The authors have not supplied their declaration of competing interest.

The current situation in Ukraine is characterized by multitude social-stress factors, resulting in an increase in alcohol consumption and alcohol addiction, which arises as a mechanism to compensate the adverse mental stress and different variant of chronic stress disorder.

Substantiate the neurobiological basis of mutual influence of stress burden and alcohol addiction.

To study the biochemical mechanisms that underlie the vicious circle of stress and alcohol addiction.

Studies the features of hypothalamic-pituitary-adrenal (HPA) axis under stress and alcohol available in Medline, Institute for Scientific Information Databases (Science citation index expanded and Social sciences citation index), EMBASE, and Cochrane Library were identified and reviewed.

Alcohol, just like stress, affects the HPA axis, changing the reaction of its parts and, by reducing the production of cortisol, which produces in response to stress and prolongs subjective experiences of nervous tension caused by stress. Stress, through the output of cortisol, reduces the effect of alcohol leads to a desire to further alcohol abuse. The system includes elements of the extended amygdala, which have as reinforcement and stress reactivity. Central nucleus amygdala plays a leading role in the reinforcing effects of pharmacological agents with narcogene potential and performs persuasive role in the activation of hypothalamic reinforcement mechanisms. This allows us to consider neurohormonal system, including the amygdala, hypothalamus, pituitary and adrenal glands as structural and functional basis of formation depending on various narcogene, primarily alcohol.

Dysregulation of the HPA axis is a neurobiological basis of mutual influence of stress burden and alcohol addiction.

The authors have not supplied their declaration of competing interest.

The potential adverse consequences, personal distress, shame and guilt presented by patients who suffer from codependency require a more in-depth understanding of the phenomenology of this disorder.

To determine targets of psychotherapy work with the codependency wives of men with alcohol dependence (AD).

To determine the features of clinical manifestations of codependency as a model of health disorders associated with stress.

Integrated clinical-psychopathological and psychodiagnostic research, using anxiety and depression scales M. Hamilton, scale of psychosocial stress L. Reeder and methods for determining stress and social adaptation of Holmes and Rahe.

One hundred and sixty wives of men with AD, depending on the type of AD (TF Babor's classification), were divided into two groups: group A, 80 patients with AD type A and 80 their wives, and group B, 80 men with AD by type B TF Babor, and 80 wives. Comparison group consisted of 50 married women whose husbands are not suffering from AD.

All the wives of men with AD distortions emotional state of the prevalence of pathological manifestations of depression and anxiety clinically delineated levels and high levels of psychosocial stress and low stress, unlike women men without alcohol problems. It was found that the more severe psychopathological manifestations occurring in the wives of men with a family history, burdened alcohol and drug abuse (group B).

Available data suggest that a single mechanism of family experiences a stressful situation, we were put in the basis for developing a comprehensive treatment measures and psychotherapeutic support codependent wives patients with AD.

The authors have not supplied their declaration of competing interest.

Use of the Internet lately has significantly been increased worldwide. The time users spend browsing the Internet is constantly increased resulting to serious consequences incurred in personal, professional and social life.

The purpose was to explore whether the economic crisis is affecting the use and addiction to Internet, whether the economic crisis is a risk factor in the appearance of addiction to the Internet and if the occupation and the existence of extra-curricular activities act as barriers to the development of addiction to the Internet on students.

A questionnaire was prepared based on the diagnostic tool IAT (Internet Addiction Test). The survey was conducted in June of 2014 on 632 students.

It was found that 6.2% of the sample population has moderately addictive behavior and 0.5% has a serious addiction. Addiction levels to the Internet are affected by someone working while studying and his monthly income, by daily time spent by the student in activities besides school, by the time spent daily on the Internet and by the operations mostly used. Also found that the risk of developing Internet addiction is higher among students who said they had difficulty paying their bills and Internet subscription and to those who due to economic crisis would stop all their activities in order to obtain money.

The economic crisis is a factor that affects on Internet addiction and occupation and activities may act as a deterrent to the emergence of the phenomenon.

The authors have not supplied their declaration of competing interest.

In 2013, the American Psychiatric Association included Internet Gaming Disorder in the appendix of the 5th edition of the DSM-5, suggesting more research is necessary for the condition to be officially accepted as mental disorder. Criticisms have emerged as to the viability, validity and reliability of the proposed condition, and researchers have pointed out that the subsuming of Internet addiction under the umbrella term of Internet Gaming Disorder (as is the case in the DSM-5) is highly problematic.

The objective of this talk is to provide a comprehensive and inclusive analysis of clinical research of Internet-use related addictions from a holistic perspective, given the ambiguity of previous research in the field.

A systematic literature review was conducted using the database Web of Science, and a total of 44 empirical and clinically relevant studies were identified.

Results indicated that the published clinical research studies can be categorized into four areas, including (i) treatment seeker characteristics, (ii) psychopharmacotherapy, (iii), psychological therapy, and (iv) combined treatment, each of which will be discussed.

At the present day, both diagnosis and research of Internet-use disorders appears rather broad. Furthermore, there appears a need for developing a gold standard of clinical assessment. This will support the establishment of efficacious and effective treatments which need to be tailored to the individual help seekers’ needs.

The authors have not supplied their declaration of competing interest.

Physical comorbidities are common in patients with concurrent mental illness and substance use disorder. Interventional studies addressing health promotion for this group of patients are scarce.

To examine the physical health condition of a non-selected group of patients with substance use disorder comorbid to other psychiatric disorders. Further, to analyze for possible changes in their health condition during a two-year intervention study in relation to physical measures and substance use. Finally, to analyze for possible associations between changes in physical measures and in substance use.

The patients were enrolled in the project continuously from October 2013 through May 2015. Physical health measures were obtained at the enrolment date and continuously as part of daily clinical practice. Interventions consisted of individual consultations with a research nurse, group sessions and an opportunity to do physical exercise together with the research nurse. Interventions included health promotion activities, i.e. guidance on healthy food intake, smoking cessation and a physically active life.

In total, 64 patients (mean age 32.7 years, SD 10.7) were included in the study. Patients were mostly diagnosed with psychotic disorders (11%), affective disorders (44%) or developmental disorders (34%). Baseline measures showed that 89% of the patients smoked cigarettes daily, 61% had used cannabis and 20% had used amphetamines within the past month. Further, few patients did moderate or vigorous physical exercise. Further results are in progress.

These interventions seem relevant and manageable in an outpatient setting.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Use of prescription psychostimulants and nootropics for non-medical purpose is a growing trend, especially in academic environment. Seeing the risks of neuroenhancement we decided to investigate situation in Lithuania.

Analyze the use of cognitive enhancers among medical students in Lithuania.

1. Determine the prevalence of cognitive enhancement. 2. Figure out what drugs are mostly used and reasons for the usage. 3. Evaluate the contributing factors.

A cross-sectional survey study was performed in Vilnius University and Lithuanian University of Health Sciences. Students were asked to fill anonymous paper questionnaires consisting of 13 items concerning prevalence of substance use to enhance cognitive performance, reasons, and correlates during lecture time.

Results are summarized in Table 1. A total of 8.1% of responders indicated that they had used cognitive enhancers. Nootropics were the most frequently mentioned: 59.6%, while psychostimulants were mentioned less frequently: 38.3% (including modafinil, methylphenidate and amphetamine derived drugs), and 23.4% indicated other substances. Improvement of concentration and increased studying time were predominant purposes (55.3% and 48.9% of users). Male students reported 3 times higher prevalence rates than females (14.6% vs. 5.1%, P < 0.05). Prevalence were also higher in students, who knew someone using these substances as compared to those who did not (17.3% vs. 5.1%, P < 0.05); it was the most associated factor with cognitive-enhancing drug taking behavior (Table 1).

In Lithuania, 1 of 12 medical students admits to having used neuroenhancing drugs. Nootropics were the most used drugs. Knowing user was the most important factor for usage.

The authors have not supplied their declaration of competing interest.

Exercise addiction is characterized by increasing exercise amounts, withdrawal symptoms and lack of control. Exercisers with addiction continue to exercise in spite of pain and injury because they use exercise to regulate emotions, identity and self-esteem. How do they react to injuries?

It is hypothesized that exercise addiction is a risk factor for emotional distress when an injury occur due to withdrawal symptoms and lack of identity.

To estimate the prevalence of exercise addiction in exercisers with injuries at the musculoskeletal system and to test the relationship between addiction and emotional distress (depression and stress).

The Exercise Addiction Inventory was used to identify exercise addiction. To measure depression and stress we used the Major Depression Inventory (MDI) and the Perceived Stress Scale (PSS). Participants (n = 694) were regular exercisers with injuries at foot, knee or shoulder at an orthopedic hospital department.

The prevalence of exercise addiction was 7.6%. We found that exercisers with addiction reported more emotional distress in terms of higher MDI-scores 18.0 (SD = 11.0) versus 11.7 (SD = 9.1); P = 0.00 and in total PSS-score 17.6 (SD = 7.2) versus 13.9 (SD = 6.8); P = 0.00. Chi2 analyses showed that 25% of the addicted exercisers met the criteria for clinical depression, while only 11% of the non-addicted exercisers were depressed; P = 0.00.

Exercisers with addiction appear at somatic departments treating musculoskeletal injuries. It is a vulnerable group characterized by elevated levels of depressive symptoms and clinical stress. We recommend to offer psychological interventions focusing on emotional distress and prevention of re-injury by reducing excessive and obsessive exercise patterns.

The authors have not supplied their declaration of competing interest.

Studies describe patients with dual pathology as subjects with worse clinical evolution and worse therapeutic response. These subjects have high percentages of worse therapeutic compliance and low adherence to psychopharmacological treatment. The conventional antipsychotics can induce dysphoria and worse craving and drug use. The long duration-injectable antipsychotics could serve as a good therapeutic alternative because they combine efficacy and tolerability.

We analyzed subjects treated with aripiprazole injectable to demonstrate its effectiveness on symptomatology, the reduction of craving and consumption of substances.

We studied subjects with dual disorders at a Center for Attention to drug addicts treated with aripiprazole extended-release injectable. All of them met criteria for the diagnosis of disorders for cannabis and cocaine use. All of them had been previously treated with oral antipsychotics and/or injectable of long duration. Evolution of craving and consumption were evaluated through clinical interviews and urine analysis.

Cannabis was the main substance for all the patients. Three of them also often abused of cocaine. All of them were taking other treatments previously. The main causes of the change were: side effects and/or poor compliance. Only one patient discontinued follow-up. The rest of them showed good therapeutic adherence and better tolerability with aripiprazole injectable. The monthly dose was 400 mg.

Aripiprazole extended-release injectable is a good choice for dual disorders. A good therapeutic adherence involves not only a psychopathological improvement but also respect to craving and consumption, which makes aripiprazole injectable a suitable therapeutic option.

The authors have not supplied their declaration of competing interest.

Alcohol abuse causes dopamine release in the mesolimbic system, which activates the reward circuit. This is linked to an interdependent opioid, serotonergic and endocannabinoid system. Nalmefene is a modulator of the endogenous opioid system, with antagonistic effect on mu and delta receptors, and a partial agonist activity kappa. This means that reduces the reinforcing effects of alcohol consumption through the cortical-mesolimbic system. Therefore, when a patient takes nalmefene, the satisfaction obtained when he drinks is lower, which increases the possibility to have more control over drinking.

The efficacy of nalmefene was evaluated in two profiles of patients: 1. No abstinence in alcohol dependence disorder and continuous relapses, 2. Cocaine dependence disorder associated to alcohol abuse.

Improving the quality of life and compliance rates due to the difficulties of following a strict treatment to achieve the abstinence. Furthermore, in cases of patients with cocaine dependence disorder and alcohol abuse, the objective is to avoid cocaine use by reducing previous alcohol consumption.

nalmefene offers the possibility of treating the addiction from a new perspective. Our current clinical experience has been able to treat subjects with conventional treatments failures and those who need to achieve the necessary control to reduce cocaine use.

The authors have not supplied their declaration of competing interest.

Aripiprazole is the firstborn of the new dynasty of antipsychotic called third generation or neuromodulator of dopamine-serotonin system. It has proven to be an effective and well-tolerated antipsychotic. Dual Pathology represents the presence of comorbidity between mental illness and substance use disorders. It is an under-diagnosed problem and it is increasing frequency.

The aim of this study was to determine and describe the clinical profile of the patients admitted to the Dual Pathology Unit (UPD) at The Montalvos Hospital (Part of Salamanca University Teaching Hospital, Spain) treated with oral Aripiprazole.

Descriptive, observational, retrospective study of a sample of patients admitted to the UPD to which oral aripiprazole was prescribed during hospitalization. A number of sociodemographic, clinical, and treatment-related variables are described.

From a sample of 25 patients and according to DSM-5 criteria (APA, 2013) main diagnoses were: 14 cases of substance-induced psychotic disorder, 3 cases of schizophrenia; 3 cases of schizoaffective disorder; 2 cases of bipolar disorder; 1 case of schizophreniform disorder; 1 case of borderline personality disorder; 1 case of personality syndrome. The most used drugs before the admittance were cocaine, cannabis and opioids. The average dose of aripiprazole was 9 mg and no side effects or drug interactions were reported.

Apart from its well known efficacy in treament of psychosis, oral aripiprazole may be a first line treatment for Dual diagnosis patients, specially those with problems of non-compliance, due to high level prolactine side effects.

The authors have not supplied their declaration of competing interest.

Dual Diagnosis (DD) refers to coexistence of a psychiatric disorder, which is often a Personality Disorder (PD), and a Substance Use Disorder (SUD). Despite DD is a topic of interest in recent years, few studies have focused on the temperament and character traits of PD patients with or without a comorbid SUD. Anyhow, the assessment of personality traits may be helpful to understand the relation among psychiatric disorder, drug use and environment in patients with addictive behaviors.

The aim of this study is to compare two subgroups of PD patients, with and without a comorbid SUD. Sociodemographic, clinical and personality profile, as assessed with the Temperament and Character Inventory, will be compared.

We are recruiting patients with a PD diagnosis referring either the psychiatry ward or outpatient service of the AOU “Maggiore della Carità”, Novara, Italy; secondly, we will group them according to the presence/absence of SUD. Cloninger's TCI-R will be administered together with a structured interview to gather sociodemographic and clinical information.

Data collection is ongoing; we expect to find a different personality profile in PD and DD Patients.

Temperament, which is the biological part of the personality, seems to have an important role in addictive behavior; therefore assessing the personality traits of DD patients can help to improve the differential diagnosis and to establish strategies for treatment and prevention. In particular, sensation seeking and impulsivity are temperamental characteristics that may favor SUD in patients with psychiatric disorders.

The authors have not supplied their declaration of competing interest.

The American Psychiatric Association introduced in Internet Gaming Disorder (IGD) in the appendix as a tentative disorder in the last edition of the Diagnostic and Statistical Manual of Mental Disorders. However, currently no systematic review exists about excessive gaming viewed from a clinical perspective.

To review clinical studies on gaming addiction in order to ascertain characteristics of both clinical and research studies to provide retrospective evidence in relation with the proposed IGD classification (including criteria, measures and therapies).

A systematic literature review of studies published from 1980 to 2015 has been conducted using three major psychology databases: Academic Search Complete, PsycInfo, and PsycArticles. A total of 5033 results from peer-reviewed journals were obtained, where 32 were identified as empirical clinical papers focused on gaming addiction.

The clinical research studies on gaming identified were published between 1998 and 2015, most of which included patient samples. Categorizations identified in the research papers included: (i) patients’ characteristics (e.g., socio-demographics), (ii) criteria and measures used (e.g., scales to diagnose), (iii) types of gaming problems (e.g., game genre), (iv) and treatments (e.g., type of therapy).

Findings will be discussed against the background of the controversial IGD diagnostic criteria proposed in the DSM-5 in order to assess the extent to which previously published clinical knowledge matched the current proposal for including gaming addiction as behavioral addiction in the next diagnostic manual.

The authors have not supplied their declaration of competing interest.

A 25-year-old man was attended in multiple times at Emergency Department by referring abdominal pain and vomiting. No organic disease was found and he was referred to Psychiatric Emergency to assess him. He had history of cannabis use (4–5 times/day) during last 5 years. He referred recurrent episodes of abdominal pain and vomiting since 4 years ago, he had found that having hot showers alleviate his symptoms. Urine screening was positive for THC and negative for other drugs. In results of blood tests, abdominal X-ray, abdominal ultrasonography, abdominal tomography and fibrogastroscopy didn’t find any abnormality. He was diagnosed from suffering a somatoform disorder. Treatment with Setraline 50 mg/day was prescribed and cannabis abstinence was recommended. He was referred to Mental Health outpatient service. He maintained cannabis abstinence for 1 month and some symptoms disappeared. However, 2 months later, he relapsed in cannabis use and all symptoms reappeared. Later he achieved cannabis abstinence again and he got full recovery, then he was diagnosed from cannabinoid hyperemesis syndrome.

Cannabinoid hyperemesis syndrome is characterized by recurrent nausea, vomiting and colicky abdominal pain in patients with long-term cannabis use. These symptoms have been reported to be alleviated temporarily by taking a hot shower or more permanently by abstaining from the use of cannabis. The phenomenon of cannabinoid hyperemesis and clinical diagnosis remained obscure until recently. For this reason, it is necessary to take it into account in order to recognize it and help provide these patients early and better approach.

The authors have not supplied their declaration of competing interest.

It is well known that certain personality traits are more linked to drug abuse than others. Psychiatrists are more likely to emphasize the importance of impulsivity in the connection with substance disorders but in the following study we found an important percentage of patients that have a substance abuse were linked to anxiety through impulsiveness as a personality trait.

Most youths admitted for a substance abuse are highly impulsive. Our quest was to differentiate what component of impulsivity was more frequently linked to a substance use disorder.

In the study were included 50 patients admitted in the 3rd Psychiatric Clinic, Substance Dependences Department, Cluj-Napoca. For the identification of the drug abused we used the multitest screening kit in correlation with the results from the Forensic Medicine Institute of Cluj-Napoca. Each patient completed the Barratt Impulsivity Scale and the Swedish Universities Scales of Personality.

High scores on BIS-11 strongly correlated with attentional impulsiveness (Pearson's r correlation = .838) which means high inattention and cognitive instability this being linked with anxiety disorders. Cognitive Instability was correlated with Psychic Trait Anxiety (r = 0.29) and Motor Impulsiveness with Somatic Trait Anxiety (r = 0.3). Normal 0 false false false EN-US X-NONE X-NONE.

The underrecognized anxiety disorders in young adults whom are admitted for an addictive disorder prefrontal cortex is known to be the source of both impulsivity and could be linked to anxiety as well (valence asymmetry hypothesis). Normal 0 false false false EN-US X-NONE X-NONE.

The authors have not supplied their declaration of competing interest.

Range of drugs has largely increased the past few years, especially with the emergence of the New Psychoactive Substances (NPS) sold online. In front of serious risks they cause on human health, they are more and more regulated by the law.

To describe cases of extreme behavioral disorders and highlight risks of potential forensic complications linked to these consumptions.

We present a case series of serious auto or hetero-aggressive behavioral disorders related to NPS abuse and notified to the Parisian addictovigilance center.

Twenty cases were identified between 2010 and 2015. Users were exclusively men, with mean age of 35.5 years (min: 20, max: 51). Synthetic cathinones are the predominant class of reported NPS (65%). An association between NPS and sexuality is found in 60% of cases (12); among them cathinones are used by 11 men. We observed 6 deaths among which, 5 were associated to sexual practice. Two cases of consumptions of cathinones induced torture and barbarian acts. Concerning aggressive behavioral disorders, we quote 3 cases of hetero-aggressivity (one by stab wound and 2 others developed an hypersexuality ± exhibitionism) and 9 cases of auto-aggressivity characterized by genital mutilations (1), defenestration (3), suicidal attempt (3), and acute psychiatric disorder with endangering life (2). Only four cases have been confirmed by toxicological analysis.

Behavioral disorders inducing forensics complications exist with NPS and particularly with cathinones. The problematic is certainly undervalued. A collaboration between addictovigilance and forensic services has to be improved.

The authors have not supplied their declaration of competing interest.

Describe the distinguishing characteristics between patients with early onset of alcohol use (EARLY, age < 15) and late onset of alcohol use (LATE, age > 16), both affected of acute non-substance use psychiatric disorders (non-SUD) and any substance use disorder admitted in a dual diagnosis unit.

Data on demographic, family, and clinical factors were gathered among subjects admitted to our dual diagnosis unit along three years, all of them meeting DSM-IV criteria of any non-substance related Axis I or II disorder and comorbid substance use disorder (SUD). Statistical analysis was performed by using SPSS program.

We show results of 748 patients (437 of EARLY group and 311 of LATE group). Predominantly male (73,53%) with a mean age of 39,60 ± 9,7 years. Most prevalent non-SUD psychiatric disorders were psychotic disorder (39,97%) and personality disorder (39,30%). In our sample, most common substances of abuse were Alcohol (45,05%) and Cocaine (30,35%). EARLY patients had an earlier first contact all substances as well as an earlier age of problematic consumption of cocaine, alcohol, opioids and nicotine; they also had major prevalence of opioid SUD, sedatives SUD and amphetamines SUD (see Tables 1, 2 and 3).

Patients who began earlier their consumptions of alcohol had major prevalence of opioid, sedatives and amphetamine use. They also had earlier consumptions of other substances and earlier problematic consumptions of cocaine, alcohol, opioids and nicotine, what probably means greater severity of drug addiction in the long run.

The authors have not supplied their declaration of competing interest.

Changing cultural values and increasing economic stress are leading to initiation into substance use. Despite religious and legal constraints on Muslims against the consumption of drugs, drug addiction is a widespread problem and is destroying the lives of many individuals and families, in Tunisia.

To examine the socio-demographic characteristics of Tunisian addicts and to identify the drugs commonly used.

This was a cross-sectional study, which included 200 patients at the addiction treatment center “Aide et Ecoute” in Sfax (Tunisia). The survey was conducted during the month of January to September 2014.

Only males were found to get treatment in the addiction center for various addictions. The mean age was 33.32 years and the mean age for starting substance use was 17.30 years. More than half (65.9%) were not married and 59.5% had involvement with criminal justice. Substance dependence was commonly seen in poor and middle socioeconomic class. The most common substance used was buprenorphine (34.8%). There was a significant relation between buprenorphine consumption and immigration (P= 0.013). Peer pressure was one of the most important factors for trial of substance in our study.

As the mean age of initiation of substance abuse was early twenties, in liaison with schools and colleges, some recreational activities can be generated to prevent diversion of youth towards the devil of drug abuse.

The authors have not supplied their declaration of competing interest.

Zolpidem is a non-benzodiazepine hypnotic drug for treatment of insomnia and is generally believed that is a safe medication. Therefore has been introduced as a lower potential agent for dependency and abusive effects however its safety and dependence potential are of great concern.

A 63 years old male patient had consulted a general physician in January 2015 for his insomnia. He started on zolpidem 10 mg at bedtime. Over the next few months he had gradually increased the dose as he found the prescribed dose to be having no significant effect. After abrupt discontinuation of zolpidem, he presented to a center for drug users “AIDE ET ECOUTE” with severe anxiety, impatience, loss of energy, insomnia, irritability, headaches, and increased craving for higher dosage of zolpidem. There was no history of any other substance abuse and he was diagnosed simultaneously a case of zolpidem dependence and major depressive disorder.

Zolpidem has a potency to be abused with high risk of dependency and withdrawal syndromes particularly among elderly patients with comorbid anxiety and depressive disorders.

The authors have not supplied their declaration of competing interest.