Pathological Gambling (PG) tends to be a heterogeneous disorder where patients differ with type and severity of gambling behaviour, psychiatric co-morbidity, family history, sex and age of onset. Age of disease onset in PG varies significantly, with many individuals having onset during childhood and adolescence and others in various stages of adulthood. Previous studies have demonstrated that age of onset is an important characteristic for a better understanding of the PG heterogeneity.

(1) To analyze differences in sociodemographic aspects between early-onset PG and non early-onset PG, (2) to study whether early-onset PG is associated with specific psychiatric diagnosis in axis I and II.

We used data from a large and nationally representative community sample of United States (US) adults, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). We selected age 25 years as a threshold for early-onset PG.

Individuals with early-onset PG were more likely to be male, never married, and young and to have a lower education level and individual income than non early-onset PGs. Early-onset PG were less likely to have mood disorder (OR = 0.42 (0.19 − 0.94)) and had non-significant higher odds of having substance and anxiety disorders than non early-onset. The odds of having Cluster B disorder were significantly higher among early-onset PGs than non early-onset PGs (OR = 4.11 (1,77 − 9.55)).

Our findings support that subgroups of Pathological Gambling defined by onset age have phenotypic differences.

Addictive and psychiatric disorders are a significant barrier to retention in medical care leading to worse outcomes. As part of an HIV care expansion project, the H-STAR intervention was designed to treat substance use and psychiatric disorders for minority patients receiving co-located HIV medical care.

The intervention aim was to increase access to treatment for substance abuse and psychiatric disorders in minority HIV+ patients and reduce substance use.

The H-STAR primary objective was to offer substance and psychiatric evaluation and treatment with an integrated treatment model.

All participants in H-STAR underwent substance abuse screening and evaluation, using DSM-IV-TR criteria. Substance use was measured on the Government Performance Reports Act (GPRA) form at baseline and 6 months. Intensive outpatient treatment (IOP) using the Matrix Model as the behavioral intervention was available to all patients. All patients were offered and scheduled psychiatric evaluation and treatment with an onsite psychiatrist.

Of 123 enrolled persons with both baseline and 6 month GPRAs, the prevalence of substance abuse/dependence disorders were as follows: Alcohol: 32 (24.2%); Opiate: 54 (43.9%); Cocaine: 47(38.2%); and Marijuana: 26(21.1%). Thirty (22.1%) completed IOP. At 6 month follow-up there was statistically significant reduced use of alcohol, heroin and cocaine. Of 136 enrolled participants, seventy-five (55.1%) had psychiatric evaluations; 53 (70.7%) received medication management.

There was a significant reduction in all substance use; cocaine use remained the most prevalent. Despite open access to psychiatric evaluation, not all patients completed evaluation in spite of multiple attempts to reschedule.

Children of patients with substance use disorders (SUD) are at high risk for mental disorders. The effects of specific SUD in both parents on the risk of psychopathology in offspring have hardly been studied.

To gain a better understanding of the morbid risk of these children.

To assess, 1) the associations between alcohol dependence (AD) or heroin dependence (HD) in patients and psychopathology in their children; 2) the morbid risk conferred by having a second parent with SUD.

The sample included 276 children aged from 6 to 17.9 years (mean age = 11.5): 23 children of 15 patients with HD, 101 offspring of 50 patients with AD, 152 children of 81 orthopedic patients (controls) and 158 biological co-parents of the children. Subjects were interviewed by psychologists blind to patient diagnoses, using a semi-structured diagnostic interview.

1) Children of HD or AD patients had largely elevated rates of recurrent major depressive disorder and children of HD patients were also at an increased risk for ADHD and SUD; 2) There were interactions between drug disorders and alcohol disorders in both parents to increase the risk of early SUD in offspring.

The early manifestations of mental disorders in children of SUD patients emphasize the need for prompt identification and treatment of these disorders. The involvement of co-parental disorders in the development of offspring psychopathology highlights the need to pay clinical attention not only to the patient, but also to the co-parent in order to optimize prevention in offspring.

Alcohol dependence is a complex psychiatric disorder.

To investigate the role of temperament on the course of alcohol dependence.

To further investigate the role of temperaments in alcohol dependent patients and to analyse the differences in relevant clinical features in correlation with the different temperament distributions.

The patients‘case files of 116 alcohol dependent patients, according to ICD-10 and DSM-IV-TR, admitted to the Vienna General Hospital between 02/08 and 03/09, were examined retrospectively. The brief-TEMPS-M auto-questionnaire was used to assess the temperamental distribution. The dimensions of alcohol dependence have been assessed using the Lesch Alcoholism Typology, a computerized structured interview. The potential effect of temperamental scores on various outcomes describing the course of illness is investigated using multi-variable regression models.

Cyclothymic score was the only temperament which significantly influenced the age of onset of alcohol abuse and age of onset of alcohol dependence. Backward selection among temperaments exhibits depressive temperament as most important effect regarding the likelihood of suicide-attempts in the patient‘s case history and anxious temperament as most important effect regarding having psychiatric treatment focusing on alcohol dependence prior to current in- or outpatient stay.

Dominant cyclothymic, but also depressive and anxious temperament, seem to be negative predictors for the course of illness in alcohol dependence.

Smoking cessation has been less effective among low SES smokers and those with other addictions/co-morbidities. There are few studies assessing different service delivery models through rigorous scientific methods while engaging the community.

To assess the utilization and effectiveness of smoking cessation group versus individual counseling interventions among economically disadvantaged clients through a Randomized Controlled Trial (RCT).

A Community-Based Participatory Research (CBPR) approach in conjunction with RCT methodology were used to compare the effectiveness of a behavior change communication intervention and pharmacotherapy through group vs. individual counseling models. Participants were recruited from a low-income urban setting in mid Atlantic area (n = 348), and randomized to either an individual or group-based intervention. Participants received training according to the Fresh Start curriculum on their 12 weekly sessions and followed for nine months after the termination of the program.

After the intervention, the overall cessation rate was 10% with no significant difference between the two arms. The Cessation rate among participants who attended 6 to 12 sessions was significantly higher (p < 0.001) compared to those who attended 1 to 5 sessions (27.8% vs. 7.0%). Those with more positive perception of being “ready to quit” had higher odds of actual quitting (OR = 5.8).

Although individual and group counseling cessation appear to be equally effective, the group counseling is more cost-effective and feasible approach for low SES smokers and those with other co-morbidities. The effectiveness of the intervention can significantly improve with better retention and motivational enhancement strategies.

NCMHD 5-R24-MD002803.

The opioid-addicted subjects increases tend to risk behavior compared to healthy subjects, it is therefore important to indicate whether the administration of methadone reduces this trend.

Objective of the study was to assess the propensity for risk behavior in opioid-dependent individuals treated with methadone substitution therapy.

The study involved 85 opioid-dependent patients. To assess the tendency to the risk behavior Iowa Gambling Task (IGT) test was used. IGT test was conducted twice: before and about 1 hour after administration of methadone. 132 healthy individuals matched for age and gender were included to the control group and was tested twice at an about 1 hour interval.

At a similar level was the incidence of risk decisions and safe decisions in the group of addicts before the administration of methadone (49.9 and 50.1) and in the control group (49 and 51). After administration of methadone in a group of addicts and control group incidences of risk and safe decisions were changed. Statistically significant reduction (Wilcoxon matched-pairs signed-ranks, p < 0.05) of risk decisions (13.47%) and increase of safe decisions (13.42%) found after methadone administration in addicts persons.

After administration of single dose of methadone there was statistically significantly decreased tendency to risk behavior, which has reduced the incidence of risk decisions compared to the safe decision. The results indicate that in the opioid-dependent individuals treated with methadone substitution therapy a single dose of methadone has an impact on risk behavior as measured by IGT test.

Withdrawal syndrome occurs in 50% of cannabis dependant patients. In our clinical practice, we observed that few patients recognize and attribute abstinence symptoms to cannabis cessation. Insight or awareness of cannabis dependence remains poorly studied.

We propose to study the relationship between insight and cannabis withdrawal syndrome. Our hypothesis is that patients showing a higher score on a cannabis withdrawal scale would have a higher score on an insight scale.

We recruited 35 cannabis dependent outpatients between October 2008 and April 2009 in an addiction clinic. Insight of cannabis dependance was assessed with the insight Q8 scale ranging [0–8]. We designed a cannabis withdrawal scale by checking DSM V withdrawal symptoms, and each symptom was retrospectively scored by an analogue scale (from 0 to 5). Correlation between insight and withdrawal scores was calculated using Spearman's ρ.

Sex ratio was 2.5. Mean age was 35.9 ± 1.4 years. Most patients (85.7%) reported at least one withdrawal symptom. Sleep disturbances (95.8%) and craving (75.8%) were the most frequent. Mean score of insight was of 4.2 ± 0.4 points.

The intensity of withdrawal syndrome and insight score were positively correlated (ρ = 0.594, p < 0.001).

Our results show an association between experiencing more withdrawal symptoms and insight or awareness of cannabis dependence. These results could be used in the treatment of cannabis dependent patients.

Opiate drug psychological dependence is acknowledged as a difficult problem in the world. Several studies have shown the short-term efficacy of deep brain stimulation (DBS) in reducing opiate addiction. In this case report, we report on long-term results up to five years in an opiate addiction patient.

A 24-year-old man with three-year history of opiate addiction presented with several withdraw syndromes and more than three-time failures in detoxification.

The patient was treated with bilateral DBS of the nucleus accumbens (NAc) for opiate psychological dependence. No relapse was found during the follow-up periods.

This study suggests that DBS of the NAC could be an effective treatment of patients in reducing psychological dependence with a good recovery in psychological dysfunction.

In alcohol dependence are distinguished two types of course of illness in relation to age of onset of dependence.

An assessment of differences between opiate addicts with early and late age of onset of dependence.

242 opiate dependent patients, treated with methadone, were asked about: length of dependence, dosage of methadone, HIV infection, effects of methadone on interviewed subjects and the age of onset of opiate dependence.

In our sample 140 (58%) subjects developed opiate dependence below the age of 19, and 102 (42%) subjects developed dependence above the age of 18. Comparison of the patients with the onset of opiate dependence above the age of 18 with the patients with the onset of opiate dependence blow the age of 19 revealed that in the group with younger age of onset of opiate dependence there were statistically significant more women (40 vs. 23%), the patients were younger (35 vs. 38 years old), had longer time of dependence (19 vs. 16 years), had shorter time of well-being after taking a dose of methadone (12 vs. 15 hours).

Our research may suggest, in accordance with findings in alcohol dependence that subjects with early age of onset of opiate dependence differ in the course of dependence with the patients with late age of onset of opiate dependence.

Sixty five patients diagnosed panic disorder and generalized anxiety disorder, having a follow up in the psychiatric department of University hospital of Sfax in Tunisia, were included in the study.

Patients were evaluated by a questionnaire assessing socio-demographic, clinical and therapeutic parameters, and the Beck Depression Inventory

Depression was associated with panic disorder in 68.6% of cases and in 56.7% with generalized anxiety disorder. In the sample of patients having a panic disorder, depression was correlated with unemployment (p = 0.048), a low educational level (p = 0.021), an addictive behavior (p = 0.015) and an impaired quality of life (p = 0.012) For patients having a generalized anxiety disorder, depression was correlated with alcoholism (p = 0.04) and an impaired quality of life (p = 0.017)

These data confirm the existence of a relationship between depression, panic disorder and generalized anxiety disorder.

These clinical findings lead to the unitary concept of anxiety and depression.

An observational prospective study in children (< 14 years old) undergoing elective major surgery and outpatient surgery was done. Clinical stage, surgery/anaesthesia procedures, and perioperative complications were recorded. Anxiety (STAIC test) and pain (VAS scale) were recorded before surgery, in post-anaesthetic recovery unit (PARU), in one-day unit (ODU) and 24 h after surgery (24 hU).

319 children 4.4 ± 0.2 years old (85 female 5.5 ± 0.4 years old, 234 male 4.1 ± 0.2 years old) were enrolled. The surgery procedures were hernia repair (40.4%) followed by dermatologic extirpations (12.5%), and appendicectomies (9.7%). A 79% of the patients had general anaesthesia and 16.9% had locorregional-general anaesthesia. In PARU: 9.1% of the patient received analgesia: ketorolac 5.3%, metamizol 2.2%, other NSAIDs 6.3%, opioids 1.8%, benzodiazepines 2.2%, NSAIDs+opioids+benzodiazepines 0.3%). In ODU: 47% of the patient received analgesia (ibuprofen 39.5%, paracetamol 7.6%, metamizol 2.8%). In 24 hU: 50.2% of the patient received analgesia: metamizol 27%, ibuprofen 16%, paracetamol 3.4%, ketorolac 0.6%, opioids 1.2%, benzodiazepines 0.3%, NSAIDs+paracetamol 0.9%, NSAIDs+opioids+benzodiazepines 0.6%, NSAIDs+opioids+ antiemetics 4.7%, elastomers 4.7%. Total medium AVS were (% of increment vs. pre-surgery): pre-surgery 0.89 ± 0.1< < PARU 1.39 ± 0.1 (56.1%) = ODU 1.44 ± 0.1 (61.7%) = 24 hU 1.91 ± 0.1 (94.8%) (p < 0.05). Anxiety positively correlated with pain sensitivity and unpleasantness in both, PARU and ODU (Pearson coefficient correlation 0.559 and 0.467, respectively).

Perisurgery anxiety increase pain perception leading an increased analgesic consumes in children.

The aim of this study was to determine the frequency of adult attention deficit- hyperactivity disorder (ADHD) co morbidity with primer SAD, and the influence of this co morbidity on various demographic and clinical variables in patients.

108 patients were applied DSM-IV (SCID-I) and diagnosed as SAD. These patients were assessed with Adult ADHD Self-Report Scale version 1.1 (ASRS v 1.1), 85 (78.7%) of these patients who fulfilled 4 and more item, were assed with K-SADS-PL (Schedule for Affective Disorders and Schizophrenia for School Age Children—Present and Lifetime Version) ADHD module. The patients also evaluated with LSAS, BDI, GAF, SDS (Sheehan Disability Scale). 41 patients, who were diagnosed with SAD and comorbid current active ADHD (SAD- ADHD group) compared with 43 SAD patients without lifetime ADHD (SAD- without ADHD group) in terms of sociodemographical, clinical features and scales.

65 patients met the diagnostic criteria for adult ADHD. Of these patients, 31 were predominantly inattentive type, 3 were predominantly hyperactive type, 7 were combined type, 24 patients were diagnosed as ADHD-NOS.

The rates of the co morbidity ADHD in SAD patients were higher (especially inattentive dominant type). In the presence of comorbid ADHD, the severity of SAD increases and functioning decreases, and the course of SAD are influenced. In the presence of ADHD, antidepressant induced hypomanic switch occurs more frequently (26.8% to 0%).

Although separation anxiety disorder is recognized as a diagnostic category in the DSM-IV-TR only for childhood, an adult form of the disorder with a lifetime prevalence of 6.6% has also been described.

In the present study we investigated, in a group of stabilized outpatients, the frequency of adult separation anxiety disorder (ASAD) as well as its clinical correlates and attachment styles.

Patients with and without ASAD were compared on several clinical indices as well as on attachment styles. The associations of separation anxiety with psychopathology and attachment were investigated by means of multiple regression analysis.

Thirty-six patients out of 53 were categorized as having ASAD. Three of them had no other axis I psychiatric disorder. Fourteen ASAD patients had an history of childhood separation anxiety disorder (CSAD). As compared with those without ASAD, patients with ASAD showed: higher frequency of alexithymia and higher scores on the “difficulty identifying feelings”; worse social functioning; greater behavioral inhibition during childhood; worse reaction to loss events; higher scores on insecure attachment styles. Independent predictors of the intensity of ASAD symptoms were an “anxious-ambivalent” attachment style, lifetime symptoms of panic disorder, difficulties in identifying feelings and behavioral inhibition during childhood.

Our findings suggest that ASAD can both represent the evolution of a CSAD or be a primary condition in adulthood. The presence of ASAD in patients with mood or anxiety disorders is associated to insecure attachment styles, alexithymia, and impairment of social functioning.

A connection between balance system dysfunction and Agoraphobia (AG) in Panic Disorder (PD) has been found. Balance control of many patients with PD and AG rely mainly on visual cues (visual dependence) and moving visual stimuli in their peripheral visual field induce postural instability and anxiety. These features may maintain agoraphobic symptoms after standard treatments.

To study whether balance rehabilitation with moving peripheral visual stimuli would benefit patients with PD and AG not fully responders to standard treatments.

Six patients with PD and AG were included. Inclusion criteria: 1) panic-phobic symptoms despite adequate treatments (SSRIs for at least 3 months; cognitive behavioral therapy) and 2) balance dysfunction with instability during peripheral visual stimuli (posturography with and without peripheral visual stimulation).

The patients went through 10 sessions (3 sessions/week) of balance rehabilitation: static and dynamic exercises, with movements of eyes and head, during projection of peripheral visual stimuli (video-films, 32 times-accelerated, on large lateral screens). Descriptive and non-parametric analyses were applied.

After rehabilitation, the patients showed significant improvement both in panic-phobic symptoms (specific psychometric scale scores) (p < 0.05) and in balance performance (post-rehabilitation posturography with and without peripheral visual stimulation) (p < 0.05).

Balance rehabilitation with peripheral visual stimuli may increase the efficacy of standard treatments in patients with PD and AG and visual-balance dysfunction. Mechanisms of physical and emotional habituation to environmental destabilizing stimuli may be involved. Further larger and controlled studies are warranted.

Schema Therapy Model proposes coping as one of the mechanism through which schemas lead to the development of psychological symptoms. Thus, it was hypothesized that the association between early maladaptive schemas and symptoms of anxiety and depression will be mediated in part by the use of dysfunctional coping strategies.

A sample of 374 university students participated in this longitudinal study (5 months between T1 and T2), completing measures of stressful life events, coping, early maladaptive schemas, anxiety, and depression.

Hierarchical multiple regressions analyses revealed that coping strategies mediated the relationship between the schema domains and distress. In particular, disengagement coping strategies (i.e. avoidance, denial and wishful thinking) fully mediated the relationship between Impaired Limits domain and anxiety symptoms. Partial mediations were found for the Disconnection & Rejection, Impaired Autonomy & Performance and Other-Directedness Domains in relation with anxiety symptoms. For depressive symptoms, the mediating role of disengagement coping was significant for the Impaired Limits and Other-Directedness Domains.

These findings expand knowledge of how early maladaptive schemas lead to distress. Young (1990) proposed avoidance as the mechanism through which the schemas operate, and the present study shows disengagement strategies to be the main mediators. Additionally, significant differences in the mediation model for anxiety and depression symptoms point to specificity in the cognitive content and the way it operates. Moreover, using a prospective design suggests that cognitive appraisal precedes coping, and therefore, interventions should focus on modifying the schemas as precursors of an individual's actions.

The behavioural inhibitory control (IC) is known to be influenced by emotion. For instance, anxiety is associated with executive impairments such as difficulties in suppression of prepotent responses (Ansari & Derakshan, 2011; Yuan et al., 2011). In faces processing, bias towards threatening faces has been considered as a marker of trait-anxiety (TA) (Pérez-Edgar et al., 2010).

Our goal was to explore if IC impairment is expressed with an emotion in particular in TA. We hypothesized that there is a bias concerning engagement of attention towards angry faces.

Thirty healthy participants were included (7 M/ 23 F; mean age = 21, range: 18–29 years). State and trait anxiety was assessed with the STAI (Spielberger et al., 1983). Participants were also assessed with a modified Simon task showing controlled Emotional Facial Expressions (EFE). Negative faces (fear, sadness, anger) and positive faces (happiness) were in the same proportion. Incongruent trials constituted 20% of the task. Participants were asked to press a key if the EFE was positive or negative.

TA scores were between 31 and 67 (mean = 48). We found a significant correlation only for angry faces during incongruent condition with TA (r = −.44; p = .016). Time to engage attention to angry faces (in incongruent condition) decreased while TA increased.

Biases towards negative stimuli appear in attentional constraints in a sample of healthy adults from the general population. TA is characterised by a hypervigilance to anger in situations where attentional control is tested.