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Agitation in patients diagnosed with personality disorders (PD) is one of the most frequent crises in emergency departments (ED). Although many medications have been tested, their effectiveness has been small or non-significant, and no specific drugs are supported by the available evidence. This study aimed to evaluate the efficacy of Inhaled loxapine (IL) as a therapeutic option for agitated patients with PD.A naturalistic, unicentric, prospective study was carried out. Thirty subjects diagnosed with PD and attending the ED with episodes of agitation were recruited most of whom were women diagnosed with Borderline Personality Disorder. Subjects were treated with a single dose of IL (9.1 mg). Efficacy was assessed with the Clinical Global Impression scale, the Excited Component of the Positive and Negative Syndrome Scale (PANSS-EC) and the Agitation-Calmness Evaluation Scale (ACES). Patients were followed 60 minutes after administration to measure IL effect and its duration.IL exhibited an overall efficacy in managing mild to severe agitation, with a quick onset of effect and persistence. 'Effect of time', where IL efficacy is maintained over time, is more marked in higher-severity agitation. No additional treatments were needed to improve agitation during the follow-up time.Results suggest that IL could be a safe and effective option to manage agitation in PD.

Cannabis and synthetic cannabinoids (SC) are related to several neuropsychiatric symptoms and disorders, especially psychotic symptoms and disorders. Interestingly, catatonia-like symptoms associated with cannabis and SC have been generally neglected in research and scarcely described despite the clinical repercussions. Hence, this review aims to analyze current clinical publications on catatonia induced by cannabis or SC in a systematized way.

Introduction: Improving the knowledge and attitudes of people facing an opioid overdose is one of the key prevention measures for reducing overdose occurrence and severity. In this respect, the Opioid Overdose Knowledge Scale (OOKS) and Opioid Overdose Attitudes Scale (OOAS) have been developed and validated in English to assess and improve knowledge and attitudes of opioid users and their families and care providers, in case of an overdose. Here, the OOKS and OOAS scales have been translated into French, Spanish, and German, and the different versions of the 2 scales have been assessed regarding their psychometric properties. Methods: The translation procedure of the scales was based on the international recommendations, including a back translation by a native English speaker. Subsequently, 80 (Spain: 29, France: 27, Germany: 24) former or current heroin users, aged from 20 to 61 years (M = 39.4 ± 9.23), completed the OOKS and OOAS versions of their native language, in test-retest, without specific between-assessment training. Internal consistency was assessed using Cronbach’s α, while test-retest reliability was assessed using intraclass correlation coefficient (ICC). The correlation between the OOKS and OOAS scores of a same language was assessed using Spearman’s (ρ) coefficient. Results: Internal consistency of the OOKS was found to be good to very good, with Cronbach’s α ranging from 0.62 to 0.87. Test-retest reliability was also very good, with ICCs ranging from 0.71 to 0.82. However, results were less reliable for the OOAS, as internal consistency was questionable to acceptable, with Cronbach’s α ranging from 0.12 to 0.63, while test-retest ICCs were very good for the French (0.91) and Spanish (0.99) versions and barely acceptable for the German version (0.41). No significant correlation was found between the OOKS and OOAS scores, irrespective of the version concerned. Conclusion: While satisfactory results were found for the 3 versions of the OOKS, results on the OOAS were relatively inconsistent, suggesting a possible gap between knowledge and attitudes on overdose among opioid users.

Ayahuasca is a psychotropic infusion prepared by boiling the bark of Amazonian plants and has many psychopharmacological effects not fully understood. Some of those effects are used as treatment for different diseases. However, the side effects of ayahuasca, including ayahuasca-induced psychosis, are an important issue. Here we report the case of a patient who had a psychotic episode after taking ayahuasca and who was successfully treated with antipsychotic medication. Given the current spread of ayahuasca consumption in developed societies, the present case highlights the need for better understanding and regulation of the social-legal condition of ayahuasca and the need for further research. Additionally, psycho-education seems advisable in order to create awareness of the potential risks of the use of ayahuasca.

Background: Hepatitis C virus (HCV) management is a challenge in patients with substance use disorder (SUD). This study aimed to describe an HCV screening and linkage to care program in SUD patients, and analyze the characteristics of this population in relation to HCV infection, particularly the impact of psychiatric comorbidities (dual diagnosis). Methods: This study was a prospective clinical cohort study using a collaborative, multidisciplinary model to offer HCV care (screening, diagnosis, and therapy) to individuals with SUD attending a dedicated hospital clinic. The characteristics of the participants, prevalence of HCV infection, percentage who started therapy, and adherence to treatment were compared according to the patients’ consumption characteristics and presence of dual diagnosis. HCV screening, diagnosis, treatment initiation, and sustained virologic response were analyzed. Results: 528 individuals attended the center (November 2018–June 2019) and 401 (76%) accepted screening. In total, 112 (28%) were anti-HCV-positive and 42 (10%) had detectable HCV RNA, but only 20 of the latter started HCV therapy. Among the 253 (63%) patients with a dual diagnosis, there were no differences in HCV infection prevalence versus patients with SUD alone ( p = 0.28). Dual diagnosis did not lead to a higher risk of HCV infection or interfere with linkage to care or treatment. Conclusion: This study found a high prevalence of dual diagnosis and HCV infection in SUD patients, but dual diagnosis was not associated with an increased risk of acquiring HCV or more complex access to care. Despite use of a multidisciplinary management approach, considerable barriers to HCV care remain in this population that would need more specific focus.

Introduction The impact of psychiatric comorbidity and addiction features throughout the course of addiction has been widely studied. This is a naturalistic study conducted in an outpatient unit, where treatment follow-up studies are scarce compared to studies including inpatients or those under experimental conditions. Therefore, this follow-up study aims to analyze the treatment adherence and abstinence of outpatients with SUD (Substance Use Disorders) according to addiction severity and psychiatric comorbidity. Methods The current six-month follow-up study examined 404 SUD outpatients. Psychiatric comorbidity, addiction severity, substance consumption and treatment adherence were systematically evaluated using semistructured interviews. Survival analyses were conducted to compare the time of treatment adherence and abstinence in a bivariate and multivariate level. Results A progressive dropout was observed, reaching 32.2% of dropouts at the six-month follow-up. More than 50% achieved abstinence during the first month and similar percentages were found until the six-month follow-up. At the multivariate level, treatment adherence, cannabis use disorder and polyconsumption were independently associated with earlier dropout. ADHD was the only mental disorder significantly related with dropout. Regarding substance consumption, the time of abstinence was independently associated with months of treatment adherence and the achievement of abstinence before starting treatment. In general, dual diagnosis was associated with less time of abstinence, but only depressive disorder across the lifespan was related to less time of abstinence in the multivariate model. Conclusion These findings highlight the importance of an accurate diagnosis at the beginning of treatment, especially in an outpatient setting, addressing the treatment needs and promoting strategies that improve treatment adherence and reduce the risk of relapses.

Substance use disorder (SUD) is a worldwide concern that has its own particularities regarding age and sex. This study aims to assess the differences between old SUD women and men regarding socio-demographics, clinical factors and outcomes. A 6-months follow-up longitudinal study was conducted in an outpatient center, on a convenience sample of 115 SUD old adults (≥65 years old, average age of 71.57). Descriptive, bivariate, and multivariate analyses were performed. Data showed statistical significant differences between men and women related to sociodemographic variables (marital status, coexistence, criminal records and stress factors), medical and psychiatric conditions (women suffer higher rates of depression and anxiety, with worse health-related quality of life), family records (women had more presence of family psychiatric records) and SUD related parameters (men tend to use more alcohol, had an early onset, consume higher doses, report more craving and more tobacco life use while women had higher rates of prescription drugs use). At 6-month follow-up, the whole sample showed excellent rates of adherence and abstinence, without sex differences. The study points out sex differences on several sociodemographic and clinical variables, indicating their specific needs. This research could facilitate better approaches by considering a sex perspective in SUD old adults.

Objective:Adverse health effects including cognitive impairment have been described in older adults with benzodiazepine misuse, although the literature about this issue is scarce. The present study...

Background and objective Dual diagnosis is the coexistence of an addictive disorder and another mental disorder. The objective is to estimate cravings and self-reported quality of life in a sample of patients with alcoholic dependence, with or without dual pathology, who attend an outpatient treatment centre. Patients and method A cross-sectional study of 112 patients (56 dual and 56 non-dual), diagnosed with alcohol dependence according to DSM- IV -TR. The presence of cravings is determined by the Multidimensional Alcohol Craving Scale and quality of life through the SF-36 Health Questionnaire. Results There are no statistically significant differences in cravings in either subgroup; the latter tend to refer to lower alcohol cravings than non-dual patients. The dual patients have a worse quality of life in all categories evaluated, highlighting a worse quality of life in the categories: social function, emotional role, vitality and general health. Females present a lower quality of life emphasizing those of social function and emotional role. No differences were detected in relation to cravings between the 2 groups. Conclusions In order to perform a correct clinical and therapeutic approach for patients with alcohol dependence, we should consider focusing on the evaluation of cravings and quality of life. In order to perform a correct clinical and therapeutic approach for patients with alcohol dependence, it is necessary to consider cravings and quality of life, since these parameters are important for the evaluation of patients with alcohol dependence.

Resumen Fundamentos y objetivo Enfermedad dual es la coexistencia al mismo tiempo de un trastorno adictivo y otro trastorno mental. El objetivo es estimar el craving y la calidad de vida autopercibida en una muestra de pacientes con dependencia alcoholica, con o sin enfermedad dual, que acuden a un centro de tratamiento ambulatorio. Pacientes y metodo Estudio transversal de 112 pacientes (56 duales y 56 no duales) diagnosticados de dependencia de alcohol segun el DSM- IV -TR. Se determina la presencia de craving mediante la Escala Multidimensional de Craving de Alcohol y la calidad de vida mediante el Cuestionario de Salud SF-36. Resultados No existen diferencias estadisticamente significativas en el craving entre ambos subgrupos; los duales tienden a referir menor craving de alcohol que los pacientes no duales. Los duales tienen una peor calidad de vida en todas las categorias evaluadas, destacando una peor calidad de vida en las categorias: funcion social, rol emocional, vitalidad y salud general. El sexo femenino presenta una menor calidad de vida, destacando las categorias de funcion social y rol emocional. No se detectan diferencias en relacion al craving entre los 2 grupos. Conclusiones Para realizar un correcto abordaje clinico y terapeutico de los pacientes con dependencia alcoholica se debe plantear evaluar el craving y la calidad de vida, puesto que son parametros importantes para la evaluacion del paciente con dependencia alcoholica. Ademas, el craving es un parametro propio de la dependencia alcoholica, no de la dualidad.

Background. Cannabis is the most widely used illegal drug in the world. Both an early cannabis use onset and the amount used contribute to the risk of suffering mental disorders in adulthood. Objective. Review longitudinal studies conducted on adolescents associating early cannabis use with the subsequent occurrence of mental disorders. Method. A search was conducted in PubMed until December 2016, focusing on longitudinal researches and prioritizing studies that clearly distinguished between an early and late onset of cannabis use. To achieve the objective, the word “cannabis” was used in combination with the main psychiatric diseases. A manual search of articles that appeared in the references was also conducted. Results. Fifteen studies met the inclusion criteria, but only five studies discriminated clearly between early and late onset of cannabis use. An association was found between early onset of cannabis use and mental disorders, particularly psychosis. The information regarding affective and anxiety disorders is more controversial. Discussion and conclusion. Early onset of cannabis use is associated with mental disorders, especially psychosis. Prevention plans for cannabis use in adolescents should be developed in order to decrease the risk of mental disorders.

Several neurobiological factors are related to opiate-use disorder (OUD), and among them, neurotrophins have a relevant role. Brain-derived neurotrophic factor (BDNF) is a central neurotrophin involved in many neuronal processes, and it has been related to several psychiatric diseases and addictive disorders. BDNF can be measured in plasma and serum; its levels may reflect BDNF concentrations in the central nervous system (CNS) and, indirectly, CNS processes. Hence, peripheral BDNF could be a biomarker in clinical practice. This manuscript explores the findings about peripheral BDNF and OUD in humans. Opiates induce neurotoxicity in the CNS, which may be correlated with modifications in BDNF expression. Thus, basal levels of peripheral BDNF in OUD patients may be altered, which could be modified with abstinence. Also, opiates may modify epigenetic processes that may be associated with peripheral concentrations of BDNF, and in this line, withdrawal could reflect recovering processes in the CNS. Additionally, treatment modifies the peripheral concentrations of BDNF, but the clinical implications of those changes are yet not elucidated. No specific conclusion can be performed and more investigation in this area is necessary to elucidate the real potential of peripheral BDNF as a biomarker.

OBJETIVOS Analizar diferencias sociodemográficas y clínicas entre consumo de cocaína vs. speedball (cocaína+heroína) en pacientes de una sala de consumo de drogas inyectadas. MÉTODOS Estudio transversal realizado en una sala de consumo de drogas inyectadas admnistrándose una entrevista semiestructarada a todos los pacientes. Se recogían datos sociodemográficos y clínicos, haciendo énfasis en diferencias entre el consumo de cocaína o de speedball y en síntomas de la esfera psicótica. RESULTADOS Hubo 1111 usos de la sala que se relacionaban con uso de cocaína o de speedball, el 89.8% fueron hombres. La edad promedio fue 40.47±5.33. Las diferencias entre uso de cocaína y de speedball se relacionaban principalmente con: sexo (p

Objetivos Identificar la prevalencia y evaluar las características clínicas del insomnio en una muestra de pacientes TDAH adultos con Patología Dual. Material y métodos La muestra la forman 252 pacientes adultos con TDAH remitidos para evaluación diagnóstica al Programa de TDAH del Hospital Universitari Vall d’Hebron. Se realizó una evaluación clínica y psicodiagnóstica, administrándose las escalas SCID-I y SCID-II, CAARS, ADHD Rating Scale y WURS. Igualmente se realizó una evaluación clínica del insomnio complementada con la administración de dos escalas específicas: la Insomnia Severity Index (ISI) y la Pittsburgh Sleep Quality Index (PSQI). Resultados y conclusiones La presencia de insomnio en pacientes adultos con TDAH presentaba una asociación estadísticamente significativa (11.6% vs. 4.3%; p

Drug dependence is a neuropsychiatric condition that involves genetic, epigenetic and environmental factors. Allele-specific methylation (ASM) is a common and stable epigenetic mechanism that involves genetic variants correlating with differential levels of methylation at CpG sites. We selected 182 single-nucleotide polymorphisms (SNPs) described to influence cis ASM in human brain regions to evaluate their possible contribution to drug dependence susceptibility. We performed a case-control association study in a discovery sample of 578 drug-dependent patients (including 428 cocaine-dependent subjects) and 656 controls from Spain, and then, we followed-up the significant associations in an independent sample of 1,119 cases (including 589 cocaine-dependent subjects) and 1,092 controls. In the discovery sample, we identified five nominal associations, one of them replicated in the follow-up sample (rs6020251). The pooled analysis revealed an association between drug dependence and rs6020251 but also rs11585570, both overcoming the Bonferroni correction for multiple testing. We performed the same analysis considering only cocaine-dependent patients and obtained similar results. The rs6020251 variant correlates with differential methylation levels of cg17974185 and lies in the first intron of the CTNNBL1 gene, in a genomic region with multiple histone marks related to enhancer and promoter regions in brain. Rs11585570 is an eQTL in brain and blood for the SCP2 and ECHDC2 genes and correlates with differential methylation of cg27535305 and cg13461509, located in the promoter regions of both genes. To conclude, using an approach that combines genetic and epigenetic data, we highlighted the CTNNBL1, SCP2 and ECHDC2 genes as potential contributors to drug dependence susceptibility.

INTRODUCTION Impulsivity and Alexithymia are related to substance use disorders (SUD) as risk factors (1,2), several cognitive skills are implied in both traits (1,2). However, few researches are published on their mutual relationship in SUD patients. OBJECTIVES To describe the correlations between alexithymia and impulsivity in SUD patients. METHODS Patients with SUD (according to DSM-5) were evaluated with invited to participate in an addiction treatment Ad-Hoc questionnaire, Toronto Alexithymia Scale-20 (TAS-20), Barratt impulsivity scales (BIS-11) and Dickamn functional dysfunctional impulsivity scale (FIDI) were performed in all patients. RESULTS 93 patients completed the full evaluation, the total score of TAS-20 was significantly related to total scores of BIS-11 and FIDI. Analyzing subscales, Difficulty Describing Feelings subscale describe better the association between total TAS-20 scores and impulsivity, and it may be the link between dysfunctional impulsivity and alexithymia. Externally-Oriented Thinking subscale was fewer correlated to any BIS-11 factor compared to the other subscales of TAS-20. Interestingly, cognitive impulsivity is not related to total TAS-20 scores and the TAS-20 subscales. CONCLUSIONS Alexythimia and impulsivity are related in SUD (especially some subfactors are better associated), and hence these relations should be considered when conducting therapeutic approaches. REFERENCIAS 1. Morie KP, Yip SW, Nich C, Hunkele K, Carroll KM, Potenza MN. Alexithymia and Addiction: A Review and Preliminary Data Suggesting Neurobiological Links to Reward/Loss Processing. Curr Addict Rep. 2016;3(2):239-248 2. Shishido H, Gaher RM, Simons JS. I don't know how I feel, therefore I act: alexithymia, urgency, and alcohol problems. Addict Behav. 2013;38(4):2014-7. doi: 10.1016/j.addbeh.2012.12.014.

To compare alcohol and other drugs abuse, state impulsivity, craving and the relationship between craving and impulsivity in alcohol-dependent patients with or without dual disorder attending to an alcohol treatment center in Cadiz town.An observational, descriptive and transversal study performed on 112 alcohol dependent patient sample who were seeking treatment in ARCA outpatient treatment center in Cadiz. The sample was divided in two groups, according to present dual diagnosis or not. The sample was assessed with an AdHoc sociodemographic and clinical questionnaire and specific scales and interviews that included: 5.0 Mini International Neuropsychiatric Interview results (MINI), State Impulsivity Scale (SIS), and Multidimensional Alcohol Craving Scale (MACS).The prevalence of dual diagnosis was 50%, being the most prevalent disorders: Current and recurrent Major Depressive Episode Mood Disorder, Current Dysthymic Mood Disorder, Panic Disorder and Anxiety Disorder. 52,7% of the total sample had a positive result on the State Impulsivity Scale. No statistically significant results were found on the Craving Scale (neither in the score or in the sub-sections). A relationship between craving and impulsivity were found for all groups and researched items.As a relationship between craving and impulsivity was observed, these aspects should be considered as main factors for the treatment and evolution of alcohol- dependent patients.

Alexithymia is related to a higher severity of substance use disorders (SUD); however, few longitudinal studies have been performed on how alexithymia impacts treatment outcomes. This study aims to evaluate alexithymia as a factor that could influence retention and the time of the first relapse in a one-year follow-up in an outpatient treatment center for SUD. In total, 126 SUD outpatients (74.60% males; M age = 43.71, SD = 14.61 years) were evaluated at baseline with an AdHoc questionnaire for sociodemographic variables, the European Addiction Severity Index (EuropASI), the Semi-structured Clinical Interview for Axis I and Axis II Disorders of the DSM-IV, and the Toronto Alexithymia Scale (TAS-20). The prevalence of alexithymia was 41.3% and the mean score of TAS-20, was 57.27 (SD = 12.84). At baseline, alexithymia was related to a lower education level, cannabis use disorder, the psychological item of EuropASI, and mood spectrum disorders. In the Kaplan-Meier analysis, SUD patients with alexithymia were in treatment for less time and presented earlier relapses than non-alexithymic patients. In the Cox regression, alexithymia was only associated with less time in treatment. Therefore, alexithymia may have an important role in the outcomes of SUD treatment, and hence, therapeutic approaches for SUD that cover emotional impairments associated with alexithymia should be investigated and developed.

Introduccion. La lamotrigina es un antiepileptico aprobado como estabilizador del animo para la prevencion de episodios depresivos en el trastorno bipolar. Entre sus reacciones adversas puede presentar sintomatologia maniforme inducida, a pesar de ser un efecto adverso de caracter idiosincratico y baja incidencia. Caso clinico. Presentamos el caso de una paciente de 58 anos, con diagnostico de trastorno bipolar desde su juventud y que, a lo largo de la evolucion de su patologia, ha precisado multiples esquemas terapeuticos. Tras un cambio farmacologico de litio a lamotrigina en dosis ascendentes progresivas, presenta descompensacion maniforme, concordante temporalmente con el inicio de la lamotrigina y que se acentua con el aumento de la dosis. La sintomatologia desaparece al retirar la lamotrigina y realizar un abordaje farmacologico. Al evaluar el caso segun los criterios de causalidad de Naranjo et al, encontramos un resultado posible. Conclusion. Aunque se ha documentado previamente sintomatologia maniforme inducida por lamotrigina, es importante tener en cuenta este efecto adverso, dada la repercusion a nivel afectivo y conductual. Son necesarios mas estudios para entender la relacion bilateral de este efecto desde un punto de vista clinico y neurobiologico.

AIMThe objective of the study is to evaluate the differences in health outcomes as well as treatment satisfaction and functionality, focusing particularly in cognitive deficits and perceived disability among stable psychotic patients with therapeutic adherence treated with oral antipsychotics (OA) vs Aripiprazole Long Acting Inyectable (A-LAI).METHODNaturalistic study, descriptive and transversal. Inclusion criteria: Schizophrenia; 18-65 years old; CGI≤3; treatment OA or A-LAI; no changes antipsychotic therapy in last 3months. Sociodemographic and clinical variables were recorded using self-applied scales (TSQM;EQ-5;SDI;PDQ) and heteroaplied (PSP;CGI;UKU). A mirror analysis was performed in the A-LAI group comparing number of psychiatric drugs and antipsychotic used, previous admissions and emergency care visits.RESULTS50 patients (25 OA, 25 A-LAI), 62% male, age 43,9±11,1, psychotic illness evolution 15,9±9,9. In comparison with OA, A-LAI patients present greater functionality scores (PSP) 75±11,5 vs 61,8,±10,5 (p.001) and better results in quality of life (EQ-5D), both quantitatively, 69±18,6 vs 48,3±22,1 (p.005), and qualitatively (particularly in everyday tasks, OR 0,15 (p.009), and better health during the last year OR 0,16 (p.011). Additionally A-LAI patients showed less disability compared to OA, particularly in work areas (4,7 vs 6,8,p.017), social life (4,5 vs 6,6,p.006), overall disability (13 vs 18,p.022) and perceived stress (4,2 vs 6,2,p.020). Perceived cognitive deficits were lower in the A-LAI group, particularly in attention and concentration. There were significant differences in weight gained OR 0,22 (p.082) and sexual disfunction OR 0,078 (p.000) in favor of A-LAI. Prolactin levels are higher for the OA group, 41,7±30,8 vs 8,6±11,67ng/ml (p.003). Treatment satisfaction (TSQM) was significantly higher in A-LAI patients in all 4 dimensions. The factor that most influences the improvement in the functionality is the treatment with A-LAI instead of OA (–10,9±4,1,p.0117). A-LAI patients required a lower number of psychiatric drugs than OA. In A-LAI patients group was observed a statistical significant difference in the number of hospitalizations (1,8 vs 0,08,p.002), the number of admission days to the hospital (45,4 vs 1,5,p.010) and the number of emergency care needed (3,96 vs 0,6,p.000); furthermore, the number of antipsychotics was significantly reduced (2±1,3 vs 0,2±0,4) as well as the number of overall psychotic drugs (4,5±2,1 vs 2,2±1,4).CONCLUSIONSAccording to the data from our study patients with schizophrenia that are treated with A-LAI show better results in quality of life, functionality, less perceived disability and cognitive deficits compare to those that received OA, as well as more levels of treatment satisfaction. Tolerance of A-LAI has been better than OA, particularly in the sexual and weight areas, being prolactin levels also lower. The change to A-LAI has allowed a reduced use of health resources.

Adverse health effects including cognitive impairment have been described in older adults with benzodiazepine misuse, although the literature about this issue is scarce. The present study aimed to assess cognitive decline in older adults with benzodiazepine use disorder and changes in cognitive state at the 6-month follow-up, as well as whether patients achieved abstinence.A 6-month follow-up longitudinal study was conducted in an outpatient drug center in Barcelona in a sample of older adults (≥65 years old) who had benzodiazepine use disorder. The sample was compared with an equivalent control group. A neuropsychological protocol was performed at baseline and after 6-month follow-up covering the most important cognitive domains.The final sample comprised 33 patients with an average age of 73.5 years. At baseline, patients presented impairment in several domains compared with the control group: visual immediate recall (p.001), visual delayed recall (p.001), copy (p.001), working memory (p.003), immediate verbal learning (p.002), total words learned (p.009), set switching (p.001), verbal fluency (p.007), speed processing (p.002), solving problems (p.006), nonverbal fluency (p.004), and sustained attention in all three areas omissions (p.001), variability (p.001), and perseverance (p.005). At 6-month follow-up, patients achieving abstinence showed improvement compared with patients in active consumption in visual delayed recall (p.006), total words learned (p.010), and verbal fluency (p.013).Benzodiazepine misuse in older adults may produce negative effects on cognitive skills. Recovery of some of these cognitive deficits may be possible with benzodiazepine abstinence.

Psychiatric comorbidity can negatively impact the course of addictions. Psychiatric features of patients who continued treatment after the first stage of an addiction program have not been sufficiently analysed. Therefore, only these patients were included in order to compare psychiatric comorbidity and clinical factors between patients who were able or not to complete a long term substance-free program. Treatment-completion status of 245 patients was systematically recorded. Addiction severity, psychiatry comorbidity, and psychological symptoms were evaluated. No significant differences were found regarding comorbid psychiatric diagnoses and the completion of the treatment. Longer treatment duration (OR: 1.22; p 0.01), higher educational level (OR: 2.37; p = 0.02), and cocaine dependence as main substance (OR: 3.68; p 0.01) were found to be related to increased likelihood in completing the treatment. Patients with higher severity of alcohol consumption (OR: 0.06; p = 0.02) and more depressive symptoms (OR: 0.95; p = 0.01) completed the treatment less frequently. Moreover, differences regarding employment problems, treatment facilities, anxiety symptoms, dysfunctional impulsivity, and mental HRQoL were found. It is concluded that comorbid psychiatric diagnoses do not determine treatment outcomes. However, therapeutic and psychological factors have a major influence on the likelihood to complete a long-term treatment program.

Brain-derived neurotrophic factor (BDNF) is linked to numerous brain functions. In addition, BDNF alterations contribute to neurological, mental, and addictive disorders. Cocaine dependence has received much attention recently due to its prevalence and psychological effects. Symptoms of psychosis are one of the most serious adverse events precipitated by cocaine use. It is particularly important to identify patients at risk of developing cocaine-induced psychosis (CIP). We described two cases of patients with cocaine dependence who presented with CIP and had changes in their BDNF levels during the psychotic episode. BDNF levels were initially low in both patients, and then decreased by more than 50% in association with CIP. The relationship between BDNF and psychosis is described in the literature. These cases revealed that BDNF levels decreased during a CIP episode and, thus, it is necessary to investigate BDNF and its relationship with CIP further.

Methadone maintenance programs (MMP) for opioid dependence treatment have been widely used due to their effective therapeutic outcomes. Harm reduction programs (HRP) are complementary programs for severe patients with high risk behaviors and when abstinence is not possible. This study aims to compare patients in MMP that use HRP (MMP-HRP) and patients in MMP who do not use HRP (MMP-NO HRP). The sample was composed of 143 patients (MMP-HRP = 42 vs. MMP-NO HRP = 101). An additional subanalysis was performed with patients under 45 years of age (n = 116; MMP-HRP = 38 vs. MMP-NO HRP = 78). All patients were assessed with an ad hoc socio-demographic questionnaire, EuropASI, SCID-I, and SCID-II. Results show that MMP-HRP patients were younger with more frequent use of intravenous drugs and with a high prevalence of Cluster B personality disorders. MMP-NO HRP patients had lower methadone doses compared to MMP-HRP patients and preferred to use drugs by smoked route more frequently. In the subanalysis of patients under 45, MMP-HRP patients were younger, had a higher prevalence of liver diseases, more intravenous drug use, greater severity on the drug use scale, less social and family support in the suescales of EUROP-ASI than compared to patients under 45 years in the group MMP-NO HRP. In conclusion, MMP-HRP patients are younger compared to MMP-NO HRP patients, they also receive higher doses of methadone and had more intravenous use. The above findings imply that the early onset of high risk drug use and long-term exposure to heroin have more severe outcomes such as higher comorbidities (e.g. infectious diseases, medical and psychiatric disorders), and consequently, these patients are a more vulnerable group with a worse prognosis.Los programas de mantenimiento con metadona (PMM) para el tratamiento de la dependencia a opiáceos han demostrado elevada eficacia, siendo los más utilizados en la actualidad. La Reducción de Daños (REDAN) se refiere a tratamientos y abordajes complementarios en personas con graves dificultades para la abstinencia y conductas de riesgo. El objetivo del presente trabajo es comparar pacientes en PMM que utilizan servicios REDAN (PMM-REDAN) versus pacientes en PMM que no utilizan servicios REDAN (PMM-NO REDAN). Se incluyó un total de 143 pacientes en PMM (PMM-REDAN = 42, PMM-NO REDAN = 101) y se realizó un subanálisis de los menores de 45 años (n = 116; 38 PMM-REDAN, 78 PMM-NO REDAN). Se hizo una evaluación de datos socio-demográficos, EuropASI, SCID-I y SCID-II. Los pacientes PMM-REDAN son más jóvenes, utilizan la vía parenteral y presentan trastornos de personalidad Clúster B comórbidos a la adicción. Los PMM-NO REDAN consumen más por vía fumada y tienen dosis bajas de metadona. Los menores de 45 años PMM-REDAN son más jóvenes, tienen mayor prevalencia de enfermedades hepáticas, utilizan más la vía parenteral, tienen un consumo de drogas más grave y menos soporte socio-familiar en las subescalas EUROP-ASI que los menores de 45 años PMM-NO REDAN. En conclusión, los pacientes PMM-REDAN son más jóvenes, reciben dosis mayores de metadona y utilizan vías de mayor riesgo, hecho que implica un inicio temprano en prácticas de consumo de riesgo, mayor tiempo de exposición a la heroína, con consecuencias de mayor gravedad de la adicción, mayor comorbilidad infecciosa, médica y psiquiátrica, siendo un grupo vulnerable y con pronóstico desfavorable.

Carlos Roncero,1 Pablo Ryan,2–4 Richard Littlewood,5 Juan Macías,6 Juan Ruiz,7 Pedro Seijo,8 Raúl Felipe Palma-Álvarez,9–11 Pablo Vega12,13 1Psychiatric Service, University of Salamanca Health Care Complex, Institute of Biomedicine of Salamanca, University of Salamanca, Salamanca, Spain; 2Internal Medicine Service, University Hospital Infanta Leonor, Madrid, Spain; 3School of Medicine, Complutense University of Madrid, Madrid, Spain; 4Gregorio Marañón Health Research Institute, Madrid, Spain; 5applied strategic, London, UK; 6Department of Infectious Diseases and Microbiology, Valme University Hospital, Seville, Spain; 7Provincial Center of Drug Addiction, Malaga, Spain; 8Addiction Treatment Center of Villamartín, Cádiz, Spain; 9Addiction and Dual Diagnosis Unit, Vall Hebron University Hospital, Barcelona, Spain; 10Psychiatry Service, Biomedical Research Networking Center for Mental Health Network, Vall Hebron University Hospital, Barcelona, Spain; 11Autonomous University of Barcelona, Barcelona, Spain; 12Spanish Society of Dual Diagnosis, Bilbao, Spain; 13Institute of Addictions, Madrid, Spain Objectives: People with a history of injecting drugs have high prevalence of hepatitis C virus (HCV) infection, and many have opioid use disorder (OUD). Modern HCV therapies with improved efficacy and tolerability are available, but access is often limited for this group, who may be underserved for health care and face social inequity. This work develops practical steps to improve HCV care in this population. Methods: Practical steps to improve HCV care in OUD populations were developed based on clinical experience from Spain, structured assessment of published evidence. Results: Options for improving care at engagement/screening stages include patient education programs, strong provider–patient relationship, peer support, and adoption of rapid effective screening tools. To facilitate work up/treatment, start options include simplified work up process, integration of HCV and OUD care, and continuous psychosocial support prior, during, and after HCV treatment. Conclusion: It is important to plan on local basis to set up a joint integrated approach between specific drug treatment services and local points of HCV care. The elements for a specific integrated program should be chosen from options identified, including education services, peer input, organization to make HCV screening and treatment easier by co-location of services, and wider access to prescribing direct-acting antiviral (DAA) therapy. Keywords: HCV, opioid use disorder, treatment, elimination, practical recommendations

There has been little research about deleterious effects, including cognitive impairment, related to hazardous long-term alcohol use in old adults. This study aims to assess cognitive decline in old patients with alcohol use disorder and changes in cognitive state at 6 months follow-up, achieving or not abstinence. A six-month follow-up study was conducted in an outpatient center in Barcelona on a sample of old adults (≥65 years old) who had hazardous alcohol use. The sample was compared with healthy volunteers adjusted for age, sex and years of education. A neuropsychological protocol was performed at baseline and after 6 months follow-up covering four cognitive domains: attention, visuospatial abilities, memory and executive functions. Several domains were significant impaired at baseline: visual immediate and delayed recall, working memory, immediate verbal learning, total words learned, set switching and sustained attention. At 6 months reassessment, alcohol abstinence was achieved in 93.5% of patients and it was detected a trend towards improvement in direct mean scores of all cognitive areas, although it was not significant. The current study points out a cognitive impairment in many areas secondary to alcohol long-term hazardous use in old adults. A trend towards cognitive improvement after recovery was detected in most patients.

Human immunodeficiency virus (HIV) and hepatitis C virus (HCV) are prevalent infections in opiate-dependent patients. Opiate replacement treatment (ORT) with methadone or buprenorphine is associated with several important outcomes among patients with opiate dependence. However, little is known about outcomes in patients with HIV and/or HCV infections that are in ORT. Also, it is not well established whether the presence of HCV or HIV infection could be associated with higher methadone doses. This paper reanalyzes the database of PROTEUS study, using two principal variables: methadone dose and presence of HIV and/or HCV infection. PROTEUS recruited 621 patients (84.1% were male, mean age: 38.9 years, SD: 7.9), information about the presence of HIV in status was available for 390 patients. Of those, 134 (34.4%) were HIV-infected. Whilst, information about HCV infection was available for 377 patients. Of those, 315 (83.6%) were HCV-infected. Information on HIV/HCV coinfection was available for 376 patients, of those, 112 (29.8%) had this coinfection. HIV-infected and HIV/HCV-coinfected patients received higher methadone doses than those without these infections. Antiretroviral therapy (ART) was used in 80% of patients with HIV infection. The proportion of patients taking antiretroviral drugs was significantly higher for patients treated with higher methadone doses (p 0.01). Findings suggest that HIV-infected and HIV/HVC-coinfected patients in ORT require higher methadone dose.

Risks factors for suicide are multiple and highly prevalent in addicted patients (previous suicide attempts, substance abuse, impulsivity, history of sexual abuse and other factors). The aim of this study is to identify and to compare the clinical and socio-demographic profile of SUD outpatients with lifetime suicidal behavior (previous suicidal ideation and/or suicide attempts) and to analyze the factors related to it. A retrospective cohort study of 696 addicted patients, according to DSM-IV-TR criteria (APA, 2000) were collected from the Addiction Unit of Vall d'Hebron University Hospital. Lifetime suicidal ideation in addicted patients is associated with presence of: borderline personality disorder (BPD), depressive disorders, sexual abuse, polydrug abuse, attention-deficit hyperactivity disorder, and motor impulsivity. The factors associated with suicide attempts were: borderline personality disorder, lifetime abuse (whether emotional, physical or sexual), co-occurrent psychotic disorders, polydrug abuse, anxiety disorders and depressive symptoms. We conclude that previous suicidal ideation and lifetime suicide attempts should be considered in the clinical care of addicted patients. Factors related to both suicidal behaviors share similarities and differences according to our findings and need to be deeply explored in the future.

Methadone maintenance programs (MMP) for opioid dependence treatment have been widely used due to their effective therapeutic outcomes. Harm reduction programs (HRP) are complementary programs for severe patients with high risk behaviors and when abstinence is not possible. This study aims to compare patients in MMP that use HRP (MMP-HRP) and patients in MMP who do not use HRP (MMP-NO HRP). The sample was composed of 143 patients (MMP-HRP = 42 vs. MMP-NO HRP = 101). An additional subanalysis was performed with patients under 45 years of age (n = 116; MMP-HRP = 38 vs. MMP-NO HRP = 78). All patients were assessed with an ad hoc socio-demographic questionnaire, EuropASI, SCID-I, and SCID-II. Results show that MMP-HRP patients were younger with more frequent use of intravenous drugs and with a high prevalence of Cluster B personality disorders. MMP-NO HRP patients had lower methadone doses compared to MMP-HRP patients and preferred to use drugs by smoked route more frequently. In the subanalysis of patients under 45, MMP-HRP patients were younger, had a higher prevalence of liver diseases, more intravenous drug use, greater severity on the drug use scale, less social and family support in the suescales of EUROP-ASI than compared to patients under 45 years in the group MMP-NO HRP. In conclusion, MMP-HRP patients are younger compared to MMP-NO HRP patients, they also receive higher doses of methadone and had more intravenous use. The above findings imply that the early onset of high risk drug use and long-term exposure to heroin have more severe outcomes such as higher comorbidities (e.g. infectious diseases, medical and psychiatric disorders), and consequently, these patients are a more vulnerable group with a worse prognosis.

Introduccion: Changes on electrodermal activity implied variations of skin conductance. It has been proposed as one of the best indicator of changes in sympathetic arousal and emotional states [1]. Its relevance has been explored in several clinical areas such as Epilepsy [3] or Autism Spectrum Disorder [4]. Substance use disorders are a public health concern, not only because its direct damage but also the medical and psychiatric commorbidities. It is not well known about factors that contribute to a better outcomes in detoxification process and abstinence achievement. Substance use disorders could increase arousal and anxiety levels during detoxification and withdrawal process trying to achieve abstinence. These signs and symptoms may affect electrodermal activity. We designed a preliminary study to validate its possible contribution in detoxification processes. © 2017 Elsevier B.V. and ECNP. Published by Elsevier Inc. All rights reserved.

Substance Use Disorders (SUD) and Attention Deficit Hyperactive Disorder (ADHD) are frequent conditions in out drug treatment centers. There are evidences about the high prevalence of ADHD in SUD patients (20%) compared with just ADHD in general population (1–7.3%). Both disorders and psychiatric comorbidity are important in the diagnosis proceeding. The objective of this study is search the difference in psychiatric comorbidity conditions between patients with ADHD and Cocaine SUD and ADHD and Cannabis SUD. ADHD was present in 158 patients of a total sample in which 46,8% used cocaine, 17.1% cannabis and 36.1% used both. Mood disorders were 26.8% in cocaine users, 21.7% in cannabis and 18.9% in both. Anxiety disorders were 20.3% in cocaine users, 37.5 in cannabis and 13% in both users. Primary psychotic disorders were 2.9% in cocaine users, none in cannabis and 11,1% in both drug users. Personality disorders by cluster were, Cluster A: 11.3% in cocaine group, 36% in cannabis group and 24.5 in cannabis and cocaine group. Cluster B: 33.8% in cocaine group, 44% in cannabis group and 51.9% in cannabis and cocaine group. Cluster C: 9.9% in cocaine group, 28% in cannabis group and 19.2% in cannabis and cocaine group. There could be common pathways of neuronal damage related to psychiatric comorbidity depending of used drug, the differences in comorbidity found in this study could explain a little part of it. It is important to manage SUD-ADHD and other psychiatric comorbidity in order to improve the outcomes of these patients.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionPain medication misuse is commonly found in patients under headache treatment and may produce co-morbid anxiety and depressive symptomatology. Management of this issue requires a comprehensive and integrative treatment including psychotherapy. Group interventions have been scarcely studied in addictive disorders, those interventions aims to decrease drug misuse and improve related psychiatric symptoms.AimTo study the efficacy of group interventions base on cognitive-behavior approach in patients with pain medication misuse.MethodPatients with pain medication misuse were included and were evaluated with BDI, STAI, SF36 and HIT scales (basal and at the end of treatment sessions). Patients were recruited from headache outpatient unit. Twelve sessions of one hour were performed with a cognitive-behavior approach (weekly).ResultsWe present preliminary results about the efficacy of group interventions in patients with pain medication misuse. Descriptive results pre- and post- treatment were analyzed in depressive symptoms (M = 20.14, SD = 12.25; M = 14.67, SD = 19.50) and in areas of quality of life: physical functioning (M = 48.75, SD = 31.13; M = 60.50, SD = 41.68), bodily pain (M = 12, SD = 9.25; M = 42.75, SD = 34.09), general health perceptions (M = 25.75, SD = 16.96; M = 44.25, SD = 22.33), vitality (M = 33.75, SD = 13.82; M = 48, SD = 34.82).ConclusionsPain medication misuse is commonly found in chronic headache patients, consequently worst outcomes for both pathologies. Group interventions may be useful in management of pain, anxiety and other comorbidities. Furthermore, it may favor drug use decrease and even abstinence.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionSubstance use disorder is a growing phenomenon among old adults. It is usually significantly undervalued, misidentified, under diagnosed and poorly treated. It has been related to cognitive impairment but there are few studies focused on the elderly.AimTo evaluate the relationship between drug use and cognitive impairment in old adults.MethodsWe conducted a prospective study (basal and 6 month follow up) in 67 patients over 65 years old seeking for treatment for drug misuse (alcohol and prescription drugs, mainly benzodiacepines) in addiction and dual diagnosis unit in Barcelona. A specific protocol was performed to evaluate attention, executive function, working memory, learning capacity, fonetic and visual fluency, decision-making, visual construction and cognitive flexibility (FCT, CPT-II, N-BACK, COWAT FAS, TAP, SDMT, IGT, CVLT, TOL, RFFT, STROOP). Patients were compared with a control group (healthy non drug users) with same characteristics (gender, age range and education status). The protocol consisted in two separated sessions of 90 minutes each one performed by a neuropsychologist.ResultsResults obtained suggested that patients under drug misuse had worse scores in fluency, visual construction, memory and attention compared with controls. After 6 month treatment and achieving abstinence patients improve in cognitive skills as verbal learning, short-term memory and free recall of verbal information. Cognitive impairment profile changes depending on the substance abused (alcohol or benzodiacepines).ConclusionsDrug use can produce deleterious effects in old adults. However, those who achieve abstinence may improve some cognitive functioning as verbal learning, short-term memory and free recall of verbal information.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionAttention-deficit/hyperactivity disorder (ADHD) is a psychiatric chronic disorder of childhood that persists into adolescence and adulthood in the most part of cases. There are various ways of treating ADHD.ObjectivesAssess the effectiveness and tolerability of atomoxetine long-term and routine clinical practice in adult ADHD treatment. Study the clinical profile of the patients who take atomoxetine.AimsThe aim of this is to study the treatment of ADHD in adults with a non-stimulant drug atomoxetine.MethodsWe obtain results from 126 patients recruited from July 2009 to May 2013 who have been prescribed Atomoxetine as a treatment for ADHD from the hospital pharmacy.ResultsComorbid disorders were presented in 57.1% of the patients included at the study (25.3% of which belong to the group of anxiety disorders). The use of other psychotropic drugs associated with atomoxetine was observed in 54.8% of patients. The 62.7% of the patients concerned continued treatment beyond 225 weeks (4 years 3 months) of observation. The Clinical Global Impression Improvement scale (CGI-I) and side effects determine monitoring treatment. A total of 61.9% of patients responded satisfactory to treatment with atomoxetine getting the CGI-I scale a score of 1-2. The duration of therapy and patient age are factors that influence the response. Furthermore, the clinical profile of patients treated with atomoxetine is characterized by different comorbidities, anxious symptomatology and personality disorders. Atomoxetine treatment with has also been shown its effectiveness and safe despite the presence of concomitant comorbidities and psychopharmacological treatment.ConclusionAtomoxetine treatment with has been effective and has proven good tolerability profile during treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.