Auditory hallucination (AH) has been always concerned as a main core symptom of schizophrenia. However, the mechanisms of AH are still unclear.

The aim of this study is to further explore the complicated neuroimaging mechanism of AHs from a new insight by using voxel-mirrored homotopic connectivity (VMHC).

Forty-two patients with AH (APG), 26 without AHs (NPG) and 82 normal controls (NC) participated in resting state fMRI scan. Correlation analyses were used to assess the relationships between VMHC and Hoffman scores. Additionally, ROI analysis was used to further know about the functional connectivity between the brain areas with changed interhemispheric FC and the whole brain.

APG showed reduced VMHC in the parahippocapus, fusiform gyrus, rolandic operculum, insula, heschl's gyrus and superior temporal gyrus (STG). Hoffman score of APG group had negative correlation with VMHC in these regions. Besides, ROI analysis supported decreased interhemispheric FC in schizophrenia with AH and verified functional connectivity abnormalities in schizophrenia.

These findings suggest impairment of interhemispheric coordination and whole brain FC in schizophrenia with AH, which may be implicated to the neuroimaging mechanism of auditory hallucination. Furthermore, this research highly support dysconnectivity hypothesis that schizophrenia related to abnormalities in neuronal connectivity.

The authors have not supplied their declaration of competing interest.

Brexpiprazole is a serotonin-dopamine activity modulator that is a partial agonist at 5-HT1A and dopamine D2 receptors at similar potency, and an antagonist at 5-HT2A and noradrenaline alpha1B/2C receptors.

To evaluate the efficacy, safety, and tolerability of brexpiprazole in patients with acute schizophrenia in a meta-analysis of three phase 3 studies with brexpiprazole.

The primary endpoint was change from baseline to week 6 in PANSS total score.

Data from the 3 clinical studies in patients with acute schizophrenia were combined and analyzed using individual patient data meta-analysis. In two similarly designed studies (NCT01396421; NCT01393613), patients with acute schizophrenia were randomized to fixed-doses of brexpiprazole 2 mg/day, 4 mg/day or placebo (a low-dose treatment group was included in each study [0.25 mg and 1.0 mg]; not included in the meta-analysis). In the third study (NCT01810380), patients were randomized to flexible dosing of brexpiprazole (2 to 4 mg/day), placebo, or an active reference (quetiapine extended release). Changes from baseline for brexpiprazole vs. placebo were analyzed using an MMRM approach.

Brexpiprazole 2–4 mg (n = 868) was superior to placebo (n = 517) in change from baseline in PANSS total score (−20.1 vs. −14.3; estimated treatment difference to placebo: −5.8 [95% CI: −8.0; −3.6]; P < 0.001). The proportions of patients reporting TEAEs were similar between the brexpiprazole and placebo treatment groups (57.9% vs. 57.5%). No unexpected safety concerns were observed.

This meta-analysis supports evidence from three individual trials that brexpiprazole is efficacious and safe in treating patients with acute schizophrenia.

The authors have not supplied their declaration of competing interest.

There is no comprehensive evidence on the influence of sleep disturbances (SD) on substance use disorders (SUD) or treatment use patterns of individuals with comorbid disturbances.

To better understand comorbidities and treatment use patterns of individuals with SD and SUD.

We combine 2010–2012 electronic health record (EHR) data from healthcare system in Boston (n = 131,966 person-years) and Madrid, Spain (n = 43,309 person-years). Patients with sleep disturbances (SD) were identified in the EHR through ICD-9 codes and medical records and substance use disorders (SUD) identified by documented treatment for drug or alcohol abuse or dependence. Rates of SUD are compared between individuals with and without SD. Among those with both, adequacy of mental health treatment (defined as eight or more outpatient visits or four or more outpatient visits with a psychotropic prescription) and ER use is compared.

Among the individuals, 21.1% with SD also report SUD, compared to only 10.6% of individuals without SD (P < .01). Those with comorbidities were more likely than their specialty care counterparts without comorbidities to be seen in the ER (57.1% vs. 36.6%, respectively, P < .05). Limiting the sample to only those with both SD and SUD in specialty mental health care (n = 268 in Boston and n = 28 in Madrid), 49.2% of Boston patients received adequate care compared to 38.5% of Madrid patients, and 57.8% of Boston patients had any ER use in the last year vs. 50% of Madrid patients.

SD is correlated with SUD and comorbid patients are more likely to use emergency services.

The authors have not supplied their declaration of competing interest.

Major affective disorders ranging from subthreshold affective temperaments to severe affective diseases and anxiety, are frequently associated with sleep–wake dysregulation. Interestingly, recent studies suggested an active role of Sensory Processing Disorders (SPD) in the emergence of sleep disturbances.

The objective of this study was to investigate the relationship between SPD and sleep quality in subjects with major affective disorders and specific affective temperaments.

This study aimed to examine the sensory profile (expressed in hypersensitivity or hyposensitivity) of patients with major affective disorders and its relative contribution to the prediction of sleep quality while also considering affective temperaments and depression, known as factors that may impact sleep quality.

We recruited 176 participants (mean age = 47.3) of which 56.8% have unipolar depression and 43.2% bipolar disorder. Reduced sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI) whereas affective temperaments were assessed using the Temperament Evaluation of Memphis, Pisa, Paris and San Diego (TEMPS).

Sensory hypersensitivity, assessed using Adolescent/Adult Sensory Profile (AASP), significantly distinguished between poor and good sleepers. Sleep quality was mainly predicted by the Beck Depression Inventory-II total score and anxious temperament. Yet, sensory hypersensitivity contributed to this prediction mainly in regard to sleep efficiency and related daytime dysfunctions.

The careful assessment of the unique sensory profile and its behavioral/functional influence on patients’ quality of life may help clinicians and health providers in developing targeted treatment interventions.

The authors have not supplied their declaration of competing interest.

Circadian rhythms and quality of sleep have been associated with temperament characteristics in healthy populations. Since temperaments are personality traits concerning the behavioral, motivational and emotional responses, adaptive capacity for sleep and circadian rhythm may also be related with temperament traits.

To identify the determinants of sleep quality (SQ) and biological rhythm (BR) in bipolar disorder, schizophrenia and depression among temperament measures.

Patients with bipolar disorder (BD, n = 49), major depression (MD, n = 35), schizophrenia (SZ, n = 30) and a healthy control group (HC, n = 36) were enrolled. Pittsburgh Sleep Quality Index (PSQI), Biological Rhythms Interview of Assessment in Neuropsychiatry (BRIAN) and the Temperament and Character Inventory (TCI) were the measures. One-way ANOVA, Spearman Correlation Test and Linear Regression analyses were the other comparisons.

Determinants of sleep quality were self-directedness in MD [F(1,26) = 6.10, P = 0.020] and BD [F(1,31) = 10.88, P = 0.002] groups. Self-transcendence (P = 0.004), self-directedness (P = 0.038) and persistence (P = 0.05) were the determinants of sleep quality in schizophrenia group [F(3,21) = 9.71, P < 0.001]. Harm-avoidance was the determinant of sleep quality in the HC group [F(1,28) = 7.97, P < 0.001]. Determinants of biological rhythms were harm-avoidance in the BD group [F(1,32) = 9.65, P = 0.004] and self-directedness in the SZ group [F(1,23) = 11.09, P = 0.003] and harm-avoidance (P < 0.001) and self-transcendence (P = 0.039) in the HC group [F(2,27) = 15.81, P < 0.001].

Self-Directedness was associated with circadian rhythm and sleep quality in MD, BD and SZ groups. Extreme temperament features may contribute to emotional and behavioral dysfunction, which may lead to abnormal sleep patterns in psychiatric disorders.

The authors have not supplied their declaration of competing interest.

Since 1897, Émile Durkheim noted that suicides occur more often during the economic changes that disrupt the social structure of society.

The objective of this study is to analyze the consequences of last global economic crisis on mortality by suicide in the EU countries in period 2007–2012.

We extracted data on mortality from the WHO database and unemployment trends from the EUROSTAT database. We had used this data to calculate the effect of unemployment on suicide rate, in pre-2004 and post-2004 EU countries.

If the number of suicides from 2007 was maintained in 2008–2012 period, EU 27 countries would have registered with 16,572 fewer suicides. The increase of suicides is based on the increasing number of suicides in men. The small increase in the suicide rate was recorded in Austria, France, Hungary and Slovenia. Luxembourg was the only country where the number of suicides was lower compared to 2007. In 2008, we can notice a slight decrease in the unemployment rate compared to 2007 and an increase in suicide by 3% in both groups of countries, followed by increasing suicide only in the post-2004 EU, where reach 10% in 2010, followed by a slight decrease in the coming years, while the unemployment rate gradually increases to 46% compared with 2007.

In European Union countries, suicides have increased both before and during the crisis, in periods in which unemployment rose. States that joined the EU after 2004 are more vulnerable in times of crisis.

The authors have not supplied their declaration of competing interest.

An expanding body of research suggests that childhood trauma and adverse experiences can lead to a variety of negative health outcomes, including substance abuse, depressive disorders, and attempted suicide among adolescents and adults. Alcoholism, depressed affect, and illicit drug use, which are strongly associated with such experiences, appear to partially mediate this relationship as observed in population studies.

We have tested the association between early trauma and suicide attempts in a sample of suicide attempters from the Eureca International Project and a matched healthy control sample.

We have studied the prevalence of childhood stressful events compared with healthy controls in a multicentre sample of 791 suicide attempters (SA) and 630 healthy controls (C), we have measured childhood parental neglect, physical abuse, sexual abuse, and emotional abuse, using the Childhood Trauma Questionnaire (CTQ). Chi2 tests were performed using SPSS v15.0.

A significant increase in prevalence of childhood trauma was found in the suicide attempters sample for all types of trauma: childhood physical abuse: 25.3% (SA) vs. 11.1% (C) (Chi2 test: 120,108 P = 0.000); childhood sexual abuse: 18.2% (SA) vs. 2.4% (C) (Chi2 test: 88,212 P = 0.000); parental neglect 25.3% (SA) vs. 1.1% (C) (Chi2 test: 164,910 P = 0.000); childhood emotional abuse: 34.9% (SA) vs. 5.6% (C) (Chi2 test: 176,546 P = 0.000).

Suicide attempters were increasingly overrepresented compared with controls if experiencing more than 1 trauma: represented 77% of the sample who suffered 1 type of childhood trauma vs. more than 90% of the sample with 2 or more types of trauma.

A powerful graded relationship exists between adverse childhood experiences and risk of attempted suicide.

The authors have not supplied their declaration of competing interest.

e-Mental Health is an emergent area within e-Health. In the evaluation area, ecological momentary assessment (EMA) has been used to investigate separately on different psychiatric disorders while a comprehensive tool to cover the entire spectrum of mental health has not yet been developed. In this study, we aimed to present the MEmind wellness tracker and to characterize the group of patients who use it.

We developed an EMA web application: MEmind, accessed through the web page http://www.memind.net. Since 20th May 2014 on, adult outpatients (n = 13,883) attended in all psychiatric services within the Psychiatry Department of Fundación Jimenez Diaz in Madrid were proposed to use MEmind and then registered. Data collected from first year of implementation of the tool were transferred to an SPSS sheet and then analysed. A comparison between patients using and not using MEmind were performed.

MEmind users (n = 2842) were significantly younger than MEmind non-users (n = 11,041) (42.2 ± 13.5 vs. 48.5 ± 16.3; P = 0.000) and mostly women (65% vs. 61.4%; P = 0.001). Also, patients with neurotic disorders were the main users of MEmind (see Table 1). Furthermore, patients with thoughts about death and suicide were more likely to use MEmind (Table 2).

Women, young people and patients with neurotic disorder were the main users of MEmind. Furthermore, people with suicidal thoughts were willing to use MEmind. Novel interventions for suicide prevention could be developed with the use of EMA web-based tools. Further studies are warranted.

The authors have not supplied their declaration of competing interest.

Internet-delivered treatments for depression have proved successful, with supported programs offering the potential for improved adherence and outcomes. Internet interventions are particularly interesting in the context of increasing access to interventions, and delivering interventions population-wide.

Investigate the potential feasibility and effectiveness of an online intervention for depression in the community.

Establish the effectiveness of a supported online delivered cognitive behavioural intervention for symptoms of depression in adults in the community.

The study was a randomized controlled trial of an 8-module internet-delivered cognitive behavioral therapy (iCBT) program for adults with depressive symptoms (n = 96) compared to a waiting-list control group (n = 92). Participants received weekly support from a trained supporter. The primary outcome was depressive symptoms as measured by the Beck Depression Inventory (BDI-II). The program was made available nationwide from an established and recognized charity for depression.

For the treatment group, post-treatment effect sizes reported were large for the primary outcome measure (d = 0.91). The between-group effects were moderate to large and statistically significant for the primary outcomes (d = 0.50) favoring the treatment group. Gains were maintained at 6-month follow-up.

The study has demonstrated the efficacy of the online delivered space from depression treatment. Participants demonstrated reliable and statistically significant changes in symptoms from pre- to post-intervention. The study supports a model for delivering online depression interventions population-wide using trained supporters.

The authors have not supplied their declaration of competing interest.

We recently demonstrated that weight gain could be prevented in young people experiencing a first-episode of psychosis commencing treatment with antipsychotics. A 12-week, intensive lifestyle and life skills intervention – the Keeping the Body in Mind program, – was delivered by dedicated nursing, dietetic and exercise physiology clinicians, for new referrals with < one month of antipsychotic exposure. (Curtis et al., Early intervention in psychiatry, in press). At the conclusion of the intervention the 16 young people participating in the program experienced a mean weight gain of 1.8 kilograms, and a mean increase in waist circumference of 0.1 centimeters. The participants were followed up for two years after initial referral.

During the two-year follow-up, participants had continuing access to an in house gym and weekly cooking groups, but without the same intensity of follow-up. Two year follow-up data were obtained from 11 participants form the original cohort.

Mean weight gain at two-year follow-up was 0.90 (SD 8.7) kilograms, and this difference was not statistically significant [t (10) = 0.3, NS]. Waist circumference decreased by 0.7 (SD 7.7) centimeters, which was not t statistically significant [t (10) = 0.3, NS]. Nine of the participants (82%) did not experience clinically significant weight gain two years after initiation of antipsychotic medication.

This two-year follow-up data demonstrated that it is feasible to prevent weight gain in youth with first-episode psychosis over the first two years of treatment.

The authors have not supplied their declaration of competing interest.

Diverse prescription patterns and differences in length of psychiatry inpatient stay among European and American countries have been reported [1,2].

To describe and compare clinical features and drug prescriptions in two Acute Psychiatric Units from Spain and USA.

Cross-sectional and comparative study. Sample: 73 inpatients from Reno (USA-Inpatients) and 65 from Oviedo (Spain-Inpatients) admitted to public Adult Acute Psychiatric Unit over a two-month period. Sociodemographic/clinical data and drug prescription were collected.

Sociodemographic/clinical comparison (Table 1) and drug prescription differences (Table 2) are shown.

No significant differences in antipsychotics’ prescription except for the most frequently used [risperidone in Spain (36%)/ziprasidone in US (19.6%), Chi2 = 39.7**].

(A) Psychiatric inpatients in US are younger, have longer hospitalization, show more comorbid substance use disorder and differ from Spanish inpatients in frequency of diagnostic categories (schizophrenic disorders represent a larger proportion).

(B) Inpatients in Spain usually receive polytherapy, and are more frequently treated with antidepressants and anxiolytics, especially benzodiazepines. In contrast, USA-Inpatients take lithium more often [1,2].

The authors have not supplied their declaration of competing interest.

Early diagnostics and treatment of comorbid disorders in drug addicts is an integral part of the rehabilitation process and a critical factor in the success of rehabilitation measures as a whole.

One hundred and thirty-three patient of inpatient rehabilitation department. The inclusion criteria in the study were: age above 18 years, withdrawal status, diagnosis (F 11.20 ICD-10). They were divided into two groups: HIV positive (n = 38) and HIV negative (n = 95).

To estimate the prevalence of HIV infection and comorbid mental disorders in substance abuse patients and the impact of comorbidities disorders on the compliance.

Clinico-anamnestic method, clinical-psychopathological method (criteria ICD-10 and clinical diagnostic scales: PANSS, HADS, MMPI). All participants also had serological blood test for antibodies to HIV.

According to our data, the incidence of comorbid mental disorders among HIV negative patients is 65%. The research also showed a correlation (P < 0.05) between HIV infection and mental disorders. So, mental disorders were diagnosed in 82% of HIV infected patients. Patients who stopped their treatment early (n = 42) significantly (P < 0.05) more often had specific personality disorders (17%). Most of them suffered from dissocial personality disorder (9%) and borderline personality disorder (18%).

This analysis showed that HIV is not significant factor (P > 0.05) of early rehabilitation treatment interruption. But comorbid personality disorders in both groups are a significant factor (P < 0.05) of the treatment interruption, while the endogenous, neurotic or affective mental disorders are not.

The author has not supplied his/her declaration of competing interest.

To study characteristics of aggression of male and female offenders with substance dependence.

One hundred and fifty-five male and 110 female adolescents abusing psychoactive substances and serving their sentence were examined. “Hand-test” and Buss-Durkee questionnaire were used in this study.

During comparison of number of offences committed by male and female adolescents, it was revealed that male adolescents commit significantly more crimes against life and female adolescents more crimes against property. Conducted analysis showed high level of aggressive and hostile reactions in this sample, indices of female adolescents (13.7 ± 2.95 and 27.6 ± 5.5) are significantly higher (P < 0.05), than in male adolescents (8.6 ± 2.8 and 23.6 ± 5.3). Significant correlations between level of aggression in female adolescents and beginning of substance use were revealed (r = 0.46, P < 0.05). In male adolescents, long-term substance use correlated with increase in level of physical aggression and tendency to manipulative behaviour (r = 0.37, P < 0.05). In male adolescents, high potential of adjustability, use of communication for self-assertion and achievement of goals, low level of attachment were revealed. Female adolescents are more aggressive in contacts, build relationships according to type of control-submission.

Conducted study allowed revealing gender traits of juvenile offenders influencing the structure of aggressive behaviour, allowing the broadening the understanding of mechanisms of aggressive behaviour.

The authors have not supplied their declaration of competing interest.

Alcohol use disorders have been associated with an increased risk of frequent readmissions. This study aimed to examine factors that contribute to the risk for readmission within one year after discharge from an alcohol rehabilitation program.

Rehospitalization status was assessed for all patients with an alcohol use disorder as primary diagnosis (n = 468) admitted to our inpatient unit between July 1, 2012, and June 30, 2014. All patients were followed up for one year after their first hospitalization (index hospitalization) within this period. Time to readmission within one year after discharge was measured using the Kaplan–Meier method. Risk factors for readmission were examined using Cox proportional hazard regression models. Three set of variables were selected to be included in the analyses:

– demographic features at time of admission of index hospitalization;

– comorbid conditions at time of admission of index hospitalization;

– treatment-related variables in relation to the index hospitalization including observer-rated outcome measures.

Readmissions within one year after discharge from an alcohol rehabilitation program as well as the corresponding time to readmission were linked to higher numbers of previous hospitalizations and the presence of comorbid opioid use disorders.

Higher numbers of past treatments for AUD are indicators for a chronic course of the disorder, which, in turn, increase the risk of further relapses. Our findings further confirmed previous findings suggesting high rates of comorbidity among alcohol and opioid use disorders, and their link with poorer clinical outcomes.

The authors have not supplied their declaration of competing interest.

Mephedrone is a synthetic cathinone derivative included in the class of “New-Novel Psychoactive Substances”. Synthetic cathinones are marketed as “bath salts” or “plant food” and gained notable popularity for similar effects to 4-methylenedioxymethamphetamine (MDMA, ecstasy), or amphetamines. Mephedrone is commonly consumed simultaneously with alcohol.

The aim of the present study was to evaluate the interactions between mephedrone and ethanol in humans.

Twelve healthy male, recreational users of psychostimulants participated as outpatients in four experimental sessions. They received a single oral dose of mephedrone (200 mg) and alcohol (0.8 g/kg), mephedrone placebo and alcohol (0.8 g/kg), mephedrone (200 mg) and placebo alcohol, and both placebos. Design was double-blind, double-dummy, randomized, cross-over and controlled with placebo. Study variables included: vital signs (blood pressure, heart rate, temperature, and pupil diameter), subjective effects (visual analogue scales-VAS, ARCI-49 item short form, and VESSPA questionnaire).

The combination produced an increase in the cardiovascular effects of mephedrone and induced more intense feeling of euphoria and well-being in comparison to mephedrone and alcohol. Mephedrone reduced the drunkenness and sedation produced by alcohol.

These results are similar to those obtained with the combination of other psychostimulants as amphetamines and MDMA. Abuse liability of the combination is greater that induced by mephedrone.

The authors have not supplied their declaration of competing interest.

Since 2004, herbal mixtures for smoking use have been sold under the generic brand “Spice”. Many of them contain synthetic cannabinoids (agonists of the cannabinoid receptors). JWH-018 was one of the first spice drugs. There is no scientific evidence of their effects on humans, except cases of intoxications and users opinions.

The present study describes the presence of the synthetic cannabinoids JWH's and their characteristics in the samples delivered for analysis to the harm reduction NGO Energy Control from 2010 to 2014 in Spain.

From 15,814 samples analyzed from 2010 to 2014, those containing synthetic cannabinoids JWH's were studied (n = 47). Analysis was done by gas chromatography–mass spectrometry.

From these 47 samples containing JWH, 55% were delivered as “legal highs” (n = 21) and 44% as JWH. Most common presentations were powder 47% and herbals 32%. Samples containing JWH 45%(n = 21) were mixed with more than one kind of JWH or were adulterated and other active principles were found 28% (n = 13) JWH-018, 11% (n = 5) JWH-210, 8% (n = 4) JWH-081 and the 6% WH-250 (n = 3). Origin of the sample was Catalunya 23% (n = 11), other provinces of Spain 46% (n = 22); other EU countries 23% (n = 11) and internet-unknown country 8% (n = 8). From the (n = 47) samples, were delivered (n = 16) in 2012, (n = 12) in 2013, (n = 11) in 2011, (n = 3) in 2010 and (n = 3) in 2014.

JWH'S represent a low percentage of new psychoactive substances analyzed. Its presence in the market seems decreasing.

The authors have not supplied their declaration of competing interest.

Tobacco is a source of mineral elements that can affect human health in various ways, such as lithium, which is used as a psychiatric medication. Lithium salts are used as mood-stabilizing drugs and indicated in the treatment of manic-depressive psychosis.

Studying the lithium content in tobacco over the smokers’plasma content and evaluate the potential role of lithium in tobacco addiction.

A total of 18 different tobacco products (cigarettes, smokeless and water pipe tobacco) and 125 plasma samples (45 from smokers, 10 from ex-smokers and 70 from non-smokers) were collected to determinate the lithium content. Tobacco samples were digested with nitric acid and lithium concentration was measured by inductively coupled plasma-optical emission. The collected plasma samples were diluted 1/10 with a nitric acid solution and the lithium level was measured by inductively coupled plasma-mass spectrometry.

The average concentration of lithium in the cigarettes (16.59 ± 0.59 μg/g) was higher compared to those in the smokeless tobacco (8.39 ± 4.44 μg/g) and in the water pipe tobacco (6.13 ± 6.32 μg/g) but with no significant difference (P = 0.182). For plasma lithium levels, there was no significant difference (P = 0.186) between smokers and non-smokers (6.20 ± 6.24 vs. 4.98 ± 6.20 μg/g). However, a significant negative correlation was noted between plasma and the lithium content in tobacco products (r = –0.435; P = 0.04). The lithium plasma level was significantly and negatively correlated with the dependence score (r = –0.316; P = 0.031).

The correlation between plasmatic lithium and dependence score in smokers suggests that lithium would be involved in tobacco addiction probably through his regulating action of mood.

The authors have not supplied their declaration of competing interest.

To study the effectiveness of antidepressant sevpram (citalopram) and its combination with galavit (imunomodulyator) on a background of standard pharmacotherapy in heroin addiction. To evaluate the immune status of the following methods:

– evaluation of lymphocytes (CD4), (CD8) with monoclonal antibodies in cytotoxicity assay;

– determination of serum immunoglobulin classes A, M, G performed by turbidimetric analysis;

– the concentration of the CIK (circulating immunnokompleks) was determined by precipitation with polyethylene glycol.

Patients of the 1st group was administered into the sevpram 10 mg/day in combination with galavit (25 mg daily); group 2 – only the standard therapy (ST).

As a result of the treatment in the first group showed an increase of 34.8%) the number of immunoglobulin A, which however does not reach the level of healthy people and reducing the number of circulating complexes by 13.8%, which also indicates the normalization of this index. The first group – a significant improvement of immunological parameters increase of 3 indicators (CD4, CD8, CD4/CD8) and a decrease in the CIK. Analysis of changes in indicators Hamilton Rating Scale for Depression, also notes a reduction in the symptoms scores.

The authors have not supplied their declaration of competing interest.

Exercise addiction is characterized by increasing exercise amounts, withdrawal symptoms and lack of control. Eating disorders and exercise addiction often appear together, but only eating disorders are recognized as diagnoses. However, exercise addiction can exist independently from eating disorders and can be as harmful as any other addictive behavior.

The Exercise Addiction Inventory (EAI) is useful to identify exercise addiction symptoms in adults and prevalence rates of 3–10% have been found. But a scale for adolescents does not yet exist even though behavioral addictions seem to be more prevalent among young people.

To develop an instrument for identification of exercise addiction in adolescents and to estimate the prevalence and negative consequences.

We developed a Youth version of the EAI and screened 383 adolescents in sport settings and 69 patients from an eating disorder department (age range 11–20 years).

The psychometric properties of the scale were good (Cronbachs alpha 0.71). The prevalence of exercise addiction was 5.5% in adolescents in sport settings and 21.2% in eating disorder patients. We found a positive linear relationship between EAI-score and “high weekly exercise amounts” (r = 0.4, P = 0.00), “the tendency to exercise in spite of injury” (r = 0.4, P = 0.00), “feelings of guilt when not exercising” (r = 0.5, P = 0.00), “reduced sport performance related to overtraining” (r = 0.2, P = 0.00), and “food dominating life” (r = 0.2, P = 0.00).

On basis of this study, we recommend the EAI-Y for identification of exercise addiction in adolescents. Early identification is important since it can prevent excessive and obsessive exercise, injuries, reduced sport performance and eating disorder pathology.

The authors have not supplied their declaration of competing interest.

Novel psychoactive substances (NPS) use is progressively increasing year on year. The new analogues of phencyclidine are frequently sold as legal dissociative anesthetic drug with hallucinogenic and sedative effects, a legal alternative to ketamine, acting as a high affinity and selective ligand of NMDA receptor antagonists.

To describe the presence of 3- and 4-MeO-PCP in samples delivered to Energy Control from 2009 to 2015 in Spain.

A total of 21,198 samples were analyzed from august 2009 to august 2015. Only those samples containing 4-MeO-PCP or 3-MeO-PCP were studied. They were analyzed by Energy Control, a Spanish harm reduction NGO that offers the possibility of analyzing the substances that users report. Analysis was done by gas chromatography–mass spectrometry.

All the samples resulted to be the acquired drug of the consumer. Three samples were adulterated with substances as tramadol, cocaine, acetone among others.

Three and 4-MeO-PCP consumption is not found to be an emerging issue according to the results of our samples. Even the potential harmful effects of these dissociative drugs, our indirect indicator seems to show that consumption has not increased. A more precise monitoring would make a better approach to the real consumption and the impact of these substances in our society.

The authors declare that they have no competing interest.