Nalmefene may be helpful in the treatment of several other addictions by blocking the positive reinforcements of the drugs.

The authors have not supplied their declaration of competing interest.

Share psychotic disorder “folie à deux” is a rare condition characterized by the transmission of delusional aspects from a patient to another linked by a close relationship. We report the case of two Spanish men who have experienced a combined delusional episode induced by mephedrone.

Describe a case of share psychotic disorder induced by mephedrone. Make a review on scientific literature about the use of mephedrone (little is known about the psychiatric consequences of the use of these compounds). The patients had no psychiatric history.

Show the danger of these novel drugs that are often bought as apparently safe and legal.

Share psychotic disorder was first introduced by Lasegue and Falret who hypothesized that transmission of psychiatric disturbance from one person to another was possible under certain circumstances. The correlation of symptoms with the intake of these substances is supposed in the light of a negative psychiatric history and no other concomitant medical treatments. An important number of case reports documented deaths related to the ingestion of mephedrone. Another problem is that these substances are not detected by standard blood and urine test so that the diagnosis of intoxication is often delayed.

The authors have not supplied their declaration of competing interest.

The number of novel psychoactive substances (NPS) available is increasing. Synthetic cannabinoids (SC) are one of many NPS sold. SC aim to emulate the effects of natural cannabis by acting on cannabinoid receptors. Despite much research into pharmacology, there is limited data on the user experience of SC.

It is useful for psychiatrists, to understand what experiences people have whilst on illicit substances. The aim of this qualitative study is to gain an initial understanding of what characterizes the experiences of those who use SC.

Fourty anonymously written online reports were collected from the “Erowid experience vaults” and analysed using the Empirical Phenomenological Psychological Method.

The analysis yielded 488 meaning units (MU). These were grouped into 36 categories revealing 5 broad themes: (1) physical affects; (2) sensory distortions and distortions of perception; (3) emotional and psychological effects; (4) re-dosing, addiction and comedown effects; (5) similarities to other substances.

Synthetic cannabinoids have a mixed effect on users with a myriad of experiences reported. Some experienced positive results from their usage such as euphoria and relaxation, however these were counter balanced by those who experienced some serious negative emotional and physical side effects such as anxiety, paranoia, palpitations and convulsions. SC appear to often emulate that of their natural counterpart, yet there is an unpredictability to them which can end with serious consequences. Online forum content gives us a strong base understanding of users experiences of SC. Further research is required to elucidate a more nuanced understanding.

The authors have not supplied their declaration of competing interest.

Hallucinogen Persisting Perception Disorder (HPPD) is a syndrome characterized by prolonged or reoccurring perceptual symptoms, reminiscent of acute hallucinogen effects. HPPD was associated with a broader range of LSD (lysergic acid diethylamide)-like substances, including cannabis, MDMA (methylenedioxymethamphetamine), psilocybin, mescaline and other psychostimulants. Symptomatology mainly comprises visual disorders (i.e., geometric pseudo-hallucinations, halos, flashes of colours/lights, motion-perception deficits, afterimages, micropsy, more acute awareness of floaters, etc.), even though depressive symptoms and thought disorders may be comorbidly present.

Although HPPD was firstly described in 1954, it was definitely established as a syndrome in 2000 with the revised forth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). However, neuronal substrate, risk factors, aetiology and pathogenesis of HPPD remains still unknown and under investigation. Furthermore, there are still open questions about its pharmacological targets.

A critical review on psychopathological bases, etiological hypothesis and psychopharmacological approaches towards HPPD was here provided.

A systematic literature search on PubMed/Medline, GoogleScholar and Scopus databases without time restrictions, by using a specific set of keywords was here carried out. In addition, a case report was here described.

Pharmacological and clinical issues are here considered and practical psychopharmacological recommendations and clinical guidelines here suggested.

The authors have not supplied their declaration of competing interest.

Dandy Walker “syndrome” (DWS) was firstly defined by Dandy and Blackfan, and then described by Hart et al. [1] as a series of neurodevelopmental anomalies in the posterior fossa, including Dandy-Walker (DW) malformation, DW variant (cerebellar hypoplasia/aplasia of the cerebellar vermis and cystic dilatation of the fourth ventricle), mega-cisterna magna and posterior fossa arachnoid cyst. Mental symptoms have been associated with DWS in previous reports, but the spectrum of mental symptomatology widely varies between clinical cases, ranging from psychotic/schizophrenia-like to mood/cognitive symptoms [2].

Here we describe a case of psychosis and polydrug abuse in a 27-year-old man with DW variant a 4-year history of polydrug abuse, sporadic alcohol abuse, epilepsy and psychotic symptoms including delusions of reference/persecution, suspiciousness, associated with obsessive thoughts, mood lability and persistent anxiety.

He was recovered for a 28-day program of detoxification from drug addiction/stabilization of psychiatric symptoms. Family history of Bipolar Disorder, gambling disorder (father) and depression (mother). The mental status examination at baseline revealed slowness of thought, psychomotor retardation, aboulia/anhedonia/apathy/hypomimic facies/asthenia/social withdrawal/deflected mood/poor thought content/blunted affect/self-neglect/poor insight, cognitive impairment and oppositive and partially collaborative attitude and behaviour. Borderline intelligence activity was found on WAIS-R (IQ = 79). At the baseline, he was taking carbamazepine 400 mg BID (baseline serum level: 6.720 μg/ml), gabapentin (400 mg BID), paroxetine (20 mg/d), olanzapine (10 mg/d) and methadone (70 ml/d), with a poor response/control both on psychotic and seeking drug symptomatology.

References not available.

Further DWS clinical cases should be evaluated in order to better investigate the role of this variant to addictive and psychotic symptoms.

The authors have not supplied their declaration of competing interest.

The Norwegian Municipal Health Care Act opens for mandated treatment for persons with severe and life-threatening substance use disorder. This study aims to examine substance use related outcomes at six-month following in-patient treatment and to analyse factors associated with improved outcomes and abstinence.

This prospective study followed 202 hospitalised patients with SUD that were admitted voluntarily (n = 137) or compulsorily (n = 65). The European Addiction Severity Index was used at baseline and at follow-up to assess socio-demographics and substance use variables. Regression analysis was conducted to investigate factors associated with abstinence at six-month follow-up.

The frequency of use of preferred substance showed markedly improvement for both voluntary admitted (VA) and compulsory admitted (CA) patients (61% and 37% respectively) at follow-up. Seventy-five percent of VA patients using amphetamine reported improvement compared to 53% of CA patients. At follow-up, the CA group continued to have a higher rate of injection use. The CA group had experienced higher rates of overdose the past six months and lower abstinence rates (24% versus 50%) at follow-up. Lower severity of drug use at intake (non-injection drug use), voluntary treatment modality and higher treatment involvement during follow-up all were significant factors associated with abstinence at follow-up.

Voluntary treatment for SUD generally yielded better outcomes; nevertheless we found improved outcomes also for CA patients. It is important to keep in mind that the alternative to CA treatment in reality is no treatment at all and instead a continuation of life-threatening drug use behaviours.

The authors have not supplied their declaration of competing interest.

Although psychiatric diagnosis is based on the clinical features and the exclusion of associated medical conditions, in this case the workup provided support to our clinical suspicion, favouring recognition of the problem and willingness to treatment by the patient.

The authors have not supplied their declaration of competing interest.

To review the available evidence, after treat the case of a 50-year-old man with addiction history whose addictive behaviour worsened after undergoing bariatric surgery, with decreased tolerance to alcohol effect and increase of the intake, as well as changes in the graduation of alcohol used (including antiseptic). As a result, a dangerous revolving door that led him to repeated admissions, including Intensive Care Unit.

The case is consistent with the literature that suggests that there is an increased risk of later alcohol-related problems after bariatric surgery. This risk is higher several years post surgery, in patients with previous history of problems related to alcohol, young, men, and Roux-en-Y Gastric Bypass procedure.

The indications for bariatric surgery should thoroughly consider the history of addiction, an adequate assessment of the patient's mental status and psychoeducation about the possible psychiatric side effects, in order to develop preventive strategies.

The authors have not supplied their declaration of competing interest.

Comorbidity of depression and opioid addiction is highly prevalent, but their outcome in MMT is not consistent.

To compare between depressed and non-depressed MMT patients.

Hamilton depression scale scores (taken during a psychiatric assessment) were studied among MMT patients on admission or during treatment (cutoff for depression > 18).

A total of 498 MMT patients were studied. Depression proportion was 22.5%, and 23.2% among 263 who were studied on admission; the depressed vs. non-depressed on admission did not differ in female proportion (19.7% vs. 25.6%), age of admission (43.2 ± 10.4), opiate use onset (21.8 ± 6.3) and education years (9.5 ± 2.8), but had higher proportion of cocaine (55.7% vs. 35.1%, P = 0.005), and benzodiazepine abuse (73.8% vs. 58.4%, P = 0.04). Retention was high and similar (80.3 vs. 82.9% P = 0.7) and of those who stayed one year, cocaine and benzodiazepine were still higher among the depressed patients (cocaine: 43.8% vs. 23.2%, P = 0.03; BDZ: 61.2% vs. 40%, P = 0.01). Compared to the non-depressed, among all study group (n = 498) the depressed patients presented higher proportion of rape history (25% vs. 9.5%, P = 0.001), of suicide attempts (43.8% vs. 25%, P = 0.001) with only a trend of shorter cumulative retention in MMT of mean 9.4y (95% CI 7.8–10.7) vs. 11.5 (95% CI 10.5–12.5, P = 0.07).

Despite cocaine and benzodiazepine abuse on admission, depressed succeeded similarly to the non-depressed in the first year retention in treatment. Intervention is recommended since admission, as their long-term retention seems to be shorter, later on, and their ability to discontinue cocaine and benzodiazepine abuse is clearly hampered.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Pregabalin is widely used in neurology, psychiatry and primary healthcare, and recently in literature different studies explain the possible misuse [1,2]. Pregabalin has shown greater potency in preclinical models of epilepsy, pain and anxiety, and may have potential in the treatment of cocaine addiction [3]. The purpose of this report is to review the clinical evidence for the potential of abuse and misuse of pregabalin. We propose ten different cases and literature review.

Ten inpatients with misuse of pregabalin were assessed with: the SCID-P, Anamnestic Folio, HAM-A and DAST. We conducted a systematic review of the literature (PubMed, Embase, PsychInfo), using the terms “pregabalin”, “misuse”.

All our patients present: cocaine, alcohol and/heroin positive in drugs urine screening at admission; a significant high level of total anxiety at the HAM-A Tot (P < .001), and especially at the item 7 (P < .001); the misuse of pregabalin is made for sniffing; the predominant symptoms assessed were euphoria, psychomotor activation and sedation.

Schifano F et al., [1,2] suggest that pregabalin should carefully prescribe in patients with a possible previous history of drug abuse. Our result identifies a particular population the misuse pregabalin that are abuser of cocaine, alcohol and/or heroin. Further research is warranted to replicate our clinical and qualitative observations and, in general, quantitative studies in large samples followed up over time are needed. Methodological limitations, clinical implications and suggestions for future research directions are considered.

The authors have not supplied their declaration of competing interest.

Alcohol dependence (AD) is a major public health problem. Currently, three drugs for the treatment of AD have been approved: acamprosate, disulfiram and oral naltrexone. Quetiapine XR is an atypical antipsychotic has been shown to be a promising medication for the treatment of alcoholism [1,2]. The aim of our study is evaluate quetiapine efficacy on impulsivity in a sample of alcoholic patients.

A sample of alcoholic patients (n = 40) was assessed at the entrance and 2 months with: SCID-P, Brief-Temps, BIS-11, GSR, BPRS, SCI-DER, and CGI. The medium dosage of quetiapine is 300 mg.

Using the last observation carried forward, the mean total BIS score decreased from 60.8 at baseline to 40.2 at the final visit (P = .03). More pronounced improvement was observed in motor impulsiveness (P < .03) and attentional impulsiveness (P < .05) compared with non-planning impulsiveness (P = .09). We observed an improvement in SCI-DER total score (P = .02), in particular in derealization (P = .03) and autopsychic depersonalization (P = .04). A mean weight gain of 4.8 kg was observed. There is not significant different related to the different affective temperament.

Analyses revealed a significant effect of Quetiapine XR in improving impulsivity and dissociation, in particular motor and attentional impulsiveness, derealization and autopsychic depersonalization. Moreover, an improvement of dissociative symptoms is probably connected with the blockade of postsynaptic 5-HT1A receptors [3]. Methodological limitations, clinical implications and suggestions for future research directions are considered.

The authors have not supplied their declaration of competing interest.

Methylphenidate is a CNS stimulant approved for treatment of ADHD. It is generally considered well tolerated and exhibiting low dependence potential, although diversion for recreational use has been described. Provided that its effects are comparable to those of more popular drugs of abuse, such as cocaine and amphetamines, we hypothesized that it could be sold as such.

The aim of this study was:

– to describe the presence of methylphenidate from the samples handled to, and analyzed by, Spanish harm-reduction service energy control between August 2009 and August 2015;

– to determine whether it is being sold as other drugs.

All samples presented to energy control (EC) were analyzed. EC is a Spanish harm-reduction non-governmental organization that offers to users the possibility of analyzing the substances they intend to consume.

Samples in which methylphenidate was detected using Gas Chromatography–Mass Spectrometry were selected for this study.

From a total of 20062 samples, 17 contained methylphenidate (0,09%), with no clear variations among the years studied. The samples were mostly sold as amphetamine (29%), methylphenidate (23%) and ethylphenidate (18%).

Presence of Methylphenidate in the Spanish illegal drug market seems anecdotic and stable over the studied timeframe. Moreover, it was sold as substances with similar dosages, lowering potential for life-threatening intoxications. Therefore, our results suggest that diversion of methylphenidate into the drug market as adulterant is not a concerning phenomenon.

The authors have not supplied their declaration of competing interest.

Buprenorphine, a partial agonist of mu opioid receptors and an antagonist at kappa opioid receptors, is widely used in the treatment of the opioid addiction, as it reduces cravings and effects of opioid withdrawal, decreases opioid consumption and diminishes rewarding effects of it. In University Psychiatric Hospital Vrapče, the oldest psychiatric hospital in Croatia, buprenorphine maintenance therapy is a standard and important part of integrative psychiatric treatment offered to opioid drug users.

To show potential benefits of buprenorphine maintenance therapy as a pharmacological agent in psychiatric care for opioid drug users.

To describe series of clinical cases in which the introduction of buprenorphine in therapy of opioid drug users lead to reduced number of their hospitalizations.

Clinical cases from University Psychiatric Hospital Vrapče Addictions Treatment Department were identified and the course of patients’ treatment was analyzed. Summaries of cases, with the emphasis on protective factors for stabile maintenance, are presented.

After switching patients from various opiates to buprenorphine in a controlled in-patient environment, our patients became more functional and their integrative psychiatric treatment could then start. After discharge, an improvement was visible in different dimensions of their lives, and the re-admittance was the exception, since recidives were rare. They continued their treatment actively, in outpatient programmes of our clinic.

Drug-seeking behaviour of presented opioid users was avoided by buprenorphine maintenance therapy provided with intermittent psychotherapeutic interventions or usual psychiatric support in aftercare. In our experience, such integrative psychiatric care prevents re-admittances and recidives.

The authors have not supplied their declaration of competing interest.

Emerging drugs are a growing problem, of which we have little information and clinical experience and pose a challenge in everyday clinical practice because many are not detectable with the test at our disposal and its effect on cognition and behavior are not well known.

Conduct a thorough literature review of all the material in this regard has been published both in high impact journals and in the last International Congress of Dual Pathology.

There are many and varied new substances used for harmful/abuse consumption mainly for their sedative effects and/or hallucinogens, easily accessible since many are easily purchased online or can even be easily obtained at any pharmacy without a prescription.

There are more and more often consumed new substances with high harmful potential and very easy to obtain. It is therefore essential knowledge to identify, treat and educate not only our patients but to the general population.

The authors have not supplied their declaration of competing interest.

The most common psychiatric disorders associated with substance use in patients with dual diagnosis, personality disorders are followed by schizophrenic disorder. Among the substances used in patients with dual diagnosis, stands cocaine, followed by cannabis and alcohol.

Evaluate the differences in the frequency of sex for cocaine and cannabis consumed in a sample of patients undergoing follow Mental-Health Center for Drug Dependency Unit.

We conducted a cross-sectional study and analyze the differences by gender for the frequency and pattern of cocaine and cannabis, in a sample of patients in treatment at the Mental-Health Center for a year to present dual pathology.

There are significant differences in the frequency of cocaine use among men and women. Eight percent of men use cocaine compared to 0% of women. This monthly cocaine use is more common in women than in men at 45.5% versus 21.8%. Of women, 27.3% use cocaine fortnightly, which is not typical for men (0% of men in the sample). The weekly use of cocaine represents 55.2% among men compared to 27.3% of women.

There are no significant differences in the frequency of cannabis use among men and women. Both sexes consume cannabis daily.

The monthly cocaine use is more common in women. In men the most common is the use of cocaine weekly.

In both sexes cannabis use is more common daily.

The authors have not supplied their declaration of competing interest.

Cocaine use is prevalent in mental health consultations in both sexes. However, in men and women there are differences in the frequency of use of substances and on the employment situation.

Show the differences for the use of cocaine and employment status of men and women, in a sample of patients followed at the Mental Health Center in Drug Dependency Unit.

We conducted a cross-sectional study and analyze the differences according to sex for cocaine use and the employment situation, in a sample of patients who are undergoing treatment at the Mental Health Center for a year diagnosed with dual pathology.

In men in active employment status, the percentage of cocaine use is 19.5% and if we compare with women in the same job situation, the percentage of cocaine use is 0%.

Men who are unemployed use more cocaine than women in the same job situation. For retirees, the highest percentage of cocaine is found in women.

Hundred percent of women use cocaine by sniffing. Men use different ways of cocaine consume.

Snorted way 67.7%, 14.9% smoked and snorted, smoked 8% and 2.3% intravenous.

Men use cocaine more frequently unemployed while women do more it often being retired.

The route most used cocaine consume in both sexes is snorted.

The authors have not supplied their declaration of competing interest.

Alcohol use is a common behavior in most people in our society. A first episode of alcoholism can be fully recovered through specialized treatment and other protective factors and need not become a relapse later.

Whether there are differences in alcohol use after 1, 3 and 6 months after the administration of paliperidone palmitate extended-release injectable suspension in a sample of patients.

This is a descriptive study that analyzed the differences observed with respect to alcohol use after administration of paliperidone palmitate in a sample of 98 patients attending in a Mental Health Centre, in the Unit for drug dependency to present pathology dual.

The percentage of alcohol use at baseline is 56.1% of the total sample.

One month after treatment with paliperidone palmitate the percentage of use is reduced to 31.6%. At 3 months of treatment the reduction is more significant assuming only the 6.1% of the total sample. Finally after 6 months of treatment the percentage of patients maintaining alcohol use is 4.1%, which represents a 52% reduction compared to the initial rate of use.

The data reflect a 92% reduction in alcohol use after 6 months of the administration of paliperidone palmitate.

We can say that paliperidone palmitate is effective in reducing alcohol use in patients with dual diagnosis.

The authors have not supplied their declaration of competing interest.

Substance use disorder is a growing phenomenon among the elderly. It is undervalued, misidentified, underdiagnosed and poorly treated.

Study prevalence, characteristics and risk factors associated with drug use among the elderly.

A 6-month prospective study of substance use in elderly patients (65+) who attended the addiction and dual diagnosis unit, Vall d’Hebron University Hospital.

Fifty-nine patients evaluated, mean age 70.04 years, 60% men. A total of 49.1% are married, 35.8% divorced and 53.8% live with a partner and/or children. A total of 67.3% have basic studies and 78.8% are pensioners. A total of 82.7% have no criminal record.

Medical comorbidity presents in 90.4% of the sample, psychiatric and addictive family background in 42.3% and 37.3%. A total of 67.3% have comorbid Axis I (mainly affective disorders) and 25% Axis II (cluster B most). A total of 7.7% attempted suicide at least once.

The main substance is alcohol (76.9%), followed by prescription drugs (19.3%). A total of 28.8% are multi-drug users. A total of 67.3% have used tobacco in their life and 63.5% are currently dependent. The average age of onset for a disorder for any substance consumption is 28.19, being lower for alcohol and illegal substances and higher for prescription drugs.

A total of 61.5% have gone through treatment before but only 32.7% has been admitted because of addiction. The adherence rate is 90.4% and the relapse rate 8.3% at first month and 13% at 6 months.

Old adults present differences compared to overall drug user population: prevalence by gender is almost equal, lower Axis II, less multi-drug consumption and both dropout and relapse rate are drastically lower.

The authors have not supplied their declaration of competing interest.

Dual diagnosis (DD) is the coexistence of a Psychiatric Disorder (PD), and Substance Use Disorder (SUD). The increase of DD observed in recent years has caused serious problems to both public and private services organization.

Our aim is to assess the prevalence and features (including clinical and sociodemographic ones) of DD over a decade, comparing the period 2003–2004 and 2013–2014.

We performed a retrospective study retrieving the medical records of DD patients at their first admission to the Psychiatry Ward AOU “Maggiore della Carità”, Novara, Italy. Sociodemographic and clinical features were recorded. The two groups of patients (2003–2004 vs. 2013–2014) were compared.

In both periods DD patients are usually Italian male, aged 19–40, single. They have usually attended middle school, live with parents, have two or more brothers and/or sisters but no kids. DD patients in 2003–2004 and 2013–2014 showed differences as far as employment and diagnosis are concerned. The first were more frequently employed than the latter: moreover the 2003–2004 patients were more frequently diagnosed with a personality disorder while the 2013–2014 patients had mixed diagnoses. We have found differences in the possible predictors of substance abuse in the two periods, as well.

The identification of changes in the prevalence of first admission DD patients and their clinical and sociodemographic features may help to highlight an evolving pattern of substance use and to identify possible risk factors which may be the target of prevention and treatment approaches.

The authors have not supplied their declaration of competing interest.