symptoms were paranoid beliefs and suspiciousness (42.4%). After a logistic regression analysis we found that a model consisted of high cocaine consumption (mean of 12.01 grams per week), cannabis dependence history and to use intranasal or smoked rout of administration had a sensitivity of 63.2% and a specificity of 70.2%. Conclusion: We conclude that is relevant to evaluate CIP in patients consuming high amounts of cocaine, with cannabis dependence history and who do not use intranasal rout. It could be useful for preventing consequences or risks of psychotic states for themselves or others. [Copyright &y& Elsevier]

Introduction: Until now, no reliable biological markers of risk and relapse in substance-dependent patients have been identified. The yawn-inducing test with apomorphine has been proposed as a marker of the functional status of the dopaminergic system and therefore a predictor of suffering an addiction or predisposition to relapse. Objectives: Studying the safety and efficacy of apomorphine test as a predictor of relapse in intranasal cocaine dependent, diagnosed according to DSM-IV-TR. Methods: We performed the test of apomorphine at the beginning (day 1) and end (day 11/12) of a detoxification program in 33 patients (29 men). The majority of patients relapsed after 22 weeks of follow up (87% relapse). The average yawns in the sample were 10.9 ± 9.3 in the initial test (Apo 1) and 10.2 ± 10.2 in the final test (Apo 2). The 42% of patients relapsed early (before 4 weeks) and 45% late (afther 4 weeks). 58% of the sample (N = 19), which did not fall belatedly filled an average of 8.0 yawns in Apo1 and 8.1 on Apo2 and 42% who did so early (N = 14), 14,8 in Apo1 and 14.6 in Apo2. Therefore there are an increased number of yawns in patients with early relapse. No important side effects were reported. Conclusions: Patients with early relapse have a higher number of yawns that those falling late or abstainers The apomorphine test is a safe test and it is a readily applicable tool in clinical practice and may be a biological marker of risk. [Copyright &y& Elsevier]