To evaluate the influence of cannabis in the long-term follow-up in patients with a first psychotic episode, comparing those who have never used cannabis with (a) those who used cannabis before the first psychotic episode but stopped it during the follow-up, and (b) those who used cannabis both before and after the first psychotic episode.

Patients were followed from the first psychotic admission. They were assessed at 1, 3 and 5 years obtaining information about functional outcome, positive and negative symptoms. At 8th year functional outcome was evaluated. Patients were classified in 3 groups: 40 that never used cannabis (NU), 27 that used cannabis and stopped during follow-up (CUS), and 25 that had continued use during follow-up (CU).

At baseline, there were differences neither in functional outcome nor in negative symptoms. The CUS group improved the functional outcome during the follow-up (p< 0.001), while CU and NU groups did not show any significant results (p= 0.466 and p= 0.370 respectively). CUS group had also a significant decreasing trend in negative symptoms (p= 0.012), whereas for the other two groups no significant results were observed (p= 0.069 and p= 0.226 respectively). All groups improved in positive symptoms during follow-up.

Although cannabis use has deleterious effect, to stop it after the first psychotic episode produces a clearly improvement in the long-term follow-up.

According to recent studies anxiety has a significant impact on cognitive functioning, especially on decision-making. Alcohol dependent patients (ADP) achieve worse performance on decision-making simulation tasks compared to healthy controls. Our aim was to investigate how trait anxiety is connected to decision-making mechanisms in ADP.

The data of 76 ADP have been analyzed. To examine decision-making mechanisms we used the “ABCD” version of the Iowa Gambling Task (IGT). The IGT total score was calculated and we divided the task into 5 equal blocks to study the pattern of the decision-making process. We administered the Spielberger Trait Anxiety Inventory (STAI) and the Wechsler Adult Intelligence Scale. The patient group was arranged into two subgroups with median split method based on the STAI scores. One group (N=38) was characterized by low trait anxiety level, and the other (N=38) had high level of trait anxiety. For comparing the two groups’ decision-making mechanisms we used independent samples t-test.

The group with higher level of trait anxiety performed significantly poorer on the IGT (t=2.09, p=0.04). The detailed analysis of the two groups’ decision-making mechanisms showed that the difference between the groups became significant in the 5th block (t=2.57, p=0.01).

Decision-making deficit is not homogenous in the ADP group, as according to our results the trait anxiety level influences the adequacy of decision-making. Psycho-biological background of the inadequate decision-making needs further investigation and this knowledge could be used in the future to improve decision-making mechanisms of the ADP.

This is a 380 heavy drinker patient's sample recruited from twelve primary care centers. The patients were screened using The Alcohol Use Disorders Identification Test (AUDIT > 8). Neuropsicological tests done at the base line and after the 4 years of the study were the Continous Performance Test (CPT) and the Barrat Impulsivity scale. The alcohol and cocaine consume accumulated along the four years was also study.

The two variables of the CPT (ommission and commission errors) had a significant correlation with the alcohol and cocaine use accumulated in these four years. The variable that was associated with a greater risk of making more commission and ommission errors was the cocaine risk consumption. The years of study were protective variable.

The most important conclusion of this study is that alcohol and cocaine use produces a modification in the conductual paradigm of impulsivity characterized by the inhibition difficulties measured by the CPT. Also, the cocaine use effects are added respect to the alcohol ones and finally that cocaine plus alcohol effects over the number of ommission and commission errors are more potent that the ones made only with alcohol.

Social data, data of drinking behaviour, stress-styles and cortisol concentrations in plasma and cerebrospinal fluid (CSF) were measured in 130 patients with alcohol dependence (35F and 95M) before and after inpatient treatment.

The age of onset alcohol dependence, the amount of alcohol consumption since last 3 months, the responsibility for education from children, living situation, and the practice of positive ore negative stress coping styles were investigated.

Female alcohol dependent patients show a significant higher age of onset for alcohol dependence (p=0.02) and have a significant lower consumption of alcohol in relation to male alcohol dependent patients (p=0.004).

Moreover, female alcohol dependent patients are significant more frequent involved in education of children (p=0.04), and are living significant less alone (p=0.023).

The cortisol levels in plasma and CSF between female and male alcohol dependent patients does not differ. However, female alcoholics show a significant higher score of negative stress-coping styles than male alcoholics (p= 0.023).

There are significant psychosocial differences between female and male alcohol dependent patients. These gender specific differences relating to social stressors and handling with stress may be clinical relevant for treatment and outcome in alcohol-dependent patients.

Aim of this investigation was to study processes of apoptosis in lymphocytes in alcoholic patients during withdrawal syndrome with method of microwave resonance therapy (MRT).

30 men 31-57 years old with alcoholism (average course of disease was 15 years) were examined along with 30 healthy age-matched men. Examination of alcoholics was carried out in dynamics: at admission of patients with severe withdrawal syndrome (point 1) and after 2 week treatment (point 2). Expression of FAS receptors on lymphocytes was assessed using an indirect immunofluorescence microscopy with monoclonal antibodies to CD95 antigen. The proportion of cells with sings of apoptosis was evaluated by light microscopy of blood smears in terms of morphological changes typical of apoptosis in lymphocytes.

The relative content of bloodstream lymphocytes expressing receptors of readiness to Fas-dependent apoptosis (CD95) in alcoholics with severe withdrawal syndrome and after their treatment (16, 32±1,39% and 15,43±5,12% respectively) exceeds analogous index in healthy men (12,00±0,77%, p< 0,05). Percentage content of apoptotic lymphocytes in alcoholic patients was 2,68±0,46% before treatment and 2,15±1,93% after treatment (0,97±0,35% in controls, p< 0,05). It has been found that tindex of apoptosis realization was significantly decreased in alcoholic patients after the treatment in comparison with those before treatment (13,44% and 21,03% respectively).

According to obtained results it may by assumed that alcohol increases readiness of lymphocytes to apoptosis but activation of mechanisms controlling and limiting the processes of programmed cell death during the therapy results in decrease of apoptosis realization index in alcoholic patients.

Although the literature suggest that alcohol misuse is common in medical students, few studies have investigated it in French medical residents. The present study aims at exploring the prevalence and associated characteristics of alcohol misuse in French medical residents

Medical residents working in one of 3 University Hospital in France (n=292) were invited to fill out an online survey using the mailing lists of the participating centers. Alcohol use was assessed with the 10-item self-report Alcohol Use Disorders Identification Test (AUDIT) (range 0-40) which provides scores for hazardous alcohol use, dependency symptoms and harmful alcohol use. Background variables were also collected.

Mean participants’ age was 27.7 (SD=1.7) and 65.5% (n=190) of them were of female gender. Mean weekly hours of work at the hospital was 57.8 (SD=13.6) and mean number of validated rotations at the time of the assessment was 5.1 (SD=2.4). Mean AUDIT score was 4.5 (SD=3). Forty-four (15.1%) participants scored on the AUDIT above the cut-off (>7) for problem use and 51 of them (17.5%) reported binge drinking at least once a month. AUDIT total score was positively correlated with male gender (r=0.26) and cannabis use (r=0.40) while negatively associated with weekly hours of work (r=-0.12) and number of rotations validated (-0.13). In a regression analysis, only male gender predicted alcohol use.

Alcohol problem use is prevalent in French medical residents, is predicted by male gender and is strongly associated with cannabis use. Future research is needed to confirm these results.

Olanzapine is prescribed in the treatment of schizophrenia and BPAD. It is not licensed for personality disorders, behavioural issues or in patients with opiate addiction.This audit sought to identify the number of opiate dependent patients in a tertiary referral centre on olanzapine and the reason why.

All patients attending one sector had their notes examined over a three year period to see whether they are or were on olanzapine. All patients were opiate dependent and prescribed methadone.Parameters looked at included Axis 1 or 2 diagnosis, previous psychiatric in-patient admissions, forensic history and whether fasting lipids and glucose were checked.

169 charts were reviewed.Of these, 37 patients either were on or had been on olanzapine (21.9% overall).20 of these patients (11.8%) had an Axis 1 disorder, 17(10%) had behavioural diffciulties.Of the 20 patients with an Axis 1 disorder, 18 of them had an in-patient hospital admission.Only 7 of 17 patients on olanzapine with behavioural issues had an in-patient admission.All patients with behavioural difficulties had a forensic history and 16/17 had custodial sentences.15 of the 20 patients with Axis 1 diagnoses served custodial sentences.

A significant percentage of patients were prescribed olanzapine off license with no clinical indication.This is a worrying finding due to the abuse potential of olanzapine and longer term metabolic effects.Caution should be taken with prescribing olanzapine to opiate addicts who abuse it for its sedative effect.The value of this study is that it is one of the few to date to describe this problem.

The use of psychoactive substances has been frequently associated with cognitive impairment. More and more people, including adolescents, use the plant hallucinogen beverage “ayahuasca” throughout the world. Long-term ayahuasca use by adolescents might eventually result in impaired cognitive performance.

The objective of this study is to assess neuropsychological performance of adolescents who consume ayahuasca within a religious ritual setting.

Forty ayahuasca consuming adolescents and forty adolescents who never used ayahuasca were compared on their performance on a battery of neuropsychological tests. Groups were matched by sex, age, and educational level.

Both groups performed well on all neuropsychological tests. However, there were differences between the groups. Controls outperformed subjects on more complex tests, that is, those requiring more cognitive functions to perform a specific task.

Adolescents who consume ayahuasca performed well on all the neuropsychological tests. However they did not perform as well as the control group whenever extra cognitive strength was required. It is possible that ayahuasca may have some subtle effect on cognition that can only be observed before highly demanding tasks. However, other variables may have interfered with these findings.

Religion and to be religious can play an important role in human's individual and social life. The religion can be entered in many aspects of human behaviour and can affect on their behaviour and reduce probably of abnormal functions.So the study was aimed to investigate personality traits and religious orientation in two groups of addicted and nonaddicted people.

91 addicts people(in prisons)selected and were compared with 91 nonaddicted people. McCare & Costa's Five-factor personality test (NEO-PIR) and Alport's religious orientation scale (AROS)was adminidtered on them.T independent test was used to analyze the data.

Results showed significant difference between personality traits and religious orientation in tow groups. Nonaddicted people are more conscientiousness and less extrinsic religious orientation than addicted people.

Based on results it is suggested to do plans to increase intrinsic religious orientation related to personality traits in order to decrease tendency to addiction.

Varenicline is an α4β2 partial nicotinic agonist approved for smoking cessation. There have been spontaneous postmarketing reports of neuropsychiatric adverse events (NPAEs) in smokers without a history of psychiatric illness quitting with varenicline.

110 smokers without history of psychiatric illness (screened by Structured Clinical Interview for DSM) were randomized to 12 weeks of varenicline (n=55) (1mg bid) or placebo. Adverse events were solicited systematically. Depressive symptoms, anxiety symptoms, aggression and irritability were measured at baseline and weekly using the Montgomery-Asberg Depression-rating scale (MADRS), the Hamilton Anxiety scale (HAM-A), and the Overt Aggression scale-modified (OAS-m). The Profile of Mood States (POMS) was administered daily. Mixed Model analysis of repeated measures was conducted to compare mean changes in scores between groups across the study period.

Smokers had a mean age of 33; smoked on average 22 cigarettes/day with mean Fagerstrom score for Nicotine Dependence >7 at baseline. Reported NPAEs were similar between groups. No suicidal events were reported. There were no significant differences between groups for the MADRS (treatment difference vs. placebo [TD] = 0.03, 95% CI: -0.68, 0.73; NS), HAM-A (TD = 0.14, 95% CI: -0.62, 0.90; NS), OAS-m irritability subscale (TD = 0.08, 95% CI: -0.17, 0.34; NS), OAS-m aggression subscale (TD = 0.5, 95% CI: -1.18, 2.18, NS) and the POMS total scores (TD = 0.5, 95% CI: -0.52, 1.53; NS).

There were no significant differences between groups on measures of depressive symptoms, anxiety and aggression/hostility. Systematically solicited NPAEs were similar between varenicline and placebo.

Drug substance abuse has been related with chronic insomnia and other sleep disorders that are thought to interfere in detoxification treatment and relapse induction. These disorders can persist after drug detoxification.

To describe sleep disorders refered by drug dependents patients in an inpatient detoxification unit.

We prospectively studied drug dependents patients admitted to our Detoxification Unit from January 2005 to March 2009. The first night, patients were asked to complete an 11-item questionnaire measure designed to assess the relationship between sleep disorders and drug use. Responses ranged from 1 to 7. The questionnaire measured the following:

1. a) insomnia before hospitalization;

2. b) patients’ beliefs about the relationship between insomnia and drug use;

3. c) insomnia in previous detoxifications;

4. d) patients’ worry about insomnia;

5. e) treatment of sleep disorder with benzodiazepines.

The study sample included 150 patients (75.3% men). 39% of the patients suffered from alcohol abuse, 34.67% from cocaine abuse, 22.67% from opiod abuse, 21% from cannabis abuse, 18% from benzodiazepine abuse, and 12.67% of patients were polydrug users.Lifetime prevalence of sleep disorders was 68.1%. 64% had suffered insomnia the months previous to detoxification. 80.1% of patients’ refered sleep disorders in relationship with substance abuse. 69.4% were worried about insomnia during detoxification. 75.4% of patients took benzodiazepines without prescription.

Sleep disorders in patients with drug abuse are frequent. A high prevalence of patients having worries about insomnia during the detoxification treatment and believing in a relationship between their sleep disorders and the drug abuse was found.

There are few studies about the characteristics of Substance Use Disorder patients that relapse, defined by restart of the substance use that motivated the intake, after discharge from a Detoxification Unit.

To analyze the percentage of patients who had a relapse in the following 3 months after discharge and to describe their sociodemographic, clinical and therapeutical characteristics.

We prospectively studied drug dependents patients admitted to our Detoxification Unit from June 2008 to August 2009. Data was gathered at admission on demographic (gender, age), clinical (main abused drug, psychiatric comorbidities, polydrug users) and therapeutical variables (hospitalisation duration, prescribed treatment). Patients were followed up for 3 months and assessed for relapse at 1 and 3 months by clinical interview, alcohol screening test and/or urinalysis. Results from patients with and without relapses were compared.

The study sample included 103 patients (77,7% men, average age 38,31±9). At month 3, 57,3% of the patients had relapsed. We found significant differences between the relapse and the non-relapse group on the percentage of polydrug users (68,6% vs 31,4%, p=0,05), on heroine as main drug of abuse (76% vs 24%, p=0,05) and psychiatric comorbidities (60,8% vs 39,2%, p=0,04), being psychotic disorders the most frequent. No significant differences were found between the 2 groups concerning therapeutical variables.

More than half of the patients that ended the detoxification process relapsed in the first 3 months. Polydrug use, opiate dependence and having a psychiatric comorbidity might be considered as risk factors for relapse.

Investigate the emotional status and social support of methadone maintenance treatment (MMT) patients to provide guidance for a pertinent intervention.

We conducted a case-control study between 86 patients of Shanghai Changning community based methadone maintenance treatment and 93 controls from Shanghai Changning district. They were investigated via questionnaires, including Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS) and Social Support Scale.

The SDS scores were significantly higher in MMT group than in control group (52.7±11.4 vs 39.9±6.4, P< 0.01); the total scores of social support and subjective support, objective support and the 3 factors of support utilization were lower in MMT group compared with control group ([17.9±6.5 vs 20.3±7.8], [5.2±1.7 vs 7.4±1.4], P< 0.05); the scores of problem solving and recourse factors were lower in MMT group than in control group ([0.74±0.18 vs 0.91±0.06], [0.64±0.20 vs 0.69±0.06], P< 0.05).

The depression symptoms are prevalent in patients. The social support is low and the problem solving and recourse approaches are less utilized in patients. Our results show that it is necessary to implement the integrative intervention of MMT patients for improving the full recovery of their social function.

Nicotine dependence is a world health problem. The objective of this paper is to present the implementation of a treatment program and the use of varenicline as a specific medication for nicotine dependence during internment at our clinic in Rio de Janeiro.

The program starts with a first evaluation done by a psychiatrist. The initial dose of varenicline is 0,5 mg on the first 3 days raising to 0,5 mg twice a day from day 4 to day 7; after that it is increased to 1mg twice a day until 12 weeks are completed. It is suggested that the patient picks up a day to quit smoking, between the first and second week of use. It was also given behavioral and focal group therapy. During 14 months, we established a continuous reduction on the number of cigarettes, from 20 to 1 and finally 4 a day.

There were 354 patients attending the program from June 2008 to August 2009 and 69 (19,5%) accepted the whole program. From them, 56 (81,2%) used varenicline and all of them reached abstinence. Also, we followed these 56 patients for the last 6 months and 38 (67,8%) were still abstinent.

There was a high number of acceptance as well as of abstinence. Group and behavioral therapies can be important allies to varenicline. It is important to remember that the high cost of this medication remains an impediment for wide use. A planned reduction with cultural changes can also be very effective.

Socio-cultural and family context of Serbian post-conflict and transition society intensifies overall risks of alcohol (mis)use.

The main purpose of this article was to analyze the risk behavior of young people in relation to (mis)use of alcoholic beverages in Serbia. Five indicators were examined: use of alcohol by the very young, frequency of use of alcoholic beverages, the state of getting drunk, combination of alcohol and psychoactive substances and motives for use of alcoholic beverages.

The study included 3.111 participants aged between 16 and 35 years from different parts of Serbia. Collection of data was conducted in April 2007. Participants completed self-administered anonymous questionnaires (modified YOUTH RISK BEHAVIOUR SURVEY) that consisted of sociodemographic characteristics and experiences related to alcohol (mis)use.

Majority of participants reported drinking alcohol at the age of fifteen or younger. Lifetime alcohol use was reported by 75% participants. Prevalence of alcohol drinking was threefold higher among males. The overall prevalence of the state of getting drunk among participants was 36%. During one month before survey 10% of participants have expirienced combination of alcohol and psychoactive substances. Key motives for use of alcoholic beverages were relaxation (33%) and friendship (17%).

Early alcohol use, history of family disorganization and parental alcoholism were identified as factors related to increased risk of (mis)use of alcohol among young in Serbia.

(Mis)use of alcohol was related to significantly higher risk of other risk behaviors as marijuana use, violence, gambling, driving car in alcoholic state.

Dopaminergic pathways are implicated in motivational aspects of substance use disorders, and might contribute to withdrawal phenomena, as well as an increased long-term risk of relapse. Molecular imaging with positron emission tomography (PET) revealed reductions in the availability of binding sites for D2/3receptor ligands in striatum of withdrawn abusers of cocaine; corresponding results in alcoholics have been inconsistent so far. In the present study, we used the D2/3ligand [18F]fallypride to investigate dynamic changes in receptor availability in the striatum of patients with alcohol use disorder before and after undergoing a detoxification protocol.

18 male patients (mean age 44±5.3y) with alcohol use disorder were recruited and scanned with 180MBq [18F]fallypride upon hospital admission, and again 1-2 weeks later after detoxification. The control group consisted of 10 age-matched healthy volunteers. PET acquisition time was 180min, consisting of 39 frames of increasing duration. Within each group binding potentials (BPND) were calculated in the striatum using the cerebellum as reference.

In the patients, the mean BPND in whole striatum was 17.2±4.2 at baseline, with a trend towards a decline at follow-up. In addition there were inverse correlations of BPNDwith age (r-0.45) and with daily alcohol consumption (r-0.2). The age-dependence of BPNDwas less pronounced in healthy controls. However, mean striatal BPNDwas only slightly lower in the patient group. No pronounced group differences were evident for extrastriatal [18F]fallypride binding.

Regressions with age suggest an accelerated loss of dopamine D2/3 receptors in the striatum of subjects with alcohol use disorder.

So far, research on cognitive functions in multiple drug abusers with a very early age of onset has been only tentative. Furthermore, outcome research for therapy or rehabilitation is urgently needed in subgroups of this heterogeneous cohort of drug abusers.

Different cognitive domains (i.e. intelligence and attentiveness) of N = 750 patients were tested in a rehabilitation hospital for multiple drug abuse and comorbid mental disorder. The test results were correlated with the prominent drug cluster of the patients over the last 10 years. Calculated were also the impact of age of onset and mental disorder on the attentional system.

Drug clustering showed different effects on attentional functions. Morphine was hardly associated with serious deficits. Cannabis showed effects in the domains of multimodal stimulus processing (i.e. divided attention) and visual attention (visual scanning) with respect to cumulative lifetime dosage and the duration of use. Cumulative use of alcohol also had a negative effect on the attentional system, particularly on frontal executive functions (i.e. flexibility and working memory). The effect of amphetamines, methamphetamines and cocaine varied depending on which other drugs were used. Comorbidity (e.g., schizophrenia or developmental disorders) also had significant effects on the test results.

Specific attentional dysfunctions can lead to diminished behaviour control and impairments in professional abilities (e.g., ability to drive or operate a machine). The results of our study are important for diagnosis and planning therapy or rehabilitation especially in younger patients.

Bipolar disorder (BPD) and alcoholism are strongly comorbid and both have significant genetic influences but no consistent genetic vulnerability has been found. We aimed to find bipolar-alcoholism vulnerability genes.

A genome-wide association study (GWAS) of 510 patients with bipolar disorder (BPD), of whom 143 met Research Diagnostic Criteria (RDC) alcoholism diagnoses, and 506 ancestrally matched supernormal controls. We genotyped 372K genetic markers on an Affymetrix 500K-array. Chi-square analysis of allelic association using PLINK, and permutation testing for gene-wise association of genes previously associated with alcoholism-related phenotypes using COMBASSOC, were performed.

No marker met genomewide significance. Gene-wise analyses of markers clustering near genes already implicated in alcoholism, but which were not associated in non-alcoholic BPD, were: Cadherin-11 (CDH11, p = 6 × 10-4), Exportin 7 (XPO7), neuromedin-U receptor 2 (NMUR2), collagen type XI-alpha 2 (COL11A2) and Semaphorin-5A (SEMA5A).

These genes replicated prior genetic reports implicating “connectivity” (adhesion, migration and neuronal signalling) genes in addictions and comorbid BPD. Connectivity genes regulate neuronal connections during development and play roles in later neuroadaptive and mnemonic processes. These processes may influence addiction vulnerability, as seen clinically in denial, cognitive impairment, and repetitive substance misuse and relapse behaviour. We propose that we have identified genes i) increasing susceptibility to alcoholism that could be unmasked or released by the presence of bipolar affective disorder; ii) and genes increasing susceptibility to affective disorder that also predispose to secondary alcoholism. We were limited by small sample size. Larger future studies are needed.

Alcoholism has a high prevalence and impacts on morbidity, mortality, life quality, and the economy. Heritability estimates of alcohol dependence are 50-61%. Putative psychological, cultural, and genetic susceptibilities to alcoholism have been identified but understanding of the genetic components is still underdeveloped.

Identify genetic vulnerabilities predisposing individuals to alcoholism and co-morbid psychiatric disorders in the largest study of its kind.

12 centres including 10 trainees are currently collecting blood and clinical samples. Nearly 1700 of 2000 cases of ICD-10/DSM-IV alcohol dependence have been collected; 500 with standardized assessments of alcohol use and comorbdity; and 2000 ancestrally-matched supernormal controls from UCL/collaborators. Genomic DNA will be isolated following standard procedures. Genotyping will be performed using the Affymetrix Gene Chip Human Mapping 1M Array to type up to 1 million single nucleotide polymorphism (SNP) and copy number variant (CNV) markers. Chi-square analysis of allelic association for the alcoholic sample versus controls will occur.

n=65; 57% male; mean age 45years; mean age onset harmful alcohol use 19years; mean age onset withdrawals 32y; mean alcohol intake 21 units; primary depression 27%; secondary depression 49%; antisocial personality disorder 14%. The candidate gene approach in this sample has shown that the GABA receptor B1 (GABRB1) and the tachykinin receptor 1 (TACR1) are involved in genetic susceptibility to alcoholism. The D2 dopamine receptor is next.

Preliminary data suggests high psychiatric comorbidity in a clinical alcohol dependence sample and implicated candidate genes. Next is genomewide analysis of markers, sequencing and biological pathway/systems alterations.