The presence of depression in addicted patients has been connected to poorer therapeutic outcome, increased percentages of drop-outs and shorter period of abstinence. The Addictions Department at the Psychiatric Hospital of Thessaloniki in Greece has an integrated Therapeutic Programme which delivers a therapeutic continuum and attempts to cover the needs of various populations through a flexible, interconnected network of multi-dimensional services.

Sixty (60) subjects were examined –they were divided in three groups of twenty persons each, equally regarding (in a randomized way) the three facilitating sections for drug abuse: Detoxification Unit, Residential Therapeutic Community and Reintegration Programme. They were screened with the Beck Depression Inventory (BDI-II), and with the General Health Questionnaire (GHQ-30).

Most of the subjects were young single men, with a secondary educational level. Depression level was statistically significant higher at the Detoxification Unit (BDI Score: 24.55±12.45) compared to the Residential Therapeutic Community (BDI Score: 13.35±10.24) (p<0.05). Furthermore, depression level was decreased at the Reintegration Programme (BDI score: 8.60±5.31) -statistically significant compared to the Detoxification Unit (p<0.000).

Addicted patients seem to have mild severe depression at the first stages of a therapeutic detoxification programme. As the therapeutic procedure goes on and abstinence is established, depression is rapidly decreased in a stable way. Future studies with larger groups of addicted patients are warranted to further investigate the role of depression during the early period of abstinence.

Since 1996 antiretroviral treatment drastically diminished morbidity and mortality of VIH infected patients. This fact allowed it to include patients with hepatic failure caused by Virus B or C in liver transplantation procedures. We intended to identify psychological factors interfering in the post-transplantation period with the further aim to define criteria for psychological assessment at the pre-transplantation period.

From 2001 to 2006 we made a psychological investigation with 34 VIH+ patients during their usual pre-transplantation assessment. ICD-10 diagnoses were given after clinical non-structured interviews. Patients' psychosocial situations were also assessed in a non-structured way as well as drug and alcohol consumption was monitored. Patients were followed up during the whole time period.

We found an elevated prevalence of psychopathology among this group of VIH+ transplantation candidates, specially personality disorders, socio-familiar problems and substance abuse.

It is important to include in-depth social and psychological assessment into the routine pre-transplantation procedure in order to preview and to minimize risk situations during the post-transplantation period.

To determine if substance abuse significantly increases the risk of relapse in first episode psychosis patients over a two year follow-up even after adherence to medication is improved.

Relapse was based on ratings on the Scale for Assessment of Positive Symptoms and weekly ratings on Life Chart Schedule (WHO). Predictor variables included gender, duration of untreated psychosis (DUP), duration of untreated illness from the time of first psychiatric symptoms (DUI), age of onset, pre-morbid adjustment, co-morbid diagnosis of substance abuse at one year, time to remission of psychotic symptoms and adherence to medication. Univariate analyses were followed by logistic regression for rate of relapse and survival analysis with Cox proportional hazard regression was used for time to relapse as the dependent variable.

Of the 207 patients, 162 achieved remission of positive symptoms and were treated and followed for two years. Relapse rates were relatively low (21.6% in the first and 13.8% in 2nd year, respectively) with 33 weeks as the mean time to relapse. Relapse rates were significantly higher for patients with a co-morbid diagnosis of substance abuse (OR= 2.59, CI 1.28-5.21), especially for the second year (OR=3.66, CI 1.30-10.27) and for those with shorter DUI (OR=0.437, CI 0.209-0.914) after controlling for other predictors. Likelihood of relapse during follow-up was associated only with a co-morbid diagnosis of substance abuse (HR= 2.49, p=.01, CI 1.21-5.10).

Specialized treatment of substance abuse may further reduce risk of relapse even after improving adherence to medication.

Detoxified alcoholics often have specific deficit in perceptual capacities, motor performance, memory function and abstracting abilities. To illustrate the clinical observations of cognitive impairment expressed in drawings of alcoholics we used two case vignettes.

Qualitative analysis of form and content of drawings and group protocols were applied. Art group therapy is a part of integrative therapy in Day unit. It involves two steps: 1) drawing by free associations and 2) discussing exhibited drawings in group. The group is open, heterogeneous and meets once a week. The drawings of two healthy, neurological intact, right-handed male alcoholics, aged 36 and 39 years were analysed. They were previously hospitalised because of serious alcohol withdrawal syndrome. There was more than 4 weeks after last drink.

The both alcoholics showed impairment of perception and executive functions, but they did not notice it. After confrontation in the group they recognised their cognitive deficit and accepted that they had serious damage caused by alcohol, regardless of good medical condition. The clinical improvement was presented by improving in next drawings, and discussing in the group with more self-confidence.

Art therapy makes possible visual expression of emotions, perceptions and cognitions, and provide large variety of confrontation and support within group, thus facilitating integrative therapeutic process of alcoholics.

The most prominent endocrinology disturbance among alcoholics is male hipogonadismus. This paper deals with the effects of early abstinence on gonadal hormones.

A total group of non-cirrhotic male primary alcoholics, without malnutrition, (N=40) aged from 20-60 years was consecutive recruited during inpatient treatment. They meet ICD-10 criteria for alcohol dependence and were compared with 20 matched healthy controls. The blood samples for testosterone, estradiol and SHBG (sex-hormone binding globuline) were collected at day 1 and 28. The plasma levels of hormones (RIA) differences between groups were tested by Student t-test.

There was significant higher concentration of estradiol and SHBG at alcoholics vs. controls, and significant lower concentration of testosterone at alcoholics compared with controls. Repeated assessment after 28 days showed non-significant elevation of testosterone and decrease of SHBG, but significant decrease of estradiol. All values were between normal range.

There is trend of development of hipogonadismus and secondary feminisation at male alcoholisc without prominent liver damage, which may be transient and resolve during early abstinence.

It is well documented that mental disorders and suicidal behavior are associated with tobacco smoking. However, investigations in which there is a distinction between high and low nicotine dependence are more recent. The purpose was to evaluate correlates associated with high nicotine dependence such as psychiatric morbidity, suicidal behavior, practice physical exercise and use of caffeine, alcohol and illegal drug.

The analysis was based on sample of 290 participants, ages varying from 18 to 65, in a primary health service of Granada (south of Spain). All of them were assessed with the Fagerström Test for Nicotine Dependence and with the General Health Questionnaire.

The prevalence of current smoking was 34,5% and the prevalence of high nicotine dependence was 9,3%. Psychiatric morbidity (GHQ-28>6), previous suicide attempts, lack of physical exercise, high caffeine intake and consumption of illegal drugs were significantly associated with high nicotine dependence. These results remained after controlling for gender or substance abuse. Also there was significant relationship between high nicotine dependence and antecedents of suicide attempts (OR=3,53; IC 95%:1,53–25,98). In the logistic regression model, after adjusting for sex and age, the differences remained statistically significant (OR=8,17; IC 95%:1,96–34,03), as well as the protective effect of married status (OR=0.08; IC 95%:0.01–0.72).

Smokers with high nicotine dependence should be distinguished from other smokers in evaluating health status populations. Serial cross-sectional and longitudinal studies of nicotine dependence are needed to determine whether certain groups are especially vulnerable to nicotine dependence when they start smoking.

Patients suffering from both psychiatric disorders and substance abuse (SA) are titled "dual diagnosis patients" (DDP). SA is associated with suicidal behavior. Although our knowledge of SA and suicide behavior is increasing, we lack sufficient knowledge of suicide among DDP.

To compare the suicide attempts rate among DDP and non-DDP; To compare the suicide attempts rate according to gender in DDP and non-DDP; To compare the suicide attempts rate according to substance in DDP.

Analysis of consecutive admissions: men and women ages 18–65 in our center (06/2003–06/2005).

Of 848 DDPs' admissions, 197 (23.2%) were after suicide attempt, whereas 403 of 2558 non-DDP's admissions (15.8%) were after suicide attempt (OR=1.6; 95%CI=1.3-1.9). The OR in multiple analysis was 1.4 (95%CI=1.1-1.8).

There is higher risk for suicide attempt among females in non-DDP (OR=.6; 95%CI=.5-.8), no differences according to gender in DDP (OR=.7; 95%CI=.5-1.1).

Opiates (OR=1.6; 95% CI=1.01-2.5) and Cocaine (OR=1.9; 95% CI=1.1-3.2) were found to elevates, but Cannabis were found to lower (OR=.4; 95% CI=.3-.6) the risk of suicide attempt.

DDP have grater risk for suicide attempt than non-DDP. In non-DDPs females have grater risk for suicide attempt than males, however in DDPs there were no differences. DDP with Opiates or Cocaine abuse are in risk group for suicide attempts. These findings suggesting that preventive efforts that have shown promise in non-DDP may need to be tailored differently to address the risk factor profile of DDP.

About a quarter of patient's admissions ages 18-65 in Abarbanel mental health center (MHC) are with substance abuse (Natan, Gimelfarb, Barak & Baruch, 2005). Concurrent comorbidity has become the rule among psychiatric inpatients. Unfortunately the majority of the clinical trials with Antipsychotic drugs exclude the Dual Diagnosis patients (DDP).

To compare the efficacy, safety, drugs craving and compliance with Risperidone versus Haloperidol treatment of DDP.

Ten DDP (meeting DSM-IV criteria for Schizophrenic spectrum disorders; median age=28 years [range, 20-39 years]) from MHC were randomly assigned to either Resperidone (N=5; mean endpoint dose 5.2 mg/day) or Haloperidol (N=5; mean endpoint dose 6.0 mg/day) treatment.

There were no differences between Resperidone and Haloperidol according to efficacy, safety, drugs craving and compliance in each point of time.

Comparing to start-point in each of the groups: No difference in treatment efficacy between the groups (NS); No weight change during Risperidone treatment (NS) and there was weight gain about 2.6 BMI points (SD=.3) after Haloperidone treatment (p<.05); No differences in drugs craving and compliance between the groups (NS).

Although not significant, 60.0% of DDPs who received Haloperidol (N=3) relapsed compared with 0.0% of the DDPs on Risperidone (Fisher's Exact Test p<.08).

The preliminary results suggest, that treatment efficacy and drugs craving are equal in both groups. Compliance with Risperidone is equal to compliance with Haloperidol. But side effects' profile of Risperidone is more convenient than of Haloperidol.

Over the past decade clinicians have become more aware of the problem of substance abuse (SA) in individuals with mental illness. Concurrent comorbidity has become the rule among psychiatric inpatients. About a quarter of patient's admissions ages 18-65 in the Abarbanel mental health center (MHC) are with SA (Natan, Gimelfarb, Barak & Baruch, 2005). The changing demography shows an ever increasing percentage of elderly in mental hospitals, however, information about dual diagnosis in elderly is unclear!!

1. 1. To explore the trends of dual diagnosis elderly patients (DDEP) in Abarbanel MHC in the period of June 2003 to June 2005.

2. 2. To compare the admission's profile of DDEP to non-DDEP according to socio-demographic and clinical characteristics.

Descriptive analysis of consecutive admissions: men and women ages 60 and more years (06/2003–06/2005) and laboratory analysis of urine.

Twenty seven of 535 admissions of elderly inpatients (5.1%) were with SA. There is a tendency of increasing of DDEP rate: in the 1st year the rate was 3.4% and in the 2nd year–6.8% (p<.07).

Profile of DDEP and non-DDEP admissions is significantly different according to place of birth, gender, age, family status, patient's suicide attempts, physical diagnosis.

There is decreasing of SA with age, but the phenomenon is fairly frequent among elderly, previously “young” DDEP. More strict assessment of SA patterns is recommended. Profile of DDEP's admissions is more complex then non-DDEP's admissions. There is significant clinical need to appropriate approach for DDEP

Involvement with illicit drugs among young people has been explained by a risk-factor matrix. This study aims to compare childhood psychopathology as a predictor between self-reported illicit drug use without registered drug offending and police informed drug offending among males in a prospective birth cohort study.

A general population sample of 2946 8-year-old Finnish boys was followed up from age 8 to 18. In 1989, childhood psychopathology was assessed using the Rutter scale and Child Depression inventory. Information about self-reported drug use at age 18 or police-registered drug offending during years 16 to 20 years was collected from 79.3% (n=2336) of the subjects.

Childhood psychopathology predicted exclusively police registered drug offending. After adjusting for family background, both severe and moderate conduct problems and ADHD symptoms were associated with subsequent police-registered drug offence. Self-reported illicit drug use was predicted only by non-intact family structure.

Our results demonstrate a clear difference, occurring already in childhood, between young men with self reported illicit drug use and those with police registered drug offending. More severe illicit drug involvement, such as police-registered drug offending, is a continuum of a childhood externalizing problem behaviour, while self-reported occasional illicit drug use does not inevitably associate with psychopathological problems in childhood. Accordingly, the preventive needs and the age period for intervention may be dissimilar for young people with divergent involvement with illicit drugs.

The investigation of the dependence of young women on psychoactive substances has revealed that it originates from dysfunctional families where parents are inclined to alcoholism, depression and other psychiatric diseases. The aim of our investigation is to determine the frequency of these disorders and diseases in parents, as well as in siblings.

The data used in the analysis derives from medical documentation. Twelve families from the rehabilitation group that were treated from January 2003 until June 2006 were investigated.

Seven patients live in an entire primary family. The mothers of patients are 45 - 58 years of age. The mothers of 2 patients were treated from depression with psychotic symptoms, and the mother of 1 patient was treated against depression without psychotic symptoms. Fathers are between 45 and 65 years of age. From 9 alcohol addicted fathers (75%), 2 (16,6%) are still drinking, 3 (25%) are in amateur abstinence, 2 (16,6%) have died from cirrhosis of the liver, 1 (8,3%) disappeared in Sarajevo, and only one as been hospitalized and is abstinating. Only a brother of one female patient is alcohol dependent. One female patient as a brother who was treated for stuttering in childhood, while another brother is being treated for agoraphobia. A younger sister of one female patient has an asocial behavior disorder.

Alcoholism in primary families represents a risk factor for the development of polytoximania and various other disorders and diseases.

Drug use, in isolated "primitive" communities, has been considered as a mechanism of social integration; in ethnocultural subgroups in contact with mainstream society, drug use has been considered as a marker, or sometimes as a cause of social disorganization.

This is a retrospective archives study. Admissions in Detox Unit of Thessaloniki (residential facility, part of Addictions Department at the Psychiatric Hospital and the only Detoxification Unit in Greece) for the decade 1996-2005 were studied. Socio-demographic and clinical characteristics of patients were recorded.

Patients belonging to ethnocultural subgroups represent 4.8% of the total number of patients admitted (109/2265) and 7.2% of the total admissions number (191/2655). 86.73% are men and 13.27% are women. The mean age is 29.68 years old. The vast majority (77%) is Greek repatriated from European Community Countries and the Former Soviet-Union Republics, and some are from Albania. The median length of stay in Greece is 8.9 years. The rest (17%) belong to ethnocultural Greek subgroups (Roma, Greek Muslim minority). Most of the patients admitted are singles and have a secondary education level. The vast majority (84.6%) are unemployed.

The very low percentage of these admissions, 7.2%, doesn't necessarily represent the actual ratio of users in ethnocultural subgroups in Greece. Specific programs would undoubtedly lift some of the obstacles that hinder minority users from seeking help.

Drug use, in ethnocultural subgroups, has been considered either as a mechanism of social integration or as a marker/cause of social disorganization. The health status and health outcomes of many minorities have remained poor, or have deteriorated, despite massive health promotion campaigns.

This is a retrospective archives study. Admissions in Detox Unit of Thessaloniki (residential facility, part of Addictions Department at the Psychiatric Hospital and the only Detoxification Unit in Greece) for the decade 1996-2005 were studied. Socio-demographic and clinical characteristics of patients were recorded.

Patients belonging to ethnocultural subgroups represent 4.8% of the total number of patients admitted (109/2265) and 7.2% of the total admissions number (191/2655). 44% of the total admissions completed the 21 days of stay and 46% left prematurely (median length of stay 5 days). 62% were admitted only once and 43% completed the program. 38% were admitted more then once and 45% of these admissions were successfully completed. The initiation drug is cannabis (82%) and the mean age of beginning drug use is 17 years old. The main substance is heroin, the median period of drug use is 7.5 years and the main way route of administration is intravenous (85%). 48% of them tested positive for Hepatitis C, 1% for Hepatitis B, and 9.1 for both HBV&HCV. 70% have problems with the law.

The percentage of completed admissions of the minorities in Detox is comparable to the Greek patients, but more campaigns about hepatitis seem to be necessary.

Nonspecific treatment response is common in pharmacotherapy trials for alcohol dependence, and results in a marked decrease in alcohol consumption even before subjects' enrollment in a treatment study. We propose that nonspecific effects are associated with trait and state factors operating prior to treatment to influence participants' expectation/perception of future treatment outcome and their drinking behavior. Trait factors include personality, and state factors include readiness to change and severity of drinking at screening. Our study goal was to determine how these nonspecific effects contribute to pre-double-blind clinical outcome.

We examined the association of trait factors (gregariousness or conformity on MacAndrew Alcoholism Scale (MAS)) and state factors (stages-of-change scale, level of drinking at screening) with pre-double-blind clinical outcome among 321 alcoholics in a pharmacotherapy trial.

Nonspecific effects were associated with significant reduction in alcohol consumption among heavy drinkers (10.3±5.9 drinks/day at baseline vs 5.3±5.1 drinks/day during the last week of single-blind treatment; p<0.001) but not non-heavy drinkers (3.07±0.65 vs 2.98±2.6; p>0.05). Partial correlations indicate that significant predictors of pre-double-blind drinking reductions were: level of drinking (–0.215) and the stages-of-change subscales of pre-contemplation (–0.152), contemplation (0.144), and the struggle to maintain (–0.284). The MAS did not predict pre-double-blind drinking reductions.

Participants with higher motivation levels and greater drinking severity were most likely to experience nonspecific treatment effects before double-blind treatment. Gregariousness and conformity were not associated with nonspecific treatment effects.

Outpatient treatment may be as effective as inpatient treatment if clients are retained, especially in the early phase. On the contrary, dropping out from treatment predicts relapse in alcohol dependence. We investigate early predictors of retention in a cohort of alcoholics undergoing a day-hospital rehabilitation programme.

A consecutive sample of 85 patients entered this prospective study by completing an intensive start-up phase. The main characteristics of the sample were: mean age 43.1± 10.7; 65% male; 68% employed; 27% polyabuser; 76% ongoing psychopharmacological therapy. Clients were assessed (AWRS, VAS for alcohol craving, OCDS, SCL-90-R) at baseline, T30, T60, T120 and T180. The statistical significance of comparisons was tested by Chi square and Mann-Whitney.

The overall retention rate was: 60 pts (70%) at T30, 54 pts (63%) at T60, 42 pts (49%) at T120, 35 pts (41%) at T180. The following comparisons reached statistical significance: the VAS score for craving at baseline was lower among retained clients at T30 (p=0.01) and T60 (P=0.02), and so was the OCDS compulsion score at baseline among retained clients at T30 (p=0.04); those receiving a psychopharmacological therapy after the start-up phase showed a better retention at T30 (p=0.01) and at T60 (p=0.04).

According to this preliminary analysis, alcohol-related symptom distress at baseline and lack of psychiatric medication after the intensive treatment phase are more frequently observed in early drop-out. Further analysis is necessary to identify true predictors of retention in a multivariate model.

BDV is a RNA virus belonging to the family Bornaviridae with a high affinity to the limbic system. BDV interferes with receptors in the CNS, causing changes in neurotransmitter systems, mood and behavioural changes. Higher positivity of BDV has been described in psychiatric patients during the acute course of disorders in comparison with remission and healthy individuals. Substance abuse is associated with behavioural, mood changes, craving, chronical course and high risk of relapses. These characteristics are explained by the influence of drugs and alcohol to opioid and dopamine systems accountable for the reward mechanism. We suppose higher BDV positivity in substance addict patients in the beginning of treatment, lower positivity due to the abstinence period associated with decrease of craving.

Examination of hospitalised patients for substance abuse according to ICD 10 for serum positivity of BDV infection (antigens-Ag, circulating immunocomplexes-CIC) by ELISA on day 1 and day 56 (2 months of abstinence). Evaluation of Questionnaire of Psychic Dependence on day 1 and 56.

We have investigated 21 patients to day. Till December 2006 we suppose there will be minimally 30 investigated patients. We have at disposition results with statistical evaluation in February 2007.

Higher BDV positivity in substance addict patients can be associated with immune changes during abuse. BDV can influence through neurotranmitter systems (dopamine) behaviour of these patients (craving) and be associated with higher risk of relapse. Higher BDV positivity is supposed in the beginning of treatment and associated with more intensive craving.