Anabolic-androgenic steroids (AAS) are synthetic derivatives of steroids which are frequently utilized in order to increase muscle mass and strength. Estimates of AAS abuse vary according to different studies. However, a global lifetime prevalence of 3.3% has been reported. The increasing illicit use of AAS over the years has raised serious public health concerns.

To report a clinical case of AAS abuse and review the psychopathology associated with AAS abuse and its treatment.

The authors report a clinical case and conducted a non-systematic review on the Pubmed database with the terms “anabolic-androgenic steroids”, “abuse” and “psychiatric manifestations”.

A 25-year-old male patient with history of body dysmorphic disorder was admitted to the emergency services following severe psychomotor agitation and verbal and physical aggression towards his family members. He explained he had begun using AAS years prior in order to improve his physical appearance. Recently he had been administering AAS injections on a more regular basis and restricting his food and water intake. His sleep-wake cycle was disrupted and he began experiencing increasing anxiety and persecutory ideation. Additionally, increased aggression was reported and numerous conflicts with his family members took place in the weeks previous to his psychiatric observation. AAS abuse has been associated with psychiatric symptoms such as aggression and violence, mania and less commonly psychosis and suicidal ideation. Moreover, its prolonged abuse can lead to symptoms of dependence and withdrawal following suspension. A biphasic model of steroid dependence has been described. First there is a brief hyperadrenergic state with opoid-like withdrawal symptoms which is then followed by a prolonged period of depression and craving. During this phase symptoms such as fatigue, muscle and joint pain, insomnia, anxiety and depression may occur. There are no established guidelines for treatment. Acute care of agitation should follow a similar course as the one utilized in other forms of substance induced-agitation: firstly, the least invasive interventions should be implemented. If medication is required, haloperidol has been reported to be effective, although evidence is scarce. Benzodiazepines may be considered, although its use with AAS has not been reported. In regards to long term care, AAS discontinuation is vital in conjunction with proper management of withdrawal symptoms. If a patient presents symptoms of opioid-like withdrawal, treatment with clonidine may be initiated. The use of medically prescribed steroids has been suggested in order to alleviate withdrawal symptoms. Other treatment options such as human chorionic gonadotrophin and clomiphene have also been proposed.

AAS abuse is a serious public health concern. Clinicians should be aware of its serious psychiatric effects and possible treatment courses.

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Nowadays, the smartphone use is increasing, similar is the trend among medical students and professionals.

The problematic use of mobile phone has become a major public health concern as it may lead to its addiction and other disorders such as sleep disorders, depression and decreased life satisfaction.

This study aims to determine the association between mobile phone usage, Insomnia and depressive symptoms among medical students and medical professionals.

We conducted a descriptive and analytical study among 40 medical students and doctors. They were asked to fill out an anonymous online survey.

Problematic Use of Mobile Phones (PUMP) scale was used to assess mobile phone usage. Insomnia Severity Index (ISI) was used to screen for insomnia and the Patient Health Questionnaire-9 (PHQ-9) to screen for depression.

The mean age of participants was 27,8 years, with a sex ratio of 1/3.

The mean of the duration of mobile phone use was 3.4 hours per day.

We found that 77% of participants spend most of their time on social media (Facebook, Instagram, Tik Tok) when using their mobile phones.

In our study, participants with higher problematic use of mobile phone (PUMP) score were significantly more likely to present symptoms of insomnia (p=0.031) and depression (p=0.023) according to ISI and PHQ-9 scales.

Furthermore, a significant association was found between the duration of mobile phone use, Insomnia and depression. In fact, the Odds Ratio (OR) of Insomnia was 1.66 in participants who used mobile phone more than 2 hours per day compared to those who used mobile phone < 2 hours per day.

Similarly, the OR of depressive symptoms was significantly increased with prolonged mobile phone use (>= 2 hours per day) compared to those who used it <2 hours per day (OR=3).

Mobile phone problematic use is negatively related to sleep outcomes and depression symptoms. It is increasingly recognized as an important modifiable risk factor for mental health problems.

Prevention strategies including information, advice, sport and cultural activities are an essential need for all medical students and professionals to help them set limits for mobile phone use.

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Substance Use Disorders are frequently associated to other medical problems. The temporal evolution of the main drug requests is related to drug and drug users’ facts. COVID-19 pandemic is worthy of investigation.

To analyze temporal trends in the characteristics of all medical requests to the Addiction Liaison Psychiatric Unit from January 2010 to December 2022.

Study data will be obtained from all patients that were referred to the Addiction Liaision Psychiatric Unit during 12 years in Hospital del Mar (Barcelona). Demographics and clinical data (substance use, medical diagnosis, dual diagnosis) will be obtained and analyzed by semesters.

The results will be presented as soon as all data is obtained. We will explore COVID-19 pandemic implications.

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Gamma-hydroxybutyrate (GHB) and its precursor gamma-butyrolactone (GBL) are popular drugs of abuse used for their euphoric, (potential) anabolic, sedative, and amnestic properties. Daily use of GHB/GBL can lead to dependence and the possibility of a withdrawal syndrome on cessation which results in tremor, tachycardia, insomnia, anxiety, hypertension, delirium, and coma.

To describe the inpatient treatment and outcome of treatment of a patient with GHB/GBL dependence.

A review of the case of patient reporting GHB/GBL dependence who was admitted for inpatient treatment.

The patient was using more potent substance GBL daily, 1.5 to 2 ml every two hours. She was using cannabis, alcohol, cocaine, and amphetamine-type stimulants additionally. Psychiatric comorbidities such as personality disorders, and eating disorders were recognized. Delirium developed after six hours of the last dose of GBL. The patient was treated with diazepam, clomethiazole, and atypical antipsychotics. She completed detoxification but stopped her treatment earlier. After two weeks she started to drink alcohol and after one month relapsed with GHB/GBL.

GHB/GBL withdrawal can be severe and retention in the program is poor. Polysubstance use, psychiatric co-morbidities, and heavier GHB/GBL use as possible predictors of poor treatment outcomes need consideration in treatment planning.

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Miroslava Vasiljević psychiatrist employed in Specialist practice of psychiatry Sunce, Belgrade, Serbia.

Substance abuse is a major public health problem with high morbidity and mortality. Treatment – seeking opioid dependent individuals frequently report mood problems in the form of depression. The aim of this study was to evaluate the depression in patients with substance abuse.

We evaluated mood problems in the form of depression and health- related quality of life (HRQoL) among patients (20) with diagnosed opiate dependance who entered detoxification program and met the criteria for abstinence in period of one month, and compared with the results of 20 healthy controls consisted of secondary medical staff.

Almost all of the patients had a total PSQI score of 6 or higher, suggestive of depression, compared with control group (PSQI < 5).Patients had problems with a depression, taking antidepressives and problem to keep up enough enthusiasm to get things done (P < 0,05), compared with the control group.

SF-36 scores for psysical functioning, role-physical, bodily pain, social functioning, role-emotional, and mental health were significantly lower mean compared to control group. Patients with disease had a reduced HRQoL, related to control group.

Majority of heroin-dependent patients reported depression and reduced quality of life. These conclusions are limited, because data was collected via questionnares of patients were small. In future we plan to include more substace abuse patients.

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In Tunisia, tobacco control remains one of the main country’s health strategies. However, it seems that the scourge of tobacco is still a prevalent problem and it’s often associated with other addictive behaviours like alcohol use.

Evaluate the addictive behaviours of the employees of an Electricity company in Tunisia and their impact on their mental health.

We conducted a cross-sectional study in May 2022. A pre-established questionnaire was filled out during a sensitization campaign that took place in the company. We used the Fagerstörm test and the AUDIT questionnaire to evaluate tobacco and alcohol dependency respectively. Signs of depression and anxiety were evaluated by the Hospital Anxiety and Depression scale (HAD). Collected data were analyzed using IBM SPSS statistics version 23.0.

Our population consisted of 83 employees. The average age was 40.79±11.23. Males represented 65.1% of employees. The mean of seniority was 15.23±10.82 years. Forty-one per cent were overweight and 22.9% had obesity. The mean Body Mass Index (BMI) was 27.17±3.92. Twenty-five employees (30.1%) were active smokers and 7 (8.5%) consumed alcohol. All of them were males. The nicotine dependency test’s mean was 4.12±2.78 and 28% of smokers had a high to a very high nicotine dependency. The mean score of the AUDIT questionnaire was 9.71±10.76. Four alcohol consumers (57.1%) had harmful alcohol use and 2 of them (28.5%) had alcohol dependency. The evaluation of the HAD score showed that the mean anxiety score was 7.59±3.13 and the mean depression score was 6.44±3.71. Twelve per cent and 10.8% of employees had elevated anxiety and depression scores respectively. Bivariate analysis showed that depression is significantly associated with the female sex (p=0.023) and with a lower number of service years (p=0.019). Anxiety was significantly associated with a high BMI (p=0.027). Anxiety and depression were not associated with alcohol or tobacco consumption.

Smoking and drinking are common in our society. Sensibilization campaigns must focus on motivating workers to quit those addictive behaviours and promote a healthier lifestyle.

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The medical field is very stressful. To reduce stress, healthcare workers may resort to different habits, including smoking and drinking.

We aimed to assess the smoking and drinking habits of interns and fellows in Tunisian hospitals.

A cross-sectional study was conducted in April 2022 through online platforms. A pre-established questionnaire was sent to Tunisian medical interns and fellows, working in public hospitals, and collected sociodemographic and occupational data. The Fagerstörm test was used to evaluate nicotine dependence.

Our population consisted of 182 Tunisian interns and fellows. Their mean age was 26.38±2.03 years. Females represented 71.4% of the total population. One hundred of them (54.95%) were fellows, out of which 18% specialized in surgery. Sixty-one per cent of these young doctors were single. Twenty-two individuals were smokers with male predominance (59.1%). Smoking was associated with age (p<0.001) and female sex (p=0.001). Fagerstörm test score’s mean was 4.09±2.52. High to very high nicotine dependency was found in 31.8% of cases. Thirty-five interns and fellows consumed alcohol and 51.4% of them were females. Alcohol use was associated with sex (p<0.001).

Despite knowing their hazard, young doctors still resort to drinking and smoking as a coping mechanism. The promotion of healthier coping mechanisms is essential.

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Schizophrenia, a chronic and complex psychiatric pathology, can be isolated. However, it can be associated with other comorbidities and thus be accompanied by addictive behaviors that complicate their management.

The objectives of our study were to estimate the prevalence and identify the characteristics of addictive behaviors in patients with schizophrenia.

A retrospective study of 151 patients with schizophrenia hospitalized in the psychiatry department of Taher Sfar University Hospital in Mahdia from January 2017 to December 2021.

The mean age of the patients was 39.8 ± 11.23 years, with a predominance of the 36-45 age group (38.4%). All patients were male. Three quarters of the patients (75.5%) were users of psychoactive substances (PAS): nearly three quarters (72.8%) were addicted to tobacco, more than one third (39.7%) were addicted to alcohol, more than one quarter (29.1%) were addicted to cannabis and nearly one quarter (26.5%) were addicted to other PAS. In more than half of the cases (54.4%), the age of onset of substance use was between 16 and 25 years. The use of PAS preceded the onset of schizophrenia in 62.3% of cases. The relationship with the entourage was marked by hetero-aggressiveness in 77.5% of patients, withdrawal from the entourage in 16.6% of patients and conflict in 5.3% of patients. The impact on the relationship with oneself was marked by self-aggressiveness in 18.5% of patients. Concerning the professional impact, three quarters of the patients (76.1%) had to stop working. The majority of patients (84.1%) continued their usual treatment, while 15.2% of patients stopped it. Only one patient required an increase in dose.

Subjects suffering from schizophrenia are particularly vulnerable to addictions, mainly to tobacco and alcohol. They are thus a group more at risk of the deleterious effects of psychoactive substances and of the aggravation of the clinical and psychosocial evolution of their psychiatric disorders. Measures for early detection and treatment of their addictive behaviors even before the onset of schizophrenia should be proposed.

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Self-esteem plays a role in the adaptive functioning of the human being. It could be a protective factor regarding multiple risks particularly substance use.

The aim of this study is to assess self-esteem among a group of young Tunisian users of cannabis.

The total study sample was composed of 137 participants, who took part of a transversal descriptive study during two months (January and February 2020). These partakers were comprehensively recruited among Emergency patients of Mahdia Hospital. Thereupon, the main criteria for the selection of these patients was their consumption of cannabis, regardless of their primary health care seeking reason or purpose.

The research was carried out upon their declaration of cannabis consumption and their compliance to be part of such a study. Thus, Data were collected on a pre-determined data sheet that included various information (age, sex, lifestyle, personal and family psychiatric history, age at which they started their cannabis consumption and the rate of cannabis use …).

Accordingly, Self-esteem was assessed using the Rosenberg Self-Esteem Scale (RSES). Consequently, the interview took place after the subject’s verbal and informed consent and the assurance of anonymity and confidentiality of the interview content.

In our study population, the cannabis consumers were young adults aged between 18 and 35 years old, with a male predominance of 71%. Among those users, 65.9% were single and 29.7% dropped out of school or experienced academic failure. On a socio-economic level, we concluded to a rate of 5.8% (lower class), 60.9% (middle class) and 33.3% (upper class).

Besides, 40.8% were employed. In total, 23.2% had a psychiatric history. Furthermore, the use of other substances was also prominent and frequent as follows: alcohol 72.5%, tobacco 74.6%, ecstasy 41.3% and 25.4% cocaine. The use of cannabis was considered as a means of indulgence and pleasure for 66.7%, as an anxiolytic for 26.8% and as a sedative for 23.9%.

Self-esteem, among those cannabis users, was very low in 20% of cases, low in 38% of cases, medium in 15% of cases and high in 25% of cases. Consequently, more than half of the study population remains below the medium average according to RSES.

These results lead us to question the relation between cannabis and self-esteem. The question that is evolved about the use of cannabis is the following: Is it used as a remedy or is it the cause of self-esteem deficiency?

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Therapeutic alliance is the key to ensure adequate and sustainable care in psychiatry.

The therapeutic alliance has been the subject of a great deal of psychotherapy research, and evidence from numerous empirical studies suggests that a strong patient-therapist relationship predicts favorable treatment outcomes and continues to be regarded as an important aspect of the therapeutic process

The purpose of this studie is to evaluate how the development of therapeutic alliance dimensions was associated with srelapses prevention.

This is a prospective, observational, cross-sectional study, carried out in the department of addictology at Ar-razi hospital in Salé using a therapeutic alliance measurement scale, and evaluating relapses’ frequency and duration of abstinence. The therapeutic alliance (TA) score was measured using Working Alliance Inventory.

The results call upon the concepts of anomie and attachment, which seem to play an important role in the follow-up and prevention of relapses, indicating the need for a global approach to care and the involvement of health and social professionals, where empathy must find its place.

Decades of psychotherapy research suggest that the strength of the relationship between patient and therapist is a common factor that is associated with treatment response. In the context of relapses specifically, most of the studies reviewed found evidence for a significant alliance-outcome relationship.

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Culture is defined by the shared beliefs, attitudes, values, and practices of a particular group of people which can influence their behaviour and social interactions, including the use of substances.

The aim of this review is to identify the evidence of cultural competence in the treatment of people with substance use disorder (SUD) and encourage the professionals and organizations to take cultural context into account.

Narrative review about the topic, using PubMed/Medline database. MeSH terms: “culture”, “cultural competence”, “addictions”, “substance use disorder”.

Studies show that culture can either be a catalyst for SUD or play a protective role. However, other factors may also play a large role in client’s response substance use and the development of SUD. Acculturation and generational differences can also impact SUD treatment, especially when intergenerational conflict causes stress that leads individuals to engage in risky behaviours. Thus, treatment for SUD has to be sensitive to cultural differences and professionals should provide culturally based approaches. Culturally targeted practices have been linked to greater outcomes, better therapeutic alliance, less dropouts and consequent increased retention in the treatment. These practices include matching clinicians and clients on linguistic and cultural backgrounds as well as being mindful of the impact of culture on client’s experience of SUD. Providing therapy and materials in the client’s language, knowledge, understanding and appreciation for cultural perspectives, involving the family and community and training therapists, are some of culturally competent practices used. These strategies involve knowledge, creativity, and experience.

Cultural competence seems to be a valuable tool for healthcare professionals working in a multicultural context, particularly with people with SUD. Unfortunately, the lack of supporting evidence limits the validity of any particular model of cultural competence. Future methodologically research is necessary in order to provide quality cultural competence models for people with SUD.

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Methanol intoxication is a public health problem in developing countries and can be ingested accidentally or with suicidal intent, leading to intoxication in isolated or collective forms. Methanol is used as a substitute for ethyl alcohol in several adulterated alcoholic beverages such as “eau de vie”, which is a drink distilled from dried fruits, such as dates, grapes and figs. Inside the body, it is metabolised into formic acid which, if left untreated, affects brain tissue, leads to blindness and can also cause death.

The objective of this retrospective study of a series of cases was to describe the epidemiological characteristics of methanol “eau de vie” poisoning cases collected by the Anti-Poison and Pharmacovigilance Centre of Morocco between 2013 and 2020 and to explain these results.

This is a descriptive and retrospective cross-sectional study over a period of 7 years from 1 January 2013 to 31 December 2020, which concerned 16 cases of intoxication by methanol “eau de vie” reported to the Anti-Poison and Pharmacovigilance Centre of Morocco, the study population concerned the entire Moroccan population throughout the territory of Morocco. The analysis concerned the frequency, the distribution in time, the distribution in space, the characteristics of the intoxicated, the type and circumstances of the intoxication and its evolution.

The CAPM recorded, during the study period, 16 cases of intoxication by methanol “Eau de vie” in Morocco. These cases were reported by telephone in 93.75% of the cases and collected by studies on hospital registers in 6.25% of the cases. Men were more affected than women. The most affected age group was adults, accounting for 50%. Adolescents accounted for 37% of cases and children for 13%. Drug addiction was the most frequent circumstance, followed by accidental intoxication and voluntary intoxication. The most frequently encountered signs were gastrointestinal signs followed by central and peripheral nervous system signs and heart rate and rhythm disorders. The outcome was favourable in 62% of cases, 6% with blindness after-effects and death occurred in 19% of cases.

Methanol poisoning can result from the consumption of illegal products containing methanol such as brandy, hence the importance of raising public awareness of this danger. It is also necessary to make health professionals aware of the clinical signs of methanol poisoning and what to do in the event of intoxication.

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Nowadays, the rates of antidepressant prescription are high and increasing. In this context, the issue of whether these medications are addictive has been increasingly discussed.

The aim of this review was to explore the debate about the addictive property of antidepressants.

We conducted a literature review in the Pubmed database, using the search terms “antidepressants”, “SSRI”, “tricyclic”, “addiction”, “dependence” in various combinations, and narrowing the search to the last 10 years, to identify articles about the addiction to antidepressants.

All the articles included in our study highlighted the fact that antidepressants were associated with withdrawal symptoms. These symptoms are heterogeneous, and long-lasting in some cases, and Paroxetine was shown to have particularly high rates of withdrawal symptoms.

Some articles reported a psychological and physical dependence on antidepressants. However, the most recent studies agreed that, using established classification systems and concepts and after integrating neurobiological and behavioral criteria, antidepressants are shown to have no addictive property.

Antidepressants are proven to be associated with withdrawal symptoms. Whether or not these symptoms are enough to constitute an “addiction” remains controversial, as recent studies agree that antidepressants should not be classified as addictive substances.

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Long-term benzodiazepine use is common although not routinely recommended. While their dependence potential is notorious, cognitive problems due to their chronic use have only recently been intensively studied. Residual cognitive symptoms may linger months after successful benzodiazepine discontinuation and significantly limit optimal functional outcome in abstinent individuals.

We present a series of cases, a 41-year-old man and a 33-year-old woman who successfully completed a ten-week benzodiazepine-dependence rehabilitation program at our hospital, including successful tapering and post-withdrawal integrative therapy. At subsequent monthly outpatient check-ups, abstinence was confirmed (including toxicology testing) and there was no residual anxiety or mood symptomatology. Still, patients complained of their suboptimal functioning due to residual cognitive problems, especially trouble concentrating and short-memory deficits, which were objectively confirmed via psychometric tests.

During continuous outpatient treatment (monthly controls), patients were clinically and neurocognitively evaluated. They were reluctant to try conventional psychopharmacology agents but were open to supplement therapy. After thorough literature review, a trial of piracetam and Ginko biloba extract was suggested. Piracetam, a positive allosteric modulator of AMPA-receptors, has been used in the treatment of vascular neurocognitive changes in the elderly. Bilobalides from G. biloba, act as atypical antagonists of GABA-A receptors and were found to exert neuroprotective effects in animal models, without epileptogenic or anxiogenic risks.

Patients were recommended piracetam (2.4 g a day) in divided doses and a once-daily dose of G. biloba extract (240 mg a day), in a standardized form containing 3.2% of bilobalides. No side effects were noticed. At subsequent monthly checkups, patients reported fewer cognitive problems and better everyday functioning. Neurocognitive testing confirmed subjective findings, with positive changes in all areas, but especially so in verbal memory, which may be due to this specific pharmacological combination. At the end of the observation period of sixth months, piracetam was gradually discontinued while patients were given free choice whether to continue with G. biloba supplementation.

According to our findings, piracetam and G. biloba extract may prove beneficial in the treatment of residual cognitive symptoms after benzodiazepine discontinuation, in long-term benzodiazepine users. Other treatments, focusing not only on modulation of glutamate and GABA, but also on other pathways should be evaluated. Further clinical studies are warranted.

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Internet use has become integral part of daily living in current world; at the same time its misuse is likely to cause addiction and negative impact in mental health. Internet addiction is similar to other substance addiction and has been associated with different psychiatric comorbidities.

To study prevalence of internet use disorder in youth patients,to find the association of psychiatric comorbidities with pattern of internet use and to study socio-demographic variables.

An institutional based cross-sectionalstudy was carried out in psychiatric out-patientdepartment of tertiary hospital. A total of 146 youth patients (15-24 years) who consented for the study were enrolled. Psychiatric diagnosis was made by the consultant psychiatrist using ICD-10/DSR criteria.

Out of total 146 patients with mean age 19.99 years, internet use was found in 89.7% of youth patients out of which 63.7% used in single device and 26.3% in multiple devices. Internet addiction was found in 67.8% youth patients and internet gaming in 33.6% patients. Higher level of internet addiction was found in adolescent (15-19 years) than adult (20-24 years) with statistically significant p value 0.014; patients from middle and higher socio-economic condition than low socio-economic conditionwith statistically significant p value 0.024; patients from uran region compared to semi-urban and rural with statistically significant p value 0.000; and patient using internet gaming with statistically significant p vallue 0.000. Among psychiatric diagnosis, ANxiety, depression and subtance use disorders were associated with internet use disorder however were statistically insignificant.

Internet addiction is high in youth patients; adolescent (15-19 years) compared to adults (20-24 years). Anxiety, Depression and substance use disorders had higher association with internet use disorder.

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Substance use is related to higher risk of criminality among prisoner with or without co-occurring mental disorder. This contributes to a poor correctional outcome and higher risk of suicide and other psychiatric disorders.

The aim of this study is to compare offenders with substance use disorder with offenders with no addictive comorbidity.

We studied the medical files of all the offenders referred to the forensic psychiatry unit in the Razi hospital for an examination between January 2010 and October 2020 analyzed sociodemographic, psychiatric and criminological factors of this population.

We found that the first group, with substance use disorder, was substantially consisted of male offenders (99.2%) compared to the second group (92%); (p=0). A significantly higher level of education was found in the second group compared to the first (p=0.004). Offenders with no substance use disorder tended to live with their family while the rest of the cases lived on their own (p=0.018), they also had three times more family history of psychiatric disorders than the other group (p=0). Psychiatric comorbidity was more important in the second group with more cases of schizophrenia and mental disability while the first group consisted mainly of people with personality disorders (p=0.018).

The average number of anterior convictions was 3.12 first group and 1.33 in the second group, which is significantly lower (p=0)

Specific interventions, in particular addiction management, are required to reduce the criminal risk in this population.

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cocaine is a widely used illegal drug, known for its fast ability to induce euphoria and arousal. However, cocaine exposure can contribute to several mental and physical effects. Cocaine induced brain damage can be divided into 3 mechanisms: direct effect leading to toxic encephalopathy, secondary to vascular damage causing vasculitis, stroke and vasospasm, and tertiary effect due to hypoxia through a cardiovascular collapse.

Here, we report 2 young men who developed a subacute encephalopathy with different clinical and radiological presentation after a cocaine overdose

a case serie

we present two men aged respectively of 28 (P1) and 42 years-old (P2). Both had a history of alcohol consumption and toxicomania (mainly cocaine) during the past year. They manifested, 2 weeks following a cocaine overdose, with gait disorder and confusion. On examination, P1 was apathic and confused. He had a subcortical frontal syndrome with gait apraxia and grasping reflex, along with a quadri-pyramidal syndrome. While patient P2 developed a cognitive decline, parkinsonism with dystonic posture of the trunk and the right limbs, and a pseudobulbar syndrome. Brain MRI was performed in both patients and showed a bilateral multifocal leukoencephalopathy (P1) and the presence of bilateral hyper T2 and FLAIR weighted images affecting basal ganglia, the mesencephalon and the periventricular cerebral white matter. Cerebrospinal fluid (CSF) analysis showed no pleocytosis and normal proteinorrachia. Electroencephalogram was also normal. Infectious differential diagnosis including Human Immunodeficiency Virus (HIV) and syphilis were excluded and metabolic screening including copper analysis, serum and CSF lactate were normal. The urine toxic screening, performed 20 days following the drug overdose, was negative. Both patients were treated with benzodiazepine and fluids without significative improvement. They were discharged with major cognitive and motor impairment.

cocaine toxicity is associated with high morbidity and mortality. Usually, cocaine abuse can lead to cardio-vascular, pulmonary and nervous complication. Neuropsychiatric sequelae are uncommon with less recovery potential. To date, there is no drug to prevent or cure cocaine addiction. The key is to educate the patient when he or she presents to the emergency department. Patients should be urged to seek drug counseling.

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Alcohol use disorder is a chronic relapsing disorder. It is a matter of global health concern affecting different countries, cultures, economic classes and ethnic groups. Although, many people benefit from alcohol related treatment, low occurrence of treatment seeking is a common denominator for the majority of people suffering from alcohol use disorder.

The aim of the present study was to study barriers of treatment seeking and assess self and perceived stigma in alcohol dependent male patients in rural population of India

An observational study was conducted at a private de-addiction center in India. Male patients who were more than 18 years old, alcohol dependent with more than seven days of admission (not currently in withdrawal) were included in the study

The mean age of the sample was 29.1 (7.8) years and age of onset of alcohol use was 18.5 (3.3) years. The mean quantity of alcohol used per day was around 550 millilitres of IMFL per day. The mean number of previous abstinent attempt were two. The most common barrier to treatment was financial (poor affordability). Not serious enough to change and being afraid of what others might think (stigma) were other common barriers. The mean value of perceived stigma was 21.9 (2.3). No co-relation was observed between stigma (both perceived and self stigma) and age of onset and quantity of alcohol consumed

These barriers and stigma needs to be addressed to improve treatment seeking and reduce relapse in our population

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Nowadays, tobacco consumption among the student population has become a very worrying phenomenon. Given the high rate of its morbidity and mortality, knowledge of the inventory of consumption and especially tobacco addiction seems necessary.

To determine the prevalence of tobacco use and the main factors associated with it in a sample of Tunisian students.

This is a descriptive and analytical cross-sectional study carried out during the 2020/2021 academic year with a sample of Tunisian students.We used an anonymous self-administered questionnaire distributed online via social networks. Our questionnaire included a section focusing on socio-demographic characteristics and the Fagerström test to detect tobacco addiction.

Our study enrolled 772 students .The average age of the study population was 23.29 3.25. The prevalence of tobacco consumption was 32.1%. Among the study population, 168 respondents (67.9%) were regular smokers.By evaluating our population with the Fagerström scale, 16.9% presented a strong dependence with a score >six.One hundred and six smokers (63.1%) began their smoking out of curiosity. The search for relaxation and the response to a need were the effects sought mainly (55.8% and 56.6%).The festive context and stress were the main elements increasing tobacco consumption (71% and 69.5%). The factors associated with smoking were age (p<0.005), male gender (p<10-3) and being single (p=0.035).

Tobacco consumption represents a public health problem, particularly among young people. Measures for the prevention and management of tobacco addiction should be put in place in the university environment.

None Declared

The use of alcohol, in particular its harmful use and alcohol dependence, represent a public health problem of interest to all age groups. Indeed, alcohol is responsible for a heavy burden of disease and a considerable socio-economic burden.

To determine the prevalence of alcohol use and the main factors associated with it in a sample of Tunisian students.

This is an analytical cross-sectional study carried out during the 2020/2021 academic year with a sample of Tunisian students. We used an anonymous self-administered questionnaire distributed online via social networks. Our questionnaire included a section focusing on socio-demographic characteristics and the AUDIT test (Alcohol Use Disorders Identification Test) to detect alcohol addiction.

Our study enrolled 772 students .The average age of the study population was 23.29 ±3.25.Two hundred ninety-nine students (38.7%) consumed alcohol. The mean age at first use was 18.44 (3.09). Fifty-two alcohol users (17.4%) presented a risk of alcohol dependence. The first consumption contexts were mostly “between friends” (57.4%) and “party time “(23.5%).The main effects sought were the effect of disinhibition (64.5%) and social integration (41.1%) were predominant responses. The determining factors of alcohol consumption were age (p<10-3), male gender (p<10-3), and the presence of grade repetition (p<10-3), wealthy socioeconomic level (p<10-3), and participation in community life (p<10-3).

Alcohol use and especially alcohol dependence may have harmful effects on student’s life. It is relevant to screen this addiction to better its prevention.

None Declared