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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.

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.

Hypoplastic left heart syndrome consists of several structural abnormalities in the left side of the heart and may be associated with a hereditary genetic cause, possibly related to the connexin gene GJA1; however, only a few studies have investigated it. The present study aimed to analyse the expression of connexin-43 in the cardiac muscle of hypoplastic left heart syndrome children by Western blot method and confocal laser scanning microscopy. For that, tissue samples were taken during corrective surgery to treat heart defects. Patients of control group (8) presented any type of heart defect not related to hypoplastic left heart syndrome, connexin-43, or its gene and those of hypoplastic left heart syndrome group (9) presented this disease singly, without any other associated congenital diseases. By means of confocal laser scanning microscopy, it was noticed no connexin-43 qualitative differences in positioning and location pattern between both groups. From Western blot analysis, the connexin-43 expression did not show a statistically significant difference (p = 0.0571) as well. Within the limits of this study, it is suggested that cardiomyocytes of hypoplastic left heart syndrome children are similar in connexin-43 location, distribution, and structural and conformational patterns to those of children with heart defects not related to this protein and its genes.

Objective: The objective of this study was to compare psychiatric comorbidity and consumption-related variables in ADHD patients seeking treatment for cocaine, cannabis, or both. Method: Assessment was conducted using European Addiction Severity Index (EuropASI), Conners’ Adult ADHD Diagnostic Interview (CAADID), Structured Clinical Interview for DSM Disorders (SCID), Adult Self-Report Scale (ASRS), Wender Utah Rating Scale (WURS), Barratt Impulsiveness Scale-11 (BIS-11), and FIDI, with statistical analyses of analysis of variance (ANOVA), Student’s t test, chi-square test, and multinomial regression model. Results: In total, 1,538 patients with substance use disorder (SUD) were evaluated for ADHD; 239 (15.5%) had ADHD, with cannabis 41, cannabis/cocaine 36, and cocaine 74. Men represented 80%, with mean age of 32.9 ± 10 years. Significant variables were—in bivariate analysis—more years of cannabis use in cannabis group and younger age for cocaine use disorder in cannabis/cocaine group, and—in multivariate analysis—lifetime anxiety disorder and younger age at onset of any SUD in cannabis group and working affected scale in cannabis and polysubstance use in cannabis/cocaine group. Conclusion: Groups with cannabis use had higher severity. ADHD features were similar in all groups. The assessment of ADHD and comorbid disorders is important.

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.

The treatment of rheumatoid arthritis (RA), an inflammatory autoimmune disease of chronic nature, consists of medications, exercises, patient education on the disease, and rest. Unfortunately, many drugs used for RA have been recently recognized to induce oral manifestations due to either immunosuppression or antiproliferative effects. Thus, the present study reports a case of a patient who was receiving multiple medications (methotrexate, leflunomide, and sodium risedronate) for RA and developed an extensive lip ulcerative lesion not responsive to previous treatments. The lesion management was performed using only a combination of photobiomodulation therapy (PBMT) and antimicrobial photodynamic therapy (aPDT), totalizing three laser sessions. Within 4 days, the patient no longer complained of pain and the lesion presented an advanced healing aspect. According to the current case, the combination of PBMT and aPDT seems to be a suitable alternative for the management of oral lesions in patients taking medications for RA. La artritis reumatoide (AR) es una enfermedad inflamatoria autoinmune de naturaleza crónica, cuyo tratamiento consiste en medicamentos, ejercicios y en educar al paciente sobre la enfermedad y el reposo necesario. Sin embargo, se ha reconocido recientemente que muchos fármacos utilizados para tratar la AR ocasionan manifestaciones orales debido a sus efectos inmunosupresores o antiproliferativos. El presente estudio reporta el caso de un paciente que estaba recibiendo múltiples medicamentos (metotrexato, leflunomida y risedronato de sodio) para la AR y desarrolló una lesión ulcerosa labial extensa que no respondió a tratamientos previos. Se optó por una combinación de terapia de fotobiomodulación y terapia fotodinámica antimicrobiana, totalizando tres sesiones de láser. A los 4 días, el paciente ya no se quejaba de dolor y la lesión presentaba aspecto de cicatrización avanzado. Los resultados sugieren que la combinación de terapia de fotobiomodulación y terapia fotodinámica antimicrobiana parece ser una alternativa adecuada para el manejo de lesiones orales en pacientes que utilizan medicamentos para tratar la AR. O tratamento da artrite reumatoide (AR), uma doença inflamatória autoimune de natureza crônica, consiste em medicamentos, exercícios, instrução ao paciente sobre a doença e repouso. Infelizmente, muitos medicamentos utilizados para AR recentemente foram associados a manifestações orais por imunossupressão ou efeitos antiproliferativos. Assim, o presente estudo relata o caso de um paciente que estava recebendo vários medicamentos (metotrexato, leflunomida e risedronato de sódio) para AR e desenvolveu uma lesão ulcerativa labial extensa não responsiva a tratamentos prévios. O manejo da lesão foi realizado apenas com a combinação de terapia de fotobiomodulação e terapia fotodinâmica antimicrobiana, totalizando três sessões de laser. Em 4 dias, a paciente não se queixava mais de dor e a lesão apresentava aspecto de cicatrização avançado. De acordo com o caso atual, a combinação de terapia de fotobiomodulação e terapia fotodinâmica antimicrobiana parece ser uma alternativa adequada para o manejo de lesões orais em pacientes em uso de medicamentos para AR.

Many oral signs and symptoms related to the novel coronavirus disease (COVID-19) have been reported; however, both prevalence and etiology are still undetermined. Since the clinical features of the oral lesions seen in COVID-19 are highly heterogeneous and the treatments differ considerably in the literature, the present study aimed to report a clinical case in which a combination of antimicrobial photodynamic therapy (aPDT) and photobiomodulation therapy (PBMT) was used for extensive lip lesions in a patient suffering from COVID-19. Within 4 days and without any systemic drug administration, after two sessions of aPDT and one session of PBMT, the lip lesions were completely healed, and the patient recovered her orofacial functions satisfactorily. According to the current case report and taking into consideration the evident lack of information about many aspects of COVID-19 infection, this combination of phototherapy modalities seems to be a promising tool for managing COVID-19-related lip lesions; however, more studies are necessary.

In hematopoietic cell transplants (HCT) patients, opportunistic fungal infections – especially candidiasis - are typical and, due to the immunosuppressed condition, severe and fatal clinical conditions may occur. Many antifungal agents are used for treating candidiasis; however, there are non-responsive, drug-resistant cases in which alternative antimicrobial therapies are strongly needed. The present study aimed to report a clinical case in which antimicrobial photodynamic therapy (aPDT) was used for extensive oral pseudomembranous candidiasis not responsive to micafungin in a patient undergoing HCT. Thus, 0.01 % methylene blue solution was applied for 3 min onto the infected area, followed by 660-nm laser irradiation. Within 72 h, there was neither a symptom nor a sign of the fungal infection. According to the current case report, aPDT seems to be highly effective for HCT patients presenting oral candidiasis not responsive to micafungin; however, further studies are necessary.

Osteoradionecrosis (ORN) is considered one of the most severe complications of radiotherapy (RT). Treatment modalities for ORN may vary considerably, including conservative or surgical procedures. Recently, alternative managements such as the combination of photobiomodulation therapy (PBMT) and antimicrobial photodynamic therapy (aPDT) have also yielded promising results in patients presenting ORN or delayed healing post-RT. Herein, it is reported a case of ORN manifested as an oral fistula on the mandibular alveolar mucosa in which a combination of PBMT and aPDT was used every 15 days for six weeks. A laser device with an optical fiber was introduced into the fistula for light delivery. Seven days after the first laser session, it was noted complete resolution of both edema and erythema; after six weeks, the ORN fistula was no longer present. According to the current case, the combination of PBMT and aPDT with an optical fiber to deliver the laser light seems to be a suitable alternative for restricted areas such as fistula paths.

Background: Insomnia is highly prevalent in patients with substance use disorders (SUD), and it has been related to a worse course of addiction. Insomnia during detoxification in a hospital has not been adequately studied. This study aims to compare sociodemographic, clinical, and psychopathological characteristics of SUD patients undergoing a detoxification program, by comorbidity and insomnia symptoms. Methodology: We recruited 481 patients who received pharmacological and psychotherapeutic treatment for detoxification. They were evaluated through semi-structured interviews, standardized questionnaires, and a specific sleep log. A bivariate and multivariate analysis of the data was performed. Results: Insomnia was reported by 66.5% patients, with sleep-maintenance insomnia the most frequent issue, followed by early morning awakening and sleep-onset insomnia. Patients with alcohol use disorder and cannabis use disorder had higher prevalence of sleep-onset insomnia. Patients with cocaine and heroin use disorder had higher prevalence of sleep-maintenance insomnia. Independent factors that allowed the identification of insomnia symptoms included being female (OR: 3.43), polysubstance use (OR: 2.85), comorbid anxiety disorder (OR: 2.02), and prior admission for detoxification (OR: 1.22). Conclusions: Insomnia symptoms are very prevalent in patients admitted for detoxification. The diagnosis and therapeutic strategies for the insomnia symptoms should be improved, especially in women and in patients with greater addiction severity and with anxiety disorders.

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.

Among the most common symptoms of COVID-19 is taste dysfunction, which has a ranging clinical presentation. As well as its pathophysiology remains to be unclear, there is not enough information about the efficacy and safety of the available treatments. This study aims to report a series of cases using PBMT for the management of COVID-19-related taste impairment.8 female and 2 male patients sought medical help for taste impairment (either partially or completely) after COVID-19 infection. Photobiomodulation therapy (PBMT) on the tongue mucosa was then proposed but with 3 different protocols. Taste perception at baseline and before every laser session was evaluated using a visual analog scale. Irrespective of the PBMT protocol, taste recovery was noted in all cases but with varying degrees of improvement.given the high prevalence rates of taste dysfunction in COVID-19 patients and the lack of information about the available treatments, PBMT seems to be a promising therapeutic modality but not dependent on the total number of laser sessions and the interval between them. The choice of the most suitable laser protocol as well as the knowledge of the exact photonic mechanisms, however, need to be better studied.

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.

Although the treatment and management options for perianal abscess vary considerably, most cases require incision and drainage. Whatever the clinical approach selected, it is imperative to monitor patients to identify postoperative signs and symptoms which suggest treatment failure or further complications, such as sepsis, recurrent abscess, and fistula formation. Considering the debate on the role of postoperative antibiotic therapy for patients with perianal abscess and the significant discomfort caused by the infection, the present study aimed to report a clinical case in which antimicrobial photodynamic therapy (aPDT) and photobiomodulation therapy (PBMT) were used after incision and drainage of a simple perianal abscess. Within 5 days, there was no sign or symptom of both infection and inflammation, and after 3 months, no fistulous pathways or perianal collections were present. According to the current case report, the combination of aPDT and PBMT following incision and drainage of perianal abscess may be a smart strategy for infection resolution and prevention of late complications.

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.

Vitamin D deficiency has been linked with schizophrenia. We aimed to determine whether patients with a first episode of psychosis (FEP) had lower vitamin D levels compared with controls considering their final diagnosis. We conducted a cross-sectional study determining 25-hydroxyvitamin D blood levels. 25-Hydroxyvitamin D levels were considered optimum at 20 ng/mL or greater. A group of 45 adult patients with FEP and a group of 22 healthy controls matched for age were recruited. The patient group was subdivided in two final diagnosis groups (schizophrenia versus other psychoses) after a 6-month follow-up. Average vitamin D values were deficient for FEP patients, especially those 22 with a final diagnosis of schizophrenia. These results relating vitamin D and schizophrenia generate interest to further examine this association.

Late effects of radiotherapy for head and neck cancer treatment have been increasingly investigated due to its impact on patients' quality of life. The purpose of this study was to evaluate the effect of low-level laser therapy on hyposalivation, low salivary pH, and quality of life in head and neck cancer patients post-radiotherapy. Twenty-nine patients with radiation-induced xerostomia received laser sessions twice a week, during 3 months (24 sessions). For this, a continuous wave Indium-Gallium-Aluminium-Phosphorus diode laser device was used punctually on the major salivary glands (808 nm, 0.75 W/cm2, 30 mW, illuminated area 0.04 cm2, 7.5 J/cm2, 10 s, 0.3 J). Six extraoral points were illuminated on each parotid gland and three on each submandibular gland, as well as two intraoral points on each sublingual gland. Stimulated and unstimulated salivary flow rate, pH (two scales with different gradations), and quality of life (University Of Washington Quality of Life Questionnaire for Patients with Head and Neck Cancer) were assessed at baseline and at the end of the treatment. There were significant increases in both mean salivary flow rates (unstimulated: p = 0.0012; stimulated: p

Background Patients with Down syndrome (DS) present functional and anatomical alterations that may negatively impact their health and quality of life. Down syndrome patients have been shown to have a high prevalence of temporomandibular disorder (TMD), but little is known about the diagnosis, treatment and prevention in these individuals. Objective To evaluate the impact of a home-based multidisciplinary programme on muscular TMD in DS adults. Methods After being diagnosed with TMD-related masticatory muscle disorder, 20 adult men and 20 adult women with DS received an educational material with instructions on how to perform daily home facial self-massage and exercises for orofacial and masticatory muscles. Participants were also provided with educational information on TMD. Those who failed to perform at least 50% of the programme (23 days) were considered non-adherent. Oral parafunctional behaviours, facial pressure-pain threshold and maximum mouth opening were assessed at baseline and after the intervention. Results Twenty-five patients adhered to the programme as opposed to 15 non-adherent patients. Statistically significant improvements in all parameters were observed among adherent patients, except for the number of parafunctions. Conclusion The proposed home-based multidisciplinary programme seemed to be effective in improving some aspects related to muscular TMD in DS adults.

Background One of the most important complications of radiotherapy (RT) for head and neck cancer (HNC) is osteoradionecrosis (ORN) of the jaws, arising mainly from tooth extractions. Thus, the present study aimed to evaluate the efficacy of leukocyte- and platelet-rich fibrin (L-PRF) in preventing ORN following tooth extraction in post-irradiated HNC patients, as well as other postoperative complications. Material and Methods 23 patients previously submitted to conventionally fractionated 3D-conformational RT for HNC underwent atraumatic tooth extractions with perioperative antibiotic therapy. Besides, they were randomly assigned to receive L-PRF clots to fill and cover the extraction sockets (n=11, Test Group) or not (n=12, Control Group). A visual analog scale was used to quantify postoperative pain on the 3rd and 7th days. For ORN diagnosis, patients were clinically assessed for up to 180 days. Other postoperative complications (edema, alveolitis, suture dehiscence, continuous bleeding, and oroantral communication) were also evaluated within this period. Results No case of ORN or another surgical complication was observed and there were no differences in the postoperative pain scores between the groups on the 3rd and 7th days. Conclusions L-PRF did not seem to provide any additional benefits than those achieved by the combination of the surgical and drug protocols used for tooth extractions in the post-irradiated HNC patients. Key words:Radiotherapy, osteoradionecrosis, tooth extraction, head and neck cancer.

Oral lesions related to the novel Coronavirus Disease 2019 (COVID-19) have been increasingly described; however, clinical and epidemiological information is still scant. Although a diversity of therapeutic strategies for the management of these lesions are present in the literature, one can note a lack of standardization and doubtful effectiveness. Thus, the present study aimed to report a series of cases in which a combination of antimicrobial photodynamic therapy (aPDT) and photobiomodulation therapy (PBMT) was used for orofacial lesions in patients suffering from COVID-19. It was noted, in all cases, a marked improvement in tissue repair and pain relief within a few days; moreover, the patients recovered their orofacial functions satisfactorily. Based on the present series of cases and having in mind the conspicuous lack of information on the different aspects of COVID-19, the protocol which combined aPDT with PMBT seemed to be effective in the management of COVID-19-related orofacial lesions.

The present study aimed to assess the impact of low-level laser (LLL) on low salivary flow rate in patients undergoing radiochemotherapy (RT-CT) for head and neck cancer.LLL has shown efficiency in preventing hyposalivation in patients under different pathological conditions, including those undergoing RT-CT.During all RT-CT, 17 patients received laser therapy and 10 received clinical care only. An Indium-Gallium-Aluminum-Phosphorus diode laser was punctually used for intraoral (660 nm, 40 mW, 10 J/cm(2), illuminated area 0.04 cm(2), 10 sec) and extraoral irradiation (780 nm, 15 mW, 3.8 J/cm(2), illuminated area 0.04 cm(2), 10 sec), three times a week and on alternate days, for a total of 21 sessions. Unstimulated salivary flow rate was assessed before the first RT session (N0), at the 15th RT session (N15), at the last RT session (Nf), and at 30 (N30) and 90 days after the end of the oncologic treatment (N90).At N15, Nf, and N30, patients treated with LLL showed significantly higher averages of salivary flow rate when compared with patients receiving clinical care only.LLL seems to be an efficient tool for mitigation of salivary hypofunction in patients undergoing RT for head and neck cancer.

Objective: To determine whether low-level laser therapy can prevent salivary hypofunction after radiotherapy and chemotherapy in head and neck cancer patients. Materials and Methods: We evaluated 23 head and neck cancer patients, of whom 13 received laser therapy and 10 received clinical care only. An InGaAlP laser was used intra-orally (at 660 nm and 40 mW) at a mean dose of 10.0 J/cm2 and extra-orally (at 780 nm and 15 mW) at a mean dose of 3.7 J/cm2, three times per week, on alternate days. Stimulated and unstimulated sialometry tests were performed before the first radiotherapy and chemotherapy sessions (N0) and at 30 days after the end of treatment (N30). Results: At N30, the mean salivary flow rates were significantly higher among the laser therapy patients than among the patients who received clinical care only, in the stimulated and unstimulated sialometry tests (p = 0.0131 and p = 0.0143, respectively). Conclusion: Low-level laser therapy, administered concomitantly with radiotherapy and chemotherapy, appears to mitigate treatment-induced salivary hypofunction in patients with head and neck cancer. Resumo Objetivo: Avaliar o impacto do laser de baixa potência na prevenção de hipofluxo salivar em pacientes portadores de câncer de cabeça e pescoço após radioterapia e quimioterapia. Materiais e Métodos: Treze pacientes receberam laserterapia e dez receberam cuidados clínicos. Utilizou-se um InGaAlP laser diodo para aplicação intraoral (comprimento de onda de 660 nm, 40 mW de potência e dose média de 10 J/cm2) e extraoral (comprimento de onda de 780 nm, 15 mW de potência e dose média de 3,7 J/cm2), três vezes por semana, em dias alternados. Sialometrias estimulada e não estimulada foram realizadas antes da primeira sessão de radioterapia e quimioterapia (N0) e 30 dias após o final do tratamento (N30). Resultados: Em N30, os pacientes submetidos à laserterapia apresentaram médias estatisticamente maiores de fluxo salivar estimulado (p = 0,0131) e não estimulado (p = 0,0143), em comparação com os pacientes que receberam apenas cuidados clínicos. Conclusão: A laserterapia de baixa potência realizada concomitantemente a radioterapia e quimioterapia foi capaz de mitigar a hipofunção das glândulas salivares em pacientes portadores de câncer de cabeça e pescoço após o tratamento oncológico.

The relationship between cytomegalovirus (CMV), a severe complication in immunocompromised patients, and graft-versus-host disease (GVHD) has already been reported but remains without complete elucidation, especially concerning oral lesions. Considering that antimicrobial photodynamic therapy (aPDT) has an antimicrobial effect and photobiomodulation therapy (PBM) provides analgesia and modulation of inflammatory processes, the present study aimed to report a clinical case in which oral CMV reactivation following acute GVHD was treated by a combination of aPDT and PBMT concomitantly with conventional drug treatment. Intense and uninterrupted oral pain and consequent impairment of the patient's oral functions were present due to ulcerated lesions in the tongue, soft palate, and labial mucosa. After 72 hours from the first laser session, a marked decrease in the severity of the lesions and pain relief was observed. All oral lesions were repaired within 30 days. Based on this case report, when used concomitantly with conventional drug treatment, the combination of aPDT and PBMT seems to play a crucial role in treating CMV associated with GVHD.

The present study aimed to compare the conventional scalpel technique and the use of a high-power diode laser for second-stage implant surgery. For that, fifteen patients were randomly assigned to receive either the conventional scalpel technique (Control Group, n = 7) or a diode laser-assisted technique (Laser Group, n = 8) for second-stage surgery of submerged dental implants placed at bone level. The local anesthetic amount required, and the total surgical time was determined just after surgery. Local pain, peri-implant mucosa status, and bleeding were assessed at the end of the surgery and after 7 and 15 days. Information on the need for postoperative pain medication on the first day and during the next two weeks was also gathered. The surgical time was significantly shorter in the Laser Group (P = 0.001) and only the Control Group presented bleeding at the end of surgery and on the seventh day (P =

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.

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.

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.

Introduction The procedure used to evaluate salivary flow rate is called sialometry. It can be performed through several techniques, but none appears to be really efficient for post-radiotherapy patients. Objective To adequate sialometry tests for head and neck cancer patients submitted to radiotherapy. Methods 22 xerostomic patients post-radiotherapy (total radiation dose ranging from 60 to 70 Gy) were included in this study. Ten patients were evaluated using sialometries originally proposed by the Radiation Therapy Oncology Group and twelve were assessed by our modified methods. Unstimulated and stimulated sialometries were performed and the results were classified according a grading scale and compared between both groups. Results There was no statistically significant difference between the salivary evaluations of both groups (p = 0.4487 and p = 0.5615). Also, most of these rates were classified as very low and low. Conclusion This novel method seems to be suitable for patients submitted to radiotherapy.

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.

IntroductionAttention Deficit Hyperactivity Disorder (ADHD) prevalence in the general adult population is estimated to be between 2–4%. Despite the high prevalence, until recently there was only one validated semi-structured interview available for the accurate diagnostic assessment of ADHD within the adult population: the Conners Adult ADHD Diagnostic Interview for DSM-IV (CAADID).ObjectivesTo examine the concurrent validity of the DIVA 2.0 interview comparing the diagnostic rate with the CAADID interview. To analyse the criterion validity of the DIVA 2.0 in the Spanish language in an adult sample.AimsThe aim of this is to study was to evaluate criterion validity of the DIVA 2.0 in an adult sample comparing with the CAADID and other ADHD severity scales.MethodsA transversal study was performed to check the criteria and concurrent validity of the DIVA 2.0 compared to the CAADID.ResultsForty patients were recruited in an adult ADHD program at a university hospital. The DIVA 2.0 interview showed a diagnostic accuracy of 100% when compared with the diagnoses obtained with the CAADID interview and goods correlations with three self-reported rating scales: the WURS, the ADHD Rating Scale and Sheehan's’ Dysfunction Inventory.ConclusionsThe DIVA 2.0 has good psychometric properties and is a reliable tool for the assessment of ADHD in adults.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.

Introduction. Although impairment in the quality of life is common among cocaine dependent patients, there are but a few researches about the interaction between addiction and quality of life. Objective. To study different parameters of quality of life in a sample of cocaine dependent patients and to compare patients with or without dual diagnosis. Also, to promote the importance of subjectivity in the quality of life and to propose to incorporate patients’ self-perception into their treatment. Method. Three diagnostic interviews were administered (SCID-I, SCID-II and PRISM) and a quality of life questionnaire (SF-36) was applied between two different patient groups: Group I (cocaine dependent patients) and Group II (cocaine dependent patients with other mental disorder). Results. Patients diagnosed with dual disorders (Group II) showed broader differences in perceptions of their quality of life in comparison with their clinicians. The perception of quality of life may vary depending on the presence and severity of mental disorders, and these different appreciations may explain the difficulties that clinicians face in understanding their patients’ expectations and motivations. Discussion and conclusion. A systematic evaluation of the subjective quality of life should be included in the management of cocaine dependent patients in order to more accurately understand the patients’ perception of their treatment, motivations and expectations.