We have compared oxcarbazepine (OXC) with acamprosate (ACP) in relapse prevention in recently withdrawn alcohol dependent patients. Oxcarbazepine blocks voltage-sensitive sodium channels. Its metabolite reduces high-voltage-activated calcium currents in striatal and cortical neurons, thus reducing glutamatergic transmission at corticostriatal synapses. This reduction is of interest in the treatment of alcohol dependence, since acamprosate modulates NMDA receptors, resulting in an inhibition of glutamatergic transmission. Furthermore, OXC has revealed a mood-stabilizing effect in bipolar affective disorders.

In a randomized open label pilot study 30 detoxified alcohol dependent patients were followed up for six months to assess treatment outcome in pharmacological relapse prevention. 15 alcoholics were treated with OXC and 15 with ACP. We asked for the time until first and heavy relapse and for drinks on drinking days. We assessed craving (OCDS), the severity of depression (ADS) and the degree of state anxiety (STAI).

After withdrawal, time to severe relapse and time to first consumption of any ethanol by OXC patients was not longer than for ACP patients. Abstinent patients in both study groups showed significantly lower OCDS-G than relapsed patients. No undesired effects occurred when OXC patients consumed alcohol.

While the current sample size clearly limits further conclusions from this pilot study, it is noteworthy that OXC is well tolerated. Thus, in medication-based relapse prevention, OXC could have the potential of a promising alternative for alcoholic patients unable to benefit from ACP or naltrexone or who suffer from affective lability. OXC certainly merits a larger placebo controlled trial.

Research has shown that Quetiapine reduce the craving and consumption for stimulants and alcohol. Due to Quetiapine's particulars and the promising receptor profile concerning addiction medicine, we set out to examine the tolerability and efficacy concerning relapse prevention of withdrawn alcoholics suffering from additional symptoms.

Our case observations attempted to evaluate nine alcoholics after withdrawal suffering from persisting craving, sleep disorder, excitement, depressive symptoms or anxiety symptoms. The patients were treated with quetiapine as relapse prevention and we followed them up in our outpatient clinic.

Eight out of nine patients were abstinent under quetiapine over a period of 2 to 7 months. One of these patients relapsed after he stopped taking the preparation at his own initiative after 10 weeks. The ninths patient stopped taking the preparation immediately because of swollen nasal mucosae. All target symptoms disappeared in the patients after an average of [mean ± SD] 24.5 ± 18.1 days. The overall tolerability was considered to be very good, however initial sleepiness appeared in four patients.

Patients reported to be very satisfied with the medication. Reports about clearly reduced craving seem particularly worthy of attention. Although uncontrolled case observations can only be interpreted with caution quetiapine seems to deserve further investigation. A double-blind placebo-controlled study is in preparation to confirm these preliminary findings. Quetiapine may hold the potential for preventing alcohol relapse in alcoholics suffering from additional above mentioned symptoms, or as an alternative in alcoholics who do neither tolerate acamprosate nor naltrexone.

Study of the relationship between bupropion and the onset of psychotic symptoms.

Review of the literature about this subject and review of the patient's history.

Mr D. was a 20 years old patient attended in our psychiatric unit for psychosis due to drug abuse that was exacerbated after the beginning of the treatment with Bupropion.

He showed a depressive episode at the age of 17, being diagnosed of Personality disorder (Cluster B), and he had history of substance abuse including cannabis (habit described as occasional), cocaine (only once in the past) and MDMA (only the 31 December 2008).

The patient recognized an intake of MDMA on the 31 December 2008, after which he showed visual hallucinations and insomnia in the following 48 hours. From the 3TH to 7TH OF January no symptom was observed although he had cannabis in unspecified amounts, appearing abnormal behaviour around January 8TH. On the 11th, his GP prescribed Bupropion at doses up to 150mg/day for smoking cessation, appearing two days later psychotic symptoms that included hallucinations, soliloquies, unmotivated laughter and an exacerbation of behavioral disturbances.

The symptoms disappeared after a week of treatment with antipsychotics.

Bupropion causes inhibition of dopamine reuptake, which would have created, an excess of this neurotransmitter that could explain the appearance of the psychotic symptoms.

We consider it appropriate to include in the contraindications section of this product, the use of bupropion among patients with history of psychotic symptoms in the context of consumption of toxic substances.

Sample of alcohol and opiate female addicts (30 patients in each group) plus control group (30 women) with no psychiatric diagnosis were questioned with the Semi-structured interview Addiction Severity Index - ASI (T.McLellan, J.Cacciola 1982).

There is a statistically significant difference among the groups compared for hereditary factors in addiction. In the group of opiate female addicts, a positive hereditary factor is present in 62.5%, in alcohol female addicts - in 50.0%, and in the control group - in 13.3%.

Alcohol addicted subjects do not differ significantly from opiate addicted subjects in terms of living with someone who has a drinking problem. However there is a statistically significant difference between opiate addicted subjects who live with someone with a drug problem (62.5%) and alcohol addicted subjects (13.3%).

Heredity is an important risk factor in addiction. A problem with chemical addiction in families of addicts, as a rule, presents as a multi-generational problem. Opiate addiction, in particular, starts and is maintained in a relationship with either a close family member or a partner.

According to Russian official statistics the average life period in males is about 59 years while in females it is about 73. The average marriage age for males is 24.4 and 22.2 for females. Thus statistically average woman in Russia lives in widowhood more than 15 years.

16 females aged 43 - 76 who began alcohol abuse in the second life period after (or during) social stress were studied. Specially elaborated Alcohol Intake Motive Self-esteem (AIMSE) scale was used.

According to ICD-10 criteria alcohol intake in all females conformed to F10.1 - Alcohol Dependence, in 12 it conformed to F10.3 - Alcohol Withdrawal. Duration of alcohol misuse before first appeal to addiction specialist varied from 1 to 8 years (mean 3,3±1,2 years). Mean duration of addiction forming was 1,8±,1,1 years; mean daily 100% ethanol tolerance was 100-150 ml. The stress situation was:

1. 1) A long-term husband illness which terminated lethally (7 persons);

2. 2) An unexpected death of a husband or constant partner (5 persons);

3. 3) Relation rupture with a husband or partner (4 persons).

The highest scores in AIMSE-scale have been obtained in the motives “solitude”, “low mood”, ‘bad physical health” and “heed deficit from children and relatives”.

The data have shown the phenomenon typical to the late onset female alcoholism in Russia. “Widow” alcoholism occurs in women in the second half of their life, when emotional bereavement situation and solitude are main provoking factors.

To identify possible differences in the ways that women and men are first texposed to drugs, in thier risks of abuse and the pattern of drug dependence.

Four hundreds and fifty seven of drug dependence who attended Outpatient clinic of Neuropsychiatry Department in Tanta University Hospital along the period from june 2006 to june 2009 were classified into two groups according to gender. The two groups (319 males and 138 females) were assessed using DSM IV structured interview and compared together regarding; age, age of starting drug use, duration of abuse, educational level in years, occupation, marital status, first drug used, number of abused drugs, route of use, possible risk factors, causes of asking help, numer of previous treatment trials and comorbid psychiatric disorders.

Males started drug abuse earlier in age than females with longer duration of addiction. Single males are more vunerable to abuse specially in illitrate group. Drug abuse is more common in female students and in male workers. Drugs that are more commonly abused by males are cannabis followed by opiates then alcohol while in females Tramadol ranked first followed by followed by anticholinergics then cannabis. Peer pressure was the most common motivating factor for drug abuse in males contrary to family troubles and sexual abuse in females. Anxiety disorders are more common in females while depressive disorders were common in males.

Gender differences in drug abuse stresses the importance of strategies of treatment, motives for treatment and prevention of drug abuse in females.

We aimed to evaluate the correlates and prevalence of psychoactive substance use in primary care patients in Ikorodu, Lagos Nigeria.

Six Primary Health Care clinics were randomly selected of the public health clinic in Ikorodu area of Lagos. A total of 1,550 were screened with World Health Organization Alcohol, Smoking and substance involvement screening test (ASSIST) between June 2007, and May 2008.

Hazardous use of tobacco was most prevalent (30%) especially among 18 - 25 age group, follow by Alcohol and then cannabis. Hazardous use of alcohol was associated with male gender, younger age group and lack of employment. For all substances, we recorded lowest rate for women.

Psychoactive substance use are common among primary care patients, effective methods of early identification and form of anti drug use education are needed. Younger age groups, especially men are to receive more attention.

Comorbidity between a substance use disorder (SUD) and another psychiatric disorder is known as dual diagnosis. The relevance of SUD with mental illness owe to his influence in the clinical practice, evolution and costs of care.

At the Hospital of Zamudio, the determination of substances of abuse in urine begins in January 1999 and in May 2003 a practical guide to detection and norms substance use was established and revised in late 2006.

The objective of this work is to make a valuation in this issue, reflected in the petitions made during this time and the evolution of the determinations of drug misuse, both of them indicating the understanding of the importance of dual diagnosis

Determinations of toxics in urine are collected from January 1999 to December 2009.

:

• YEAR NUMBER OF TOXIC DETERMINATIONS

• 1999 2644

• 2000 2411

• 2001 3360

• 2002 6456

• 2003 10199

• 2004 9175

• 2005 8724

• 2006 8689

• 2007 8362

• 2008 10766

• 2009 14625

The distribution of toxic determinations is mainly between amphetamines, opiates, THC and cocaine, in equal proportion (25% for each approximately).

The gradual increase over the years, could be translated into a greater awareness of the importance of dual diagnosis.

However, the homogeneous distribution of the petitions among the different toxics perhaps could lead to the need of an implementation of the protocol, considering that sometimes the physicians order the screening without taking into account the economical and technical difficulties of the laboratory and the previous history of inpatients.

Aim of this study was to investigate the changes in life quality during 12 months follow-up among alcohol dependent inpatients.

Participants were 102 consecutively admitted male alcohol dependents, whom were available for second evaluation at 12 months follow-up. Patients were investigated with the Medical Outcomes Study Short Form 36-item health survey (SF-36) at the end of inpatient treatment program and 12 months later in follow-up.

Among alcohol dependent inpatients 61.8% were considered to be relapsed. Sociodemographic variables did not differ between relapsed and non-relapsed groups. Mean scores of physical and mental component summaries did not differ between groups at baseline evaluation, whereas they were lower in relapsed group at 12 months follow-up. In non-relapsed group mean scores of all the life quality subscales and physical and mental component summaries improved at 12 months follow-up, whereas in relapsed group mean scores of life quality did not differ significantly.

Among alcohol dependent men life quality improves after 12 months of abstinence following inpatient treatment. Thus after measuring the impairments in life quality, if the findings are communicated to patients, this may enhance their motivation to stay sober after inpatient treatment programs.

Aim of this study was to evaluate the relationship of posttraumatic stress disorder (PTSD) and alexithymia with relapse to alcohol use during 12 month follow-up after inpatient treatment in male alcohol dependents. Age at regular alcohol use, severity of alcohol related problems and psychiatric symptoms were controlled while evaluating these relationships.

Among 156 consecutively admitted male alcohol dependents 136 could be reached at the end of 12 months. Patients were investigated with the Clinician Administered PTSD Scale, the Symptom Check List and the Michigan Alcoholism Screening Test (MAST) and with the Toronto Alexithymia Scale (TAS-20) at baseline.

Among 136 alcohol dependent patients 66.2% (n=90) were considered to be relapsed according to telephone interview. Among these 102 were interviewed face to face. Rate of alexithymia and relapse and mean of “difficulty in identifying feelings-DIF” of TAS-20 were higher in PTSD group. Other than these there were no significant relationship between PTSD, alexithymia and relapse. PTSD diagnosis predicted relapse during 12 month follow-up (n=136). When only those who were evaluable to interview face to face included, only DIF predicted relapse (n=102).

PTSD and alexithymia (particularly DIF factor) may be related with relapse during 12 month follow-up. This study suggest that rather than the early onset of alcohol use, the severity of alcohol related problems and the general psychiatric symptoms, PTSD and DIF, which may be related, are two factors to focus when relapse prevention programs are planning.

Most pleasures have been condemned at some time and many laws have attempted to prohibit supposedly harmful behavior. Evolution has not collaborated perhaps because addictive behaviors, associated with reward and pleasure circuits/centers in the brain, are important for survival.

Withdrawal symptoms are treatable with nicotine replacement therapy. Pleasure, is a harder problem to tackle and is associated with rituals, the senses and affect regulation and may be a major culprit in relapse.

Dopamine dysregulation may favor addiction and addiction may lead to dopamine dysregulation. Many psychiatric patients may have dopaminergic dysregulation and altered pleasure circuit function and are more prone to addiction, especially to nicotine, and probably harder to help.

A reflection on desire and pleasure in smokers in general and psychiatric patients and on possible strategies to overcome these difficulties.

1. 1) A review of philosophical, sociopolitical, biological and neuropsychiatric views of pleasure

2. 2) Rating of smoking as a pleasure on a visual analog scale on first assessment of a smoking cessation program in a psychiatric hospital

3. 3) Reflections on difficulties encountered in a smoking cessation program and possible strategies to overcome these

Treating addictions poses tremendous challenges since the very mechanisms nature disposed for survival, are those gone awry. Pleasure is identified as a major driving force behind addiction in tobaco smoking therefore should be specifically addressed in smoking cessation programs. Psychiatric patients who smoke tobaco are an especially difficult patient population and one of the contributing factors may be dopamine dysregulation/pleasure dysregulation.

This study aims to evaluate different kinds of temperament and attachment in a sample of alcohol-dependent patients, divided in Cloninger typology 1 and 2, compared to an healthy group.

A group of 40 patients was recruited, in a 3 months period, from Alcohology Unit of “Villa Rosa” in Viterbo. This sample was selected by a clinical diagnosis of Alcohol Dependence and compared to a control group of 40 healthy subjects. Each participant was screened by: SCID-I for Axis I Diagnosis, SCID-II for Axis II Diagnosis, TEMPS-A for Temperament, ECR for Attachment Styles.

Statistical analysis showed significative differences between the two groups (p< 0.05). The mean of the scores (t Student) and the Mann-Whitney U test results higher in the experimental group. Regarding the ECR, we found differences in the “avoidance” between Cloninger's typology 1 and 2. Control group: 92.5% of the subjects showed a “secure” attachment, 7.5% a “dismissing” attachment. Experimental group: 40% of the sample showed a “secure” attachment, 35% a “dismissing” attachment, 17.5% a “preoccupied” attachment and 7.5% a “fearful/avoidant” attachment.

Our sample showed that the “preoccupied” and the “dismissing” attachment styles were the most prevalent among alcoholists, while the “secure” style was typical of control subjects. Concerning the TEMPS-A we found high prevalence of the hyperthymic and cyclothymic temperaments.

Emotional intelligence (E / I) consists of appraisal of emotion in the self and others, regulation of emotion in the self and others and utilization of emotion in solving problems. Subsumed under these branches are functions such as verbal and non verbal appraisal and expression of emotion and using emotions to motivate as part of the utilisation of emotions. (Salovey & Mayer's, 1990). Emotional intelligence components are important in psychological functions such as problem-solving, happiness, stress-tolerance, self-actualization and interpersonal relationship. So the research aimed to investigate role of Emotional intelligence in tendency to addiction.

In sampling process a total of 73 addicted people and 73 non-addicted people were randomly selected. All participants were requested to complete Schutte's Self- Report E / I Test (SSREIT) (33 item). The test measures ability of E / I in three fields: Appraisal of emotion, regulation of emotion and utilization of emotion. In order to analyzing the data independent T test was used to compare means of two groups.

Findings indicated significant differences between two groups in components of emotional intelligent. Nonaddicted people had more scores in appraisal of emotion, utilization of emotion and general score of emotional intelligence. But there was no significant difference in regulation of emotion in two groups.

Considering the results, it is recommended to apply the plans for enhancing emotional intelligent components in order to increasing abilities and competencies in confronting with crisis and bad events and reducing risk of abnormal behaviors, specially addiction.

The study is to clarify psychological effects of two kinds of religious orientation (Extrinsic / Intrinsic) on tendency to addiction.

Participants were 80 addicted people that attended in addiction treatment center. Alport's Religious Orientation Scale was administered on participants. Data analyzed with Chi Square formula.

Analysis of data showed that eighty percent of addicted people are extrinsic religious oriented. Also seventy five percent of addicts were less educated and under high school.

Addicted with extrinsic religious orientation apply the religious to access their goals and when they do not access their goals, they disappointed, get anxiety and depression and try to make a defense about the event. The intrinsic religious oriented people tend to religious for developing in personality, life, attitude and cognition and like to reach the optimal goal that is cognition of God and this is a factor that makes hopeful and not disappointing from bad event and not reaching to goals. But in extrinsic religious oriented people, when they do not reach to goals, disappoint soon and want to make defense that one of the defense is addiction.

The epidemiology of HIV in Belarus, main trends in addiction treatment, attitude to rehabilitation of addicts with HIV are presented.

The questions of social maladjustment of such patients are revealed as well as organization of medical and social rehabilitation and self-maladoption. The correlation between the amount and characteristics of rehabilitating services and the grade of maladjustment is stressed. The analysis of social functioning as well as quality of life of patients with dual pathology ((HIV and addiction) is presented.

The background for different approach towards research of HIV-positive and HIV-negative IV drug consumers is presented.

In the present study we intend to show the effectiveness of therapeutic services provided to adolescent drug users.

The Counseling Center for Combating Drug Abuse offers an outpatient counseling psychotherapeutic program for substance users. For adolescent users the program is adjusted to their needs, which are defined by the substance type, the drug use history, and the adolescent personal, familial, social, and academic level. No medication for withdrawal syndrome or maintenance therapy is administered, while there is psychiatric care in the case of comorbidity. The program's length is individualized, and usually lasts two years. Family is involved in the therapeutic procedure, as it constitutes the basic supportive system for adolescents. Dysfunctional families are helped to resolve their problems. Great emphasis is also given to the peer group. Our goal for the adolescent is to distance himself from friends involved with drug use, to empower the existing relationships with persons who keep off substances, and to be encouraged to make new, healthy relationships.As heroin user usually presents a decline in academic success, or has already stopped school, successful comeback is a critical therapeutic goal.

From our data emerges that the effectiveness of therapy depends directly both on the progress in individual level and on the positive changes in the other three levels of intervention (family, friends, school).

An outpatient drug addiction psychotherapeutic program for adolescent users can be effective when it considers user not only as an individual but within his family, school and social environment.

Recent studies have conclusively proven the effectiveness of cognitive training in the context of psychiatric rehabilitation. Examinations on young schizophrenic drug users are yet to be done, although it could be shown that most of these patients are likely to relapse, abandon therapy and show untreated social adaptation disorders if existing cognitive functional deficits are not treated appropriately.

Pre-post examinations were done on 35 schizophrenic drug users (mean age 26±8 years; 27/8 men) to assess various attentiveness functions (i.e. alertness, divided attentiveness, visual scanning) before and after computerised attentiveness training (CURE therapy system, Siemens (NCSys)). Patient results were compared to those of a control group matched for age, education, illness characteristics and current medication which did not undergo cognitive training. Cognitive training lasted 10 weeks. At the same time, patients were assessed using standardised scales to determine whether their performance improved after work therapy.

Computerised attentiveness training led to significant (>30%) improvement in everyday attentiveness functions (tonic and phasic alertness, divided attentiveness) as did work therapy (precision, endurance), although some patient subgroups different in their course of therapy.

Training specific attentiveness functions helps improve rehabilitation of young schizophrenic patients with multiple drug abuse. Subgroup effects may also be of clinical relevance.

Benzodiazepines are widely used drugs. However, their chronic use has revealed that they can lead to dependence. The objective of this study is to review the different pharmacological strategies used in the management of benzodiazepine dependence and new trends in pharmacological interventions.

We searched in MEDLINE and in the Cochrane Database System Review, selecting studies from 1980 until the present, in which a pharmacological intervention was made for benzodiazepine detoxification in mono-dependence cases.

There is a consensus about gradual rather than abrupt tapering benzodiazepines in benzodiazepine discontinuation. Other extended traditional strategy has been switching from short half-life to long half-life benzodiazepines before gradual taper. A great variety of agents have been used as adjuvant medication in Benzodiazepine Withdrawal Syndrome (BWS) with varying degrees of success. In the last years research has focus in the use of anticonvulsant drugs. Both carbamzepine and valproate, have demonstrated to be beneficial in benzodiazepine discontinuation. Also, preliminary data suggest that new anticonvulsant agents (gabapentin, pregabalin, oxcarbazepine and topiramate) could be helpful.

Although multiple drugs have been investigated for pharmacological management of BWS, only few have demonstrated significant efficacy. Anticonvulsant drugs are one of them. Both, carbamazepine and valproate, have shown benefits in reducing withdrawal severity. The available data currently support the use of new anticonvulsant (gabapentin, pregabalin, oxacarbazepine and topiramate), in the treatment of different drug-dependences such as alcohol, cocaine and opiate dependence. Moreover, there is a growing trend in the literature toward the use of these agents in benzodiazepine mono-dependence.