Study of a patient population with drug problems. Analyses of demographics and drug abuse data.

We examined medical files of all new patients who attended the outpatient clinic of the Drug and Drug Abuse Institute in Coimbra, Portugal, during a period of a year, in order to characterize this population.

A sample of 171 patients, predominantly male, age ranging from 15 to 54 years-old, was evaluated. Within our sample, low education predominates, with early school drop-out. The predominant initial drug (excluding alcohol and tobacco) was hashish. The age of onset of consumption varied between 7 and 38 years-old. The main drug of most patients is heroine (n=100), and most started their consumption between ages 15 and 18 years-old.

The best treatment of substance abuse is prevention. While there are well-controlled studies available for the treatment of substance use disorders in adults, no such studies are available for children or adolescents. Psychological, although not physical, dependence has been reported with cannabis use. Regular users may withdraw from the challenges of the external world into a state of chronic low motivation. Such individuals then become at risk for entering into more dangerous drug-taking activities. Earlier adolescent substance use and heavier adolescent substance use are associated with greater risk of later drug problems. In addition to providing a service to people with drug problems, it is necessary to focus on prevention and discourage the consumption of the so called mild drugs.

To benefit from the usefulness of ultrasonography in measurement of common bile duct in opiate addicts and to correlate between the common bile duct (CBD) diameter and the duration of addiction.

Fifteen addicts, diagnosed according to DSM IV diagnostic criteria, were examined by abdominal ultrasound. The common bile duct is measured and the results were analyzed with other factors like age, the period of addiction, laboratory findings.

According to the findings, there is a significant increase in the range of the CBD diameter in comparison with normal bile ducts. Also, the mean diameter of the CBD in the different age groups showed a significant difference (p < 0.01) and there was a positive significant correlation between the CBD diameter and the period of addiction (p < 0.05, r = 0.875); the multiple comparisons shows that the significant difference between the 3 age groups were due to a significance between group (1) & (2), and group (1) & (3) but no significance between group (2) & (3). So, with the increased length of the addiction period, the mean CBD diameter increases.

In opiate addicts, the common bile duct is found to be dilated; however with normal serum bilirubin and alkaline phosphatase level and no obstructive causes by ultrasound examination, no need for any further assessment.

Emotional intelligence (EI) can play crucial role in improving individuals’ performance in many aspects such as career prospects in organizations, employees, consulting centers and psychological health centers across the world. So for better and more understanding of emotional intelligence, this study investigated Emotional intelligence and personality traits in addicted people.

Participants were 42 addicted people that randomly selected and Mc Care & Costa's NEO PI-R inventory and Shutte's self report emotional intelligence test (SSREIT) were administered on them. The data were analyzed with Spearman correlation Coefficient formula.

Results showed that high emotional intelligence was related positive and significant with Extroversion, Openness to experience and Conscientiousness.

It is recommended to set the programs for enhancing the emotional intelligence to increase mental health, life satisfaction and social skills in order to have personality and psychological health and prevent tendency to abnormal behaviour specially tendency to addiction.

Over The Counter (OTC) medication abuse is an increasing yet under-researched public health concern, particularly in the UK and Ireland. Our study provides a descriptive analysis of the clinical profiles; treatment and prevalence of patients admitted with OTC opiate abuse.

Using a specially designed demographic form, the records of patients admitted to St. Patrick's Hospital, a 280 bed inpatient mental health and addiction treatment facility in Dublin, Ireland with a diagnosis of harmful OTC opiate abuse or opiate dependency as defined in ICD-10 were reviewed retrospectively. All patients diagnosed with OTC opiate abuse (ICD F11.1) or dependency (ICD F11.2) on admission to our centre were included in the study. Patients with a diagnosis of primary illicit opiate misuse were excluded. Diagnoses were established by a consultant psychiatrist.

Approximately 1% (n=20) of inpatients admitted in a year were diagnosed with OTC opiate abuse. The average daily codeine intake was 261.10 mg per person. Seventy five percent (n=15) of the inpatients experienced OTC opiate withdrawal and were treated with protocol driven withdrawal regimes for an average of 16.10 days. The female: male ratio was nearly 2:1 with an average age of 49.2 years. Patients tended to have comorbid psychiatric (n=19, 95%), physical (n=17, 85%) and polysubstance (n=13, 65%) illness. The relapse rate of re-admissions within six months of discharge was 35%.

OTC opiate abuse is a covert illness since abusers often have significant comorbid psychiatric, medical and polysubstance illness making its assessment, diagnosis and subsequent treatment challenging.

The only randomized trial comparing the efficacy of disulfiram against placebo showed no differences in recovery time of alcohol consumption or total abstinence. Moreover, even if the potentially dangerous side effects are rare, their risks overcome the hypothetical benefits. Therefore, in December 2007 the division of addictology, department of psychiatry, decided to stop Disulfiram prescription. The healthcare team's perception of this decision was monitored.

An auto questionnaire (31 questions) was administered to the healthcare team in June 2009 for a 3 month period evaluating their perception of the utility of Disulfiram and of the pertinence of the decision.

Demographics: 55 participants (response rate 61.1%), 54.1% women, age (M = 43.7).

Professions: 54.8% nurses, 30.6% MD, 9.7% social workers, 4.8% psychologists.

78.7% participants already worked in the team in December 2007.

54.6% didn’t agree to stop Disulfiram prescription. While 72.2% think that the decision is based on evidence based medicine, 69.1% think that Disulfiram works because of the context of administration and 69.1% think it works because of the fear generated by its effects, 75.5% still believe that Disulfiram is useful for some patients (76.8% at the time of the decision).

Despite the fact that aversive treatments in addictology have failed to demonstrate an efficacy through EBM, the perception of its utility is still strong in caregivers. While most of them admit that it works mainly trough psychological constraints, they don’t support the fact that EBM could generate a practice change such as stopping Disulfiram prescription.

Most of brief instruments of evaluation of substance related disorders focuses on the dependence physical indexes and/or on compulsion, evaluating only incidentally the dependence-related social and psychological factors. Our aim is to create and validate a short questionnaire, easy to be distributed, exploring the dependence social and psychological indexes and to be used to evaluate the effectiveness of the therapeutic and rehabilitation treatments whose aim is to change lifestyle as well as abstinence.

The S.A.I.D. is an auto-evaluation questionnaire of 39 items that explore emotions, thoughts and behaviours in addictive subjects, thus providing patient's diagnostic profile in two areas: social area, divided into 4 scales (work/study, relationships, social interaction, cure/physical health); psychological area, divided into 5 scales (depression, hostility, lack of attention, anxiety, alexithymia).446 subjects have been examined: 256 with alcohol dependence diagnosis by using DSM-IV-TR, 70 with cocaine dependence diagnosis by using DSM-IV-TR, 120 not clinical subjects representing the control sample, that are not under psychiatric treatments.

The statistical analysis by Student's t test has showed that the instrument is able to discriminate between alcoholics, cocaine addicts and healthy control subjects; Cronbach's Alpha analysis has noticed a good internal validation in two main areas of the questionnaire, but a substantial unhomogeneity about single subscales.

These results indicate that the instrument is useful for the overall evaluation of social and psychological impairment in addictions, but also suggest the need for a revision of the instrument aiming to a better internal consistency of subscales.

Analysis of Rorschach inkblot responses of 22 alcohol-depended patients of the Acute Ward, Psychiatric Hospital of Petra Olympus, Greece.

The Acute Ward is a relatively small psychiatric ward that receives both voluntary and involuntary admissions of psychiatric patients of a catchment area of about 1000000 people.

The material used for this study was the Rorschach inkblot responses of 22 alcohol-depended patients (19 males, 3 females) that were hospitalized in the Acute Ward during the first semester of 2009. The test was administered once, 2-5 days after admission and scored according to J.E. Exner's Comprehensive System.

Rorschach profile was similar for most of the cases. 19 out of 22 Rorschach performances (with no significant differences among the sexes) revealed recurrent attempts to elucidate alcoholic ‘signs’ and put forward characteristic alcoholic perceptual style. These patients also produced more responses revealing greater interest in other people, marked though by ambivalence, feelings of aggression and withdrawal or isolation from social interaction. Dependency needs were also exhibited.

The Rorschach inkblot test is a psychological projective test of personality in which subjects’ interpretations of 10 standard abstract designs are analyzed as a measure of emotional and intellectual functioning and integration. It gets into the deepest recesses of patients’ psyche or subconscious mind. In the case of these alcohol-depended patients displayed specific problems of personality structure comprising a concrete Rorschach profile.

Heroin use has been associated with increased impulsive behavior. Overdose (OD) is a common cause of death among in opioide users, but majority of them report a history of non fatal OD. The aim of this study has been to observe the role of impulsivity among heroin users, as a prominent factor which can lead to non-fatal OD.

Sixty patients, heroin users (30 male and 30 female), were separated in two groups- first with positive history of non fatal OD and intravenous administration opoides and second without history of OD and same addiction pattern. Control group was formed of 30 heroin users reported non fatal OD and with intranasal administration opioides.The psychometric inventory- Barrat Impulsivity Scale (BIS 11), Dickman Impulsivity Inventory (DII), and Sensation Seeking Scale (SSS) were also administrated to patients with Hamilton Depression Rating Scale (HAMD).

The results have demonstrated significantly higher mean scores on Barrat and Dickman scale, compared with control. Separated analyses of variance conducted on Motor Barrat Subscale and Dysfunctional impulsives on Dickman Inventory revealed significant correlation in mean scores (p< 0.01).The important relationship between seeking for sensation and motor impulsivity was shown.There is no relevant diference detected on HAMD compared to control.

Chronic abuse of illicit drugs, such as heroin, produces significant deficit in executive control functions.These findings suggests that impulsivity could be associated with increase risk of non- fatal overdose.

Alcohol use by students is a major public health problem, leading to the Secondhand Effects - decrease in academic performance, injuries, blackouts etc.

To determine the extent of alcohol use on academic performance of university students.

Participants (n=46, mean age - 21 yrs) received the AUDIT questionnaire and other alcohol related questions. Grade Point Average and the effectiveness to sit for examinations of all participants from the 1st to 6th semesters of university education were used as objective criteria for problems related with alcohol use. The Pearson χ2 and Student's t-tests were employed for analysis of results. The probability value for significance was set at p< 0.05.

Alcohol and non-alcohol users were 41.3% and 58.7% respectively. Among alcohol users, the average quantity of alcohol used by one person per month was 37ml of absolute ethanol. A 10.9 - 11.4% higher rate of academic performance was noted among the non-alcohol users only in the 3rd, 4th and 5th, 6th semesters. The cases of injuries and blackouts were higher among the alcohol users by approximately 35 times. About 75% of all drinkers reported alcohol use only during their university education. The dose-time response effect of alcohol use on cademic performance was also proven.

A variety of inconsistencies in the pattern of alcohol use exists between male and female genders.

To examine the differences in the rate alcohol use and related problems in the general students’ population in Minsk, Belarus.

A total of 465 males (mean age of 21yrs) and 1030 females (mean age of 20.5yrs) were administered standardized anonymous AUDIT questionnaire. The cut-off point on the AUDIT was set at 8. Statistical analysis: All data analyses were performed using SPSS 16.0 version for Windows; the Pearson criteria and t-test. The probability value for significance was set at p< 0.05. All volumes of alcohol are in values of pure ethanol.

All in all, 85.7% males and 88.5% females were alcohol users. On the average, the total monthly quantities of alcohol use by the males and females were 131.3ml and 100.9ml respectively. Problem drinkers were 33.7% males and 10.1% females.

Even though the rate of alcohol use for the males and females was approximately the same, the percentage of related problems was significantly higher among the male population. Also, the quantity of alcohol use was higher among the males. The present study confirms that alcohol related problems are higher among males, compared to females.

Participation in social, cultural, and physical activities positively influences perceptions of health and quality of life. Few have studied how substance abuse influences patients’ participation in social, cultural and physical activities.

We examined patterns of past, recent and future (desired) activities of patients being admitted to substance abuse treatment at a Norwegian university hospital.

A questionnaire was developed specifically for the self-reporting of social, cultural, and physical activities. Psychiatric diagnoses including substance use diagnoses and other clinical and demographic data were also obtained. Data were analysed with descriptive and comparative analyses, including ANOVA.

78 patients responded (71%), 23 women, 55 men. Mean age was 38. 71% had a diagnosis of mental and behavioural disorders due to psychoactive substance use, while some had personality disorders (8.9%) or schizophrenia (3.6%). The total amount of activities had dropped significantly compared to before the respondents started abusing substances, and the drop was particularly pronounced for physical activities (Figure).

Changes in activities

Most expressed an interest in increasing their social, cultural, and physical activities.

The total amount of social, cultural, and physical activities falls markedly after starting substance abuse. Helping patients regain positive activities may improve subjective health and quality of life.

The hypothalamus plays an important role in regulating stress, reward and motivated behaviours. Central to this is the orexin (hypocretin) system, which is a key player in regulating these processes. The orexin system reflects an established functional dichotomy, where reward-mediated pathways are regulated by the anatomically distinct lateral hypothalamic orexin neurons; and stress is regulated by the orexin neurons located in the perifornical area.

To analyse current experimental literature on the role of orexin in the regulation of both stress and addiction

PubMed - searched with MeSH term “orexin” or “hypocretin”, with additional terms; “addiction”, “stress”, “relapse”.

The orexin neurons of the lateral hypothalamus act on the mesolimbic dopamine pathway, activating it directly, to produce its reward-seeking behavioural effects. The orexin neurons of perifornical area however mediate the response to stress, by increasing arousal, locomotor activity, and cardiovascular responses. But, via the activation of the hypothalamic-pituitary axis (HPA), it can also mediate effects on the mesolimbic dopamine pathway, in particular the ventral tegmental area (VTA), and cause reward-seeking behaviour as well. Additionally neurons containing corticotrophin-releasing factor connect the HPA reciprocally with lateral hypothalamic orexin neurons.

The pathways by which they work through are now understood reasonably well, but there is still new evidence emerging all the time which is increasing our understanding of the whole system, and this will have major implications in how we can approach addiction and diseases where the reward pathways are continuously activated.

It is widely described in literature, the high comorbidity between drug misuse and psychiatric disorders. 85% of patients with serious mental disorders, use alcohol or tobacco and other drugs. In almost 50% of them consume alcohol and cannabis. If we consider just hospitalized patients, the prevalence varies between 12 and 50% of the cases.That is why in 2003 a multidisciplinary group was formed in order to study drug consumption at hospital and to establish a drug screening protocol to control this issue.The objective of the study is to explain the protocol introduced in 2003 and an example of its benefits specially in the reduction of cannabis consumption.

There was elected a multidisciplnary group formed by the hospital administrator, the laboratory technician, different psychiatrists and nurses. They designed the drug screening protocol that we show in this work.

As an example of the effectiveness of the protocol, we consider the evolution of cannabis misuse before and after protocol enforcement, looking for positive results in urine samples. In 2003, there were taken 2575 urine samples for cannabis screening and in the 35,22% of the cases the result was positive. On the other hand in 2009, 3656 urine samples were collected and just the 17.7% of the determinations were positive.

The design of a specific, serious, standarized drug screening protocol in a hospital permits to control and minimize drug misuse during inpatients' hospitalization.

In some different studies, a high prevalence of posttraumatic stress disorder (PTSD) has been found in patients with several mental illness (SMI): schizophrenia, schizoaffective and bipolar disorder.

Evaluate the prevalence and correlates of PTSD in a sample of patients with SMI.

Adult patients with schizophrenia, schizoaffective disorder or bipolar I disorder were enrolled.

Patients who score 3 or more in conceptual disorganisation, hallucinations and/or unusual contents of thinking and 4 in another item of the Brief Psychiatric Rating Scale (BPRS) were excluded.

• Sociodemographic data

• Traumatic Live Events Questionnarie. Kubany ang Hayne, 2001.

• Distressing Event Questionnaire. Kubany anb Haynes, 2001, related to PTSD diagnostic DSM-IV criteria.

• 102 patients were included.

• The diagnostic subgrup of SMI patients were: 40 bipolar disorder, 52 schizophrenia and 10 schizoaffective desorder.

• The prevalence of PTSD was found in 15.1%: Criterion B (reexperiencing) 34.4%, Criterion C (avoindance and numbing) 27.1%, Criterion D (hyperarousal) 27.1%.

• The PTSD was more prevalent in females: 21.7% versus 8.5% (p 0.074). Only in criterium of hyperarousal the differences of gender were significatives (p 0.02).

• There were no significative differences in dignostic subgrups (p 0.381).

• Patients with PTSD had some suicide attempt history in 64.3% versus in 35.7% the patients without PTSD (p 0.042).

The comorbidity of PTSD in SMI was found in a fifteen percent, and only three patients had been diagnostiqued.

PTSD is significantly related to history of suicide attempts in patients with SMI.

The relationship between psychiatric disorders and adolescent suicide is well established. The aim of the present study was to examine gender differences in suicidal behavior among adolescents.

A structured diagnostic interview (Mini International Neuropsychiatric Interview Kid (M.I.N.I. Kid)) was used to determine 25 psychiatric diagnoses defined by the DSM-IV and suicidal behavior (having any current suicidal ideations or suicide attempts). The study population consisted of adolescents (aged 11-18), who were consecutively, first time admitted patients with suicidal behavior (according to the M.I.N.I. Kid) into the Vadaskert Child Psychiatry Hospital, Budapest.

Altogether 81 adolescents (46 girls (56.8%) and 35 boys (43.2%)) met the inclusion criteria. The most common psychiatric disorder of suicidal boys (n=35) was attention deficit hyperactivity disorder (ADHD) (n=17; 48.6%), followed by oppositional defiant disorder (ODD) (n=16; 45.7%) and generalized anxiety disorder (GAD) (n=13; 37.1%). Among girls (n=46) the most common psychiatric disorder was dysthimia (n=23; 50%), followed by GAD (n=22; 47.8%) and ODD (n=20; 43.5%).

This study examined an inpatient population with suicidal behavior, generalizations about outpatient and community samples cannot be made.

Based on the present study in adolescent suicide prevention, in both sexes professionals have to pay attention to externalization and internalization disorders as well. The striking finding is the very high prevalence of ADHD among suicidal boys. It's important to emphasizes the important role of GAD and ODD as risk factors of suicidal behavior in both sexes and dysthymia among suicidal girls.

Suicide is a leading cause of death in young people worldwide. Risk factors for suicidal behaviors and endophenotypes are partly heritable, and include variants in genes that drive stress diathesis in addition to, or by interaction with, certain adverse environments. Hypothalamic-Pituitary-Adrenal (HPA) axis genes are candidates for association with the dysregulated cortisol response to psychosocial stress that is observed in suicidal individuals. The role of HPA axis genetic variation will be explored in the context of varying “susceptibility” to suicidality after exposure to certain stressful life events.

A family-based association test was used on a case offspring-parent “trio” sample of 672 suicide attempt cases and their parents. Single nucleotide polymorphisms (SNP's) and/or haplotypes in CRHR1 were studied for interaction with age of exposure to physical and/or sexual assault, gender, and/or lifetime exposure to other types of stressful events.

Preliminary findings show interactions of certain CRHR1 SNP's with sexual and/or physical assault that are associated with suicide attempt, possibly using a violent method. Possible associations with candidate endophenotypes such as Cluster B personalities and early-onset major depression are under investigation.

Interactions of HPA axis genetic variants and stressful life events are consistent with a stress diathesis model of suicidal behavior, and may additionally influence the method and medical damage outcomes of suicide attempts, which may explain part of the diversity within this phenotype.

To provide information about psychiatric comorbidity and suicidal behavior in people with epilepsy compared to those without epilepsy from a community sample in Brazil.

An attempt was made to evaluate all 174 subjects with epilepsy (cases) identified in a previous community survey. For every case identified, an individual without epilepsy (control) and matched by sex and age was selected in the same neighborhood. A structured interview with validated psychiatric scales was performed. 153 cases and 154 controls were enrolled in the study.

People with epilepsy had more frequently anxiety (39.4% versus 23.8%, OR 2.1 [95% CI 1.2 - 3.5]; p=0.006), depression (24.4% versus 14.7%, OR 1.9 [95% CI 1.01 - 3.5]; p=0.04) and anger (55.6% versus 39.7%, OR 1.9 [95% CI 1.2 - 3.1]; p=0.008). They also reported more suicidal thoughts (36.7% versus 23.8%, OR 1.8 [95% CI 1.1 - 3.1]; p=0.02), plans (18.2% versus 3.3%, OR 2.0 [95% CI 1.0 - 4.0]; p=0.04) and attempts (12.1% versus 5.3%, OR 2.4 [95% CI 1.1 - 3.2], p=0.04) during life than controls.

These findings call attention for psychiatric comorbidity and suicidal behavior associated with epilepsy. Suicide risk assessment, mental evaluation and treatment may improve quality of life in epilepsy and ultimately prevent suicide.