Alcohol dependence is a serious problem in Central Europe and the treatment effect depends on level of patient's motivation. The theory of change assumes that therapeutic approaches should be adapted to the motivation stage.

To examine the state of readiness to change at the beginning and the end of inpatient 6-week and 12-week therapeutic program in Slovakia, Poland, and Czechia.

To compare readiness to change with insight and motivation. To find out, whether patients change during the therapeutic program and how this change leads to advances in treatment.

A total of 380 inpatients were examined using Alcohol Use Disorders Identification Test (AUDIT), the Stages of Change Readiness and Treatment Eagerness Scale (SOCRATES), Readiness to Change Questionnaire (RCQ), and Demographic Questionnaire.

Measured by AUDIT, single patients declared higher severity of alcohol dependence than married or divorced patients. A majority of patients were at the stage of action (68.5%) or preparation (26.3%) according to RCQ at the beginning of the treatment. Readiness to change was higher at the end of both programs in terms of taking steps in married patients and in terms of Decreasing of Ambivalence in single patients. The results of the 6-week program appear to be slightly better than 12-week treatment.

The intention and motivation to treatment changed during therapy. Marital status may increase the active component for readiness to change, while passive component (decreasing the ambivalence) is observed in single patients. Duration of the program does not seem to be crucial for readiness to change.

The authors have not supplied their declaration of competing interest.

Prevalence of psychiatric comorbidities in alcohol dependence syndrome and association of severity of alcohol dependence, personality dimensions, motivation and short delay relapses.

A prospective study in 91 male alcoholic patients for 2 months.

Two groups not relapsed (NR = 48) and Relapsed (R = 43) were comparable in age, SADQ severity score, average units of alcohol consumption and years of alcohol use. Average consumption was 17 units/day (500 mL spirits), age of onset before 25 years 87%, mean age 40 and severe alcohol dependence was in 57% of study population. Co-morbid nicotine use was 80.2% and in equal numbers in the relapsers and non-relapsers group.

Bipolar disorder was the most prevalent (19.8%) in the study population. About 53.8% had alcohol dependence as the primary diagnosis with no associated psychiatric comorbidities. Anxiety disorders (12%) and personality disorders (19.7%) were found more in the relapsers group. Anxiety symptoms seemed to be a risk factor for relapsing compared to other comorbidities in bivariate analysis (Pearson Chi2 5.998, P = 0.014). Psychoticism among relapsers were high (Pearson Chi2 4.901, P value 0.027, OR: 3.782, 95% CI: 1.103–12.958). Co-morbidities were not statistically significant in multivariate (Pearson Chi2 1.765, P = 0.184, OR: 1.755, 95% CI: 0.763–4.037). Severity of alcohol dependence in relapsers was not significant (Pearson Chi2 0.650, P = 0.722). Motivation levels of 62.8% of relapsers were low, 32.6% medium and only 4.7% reported high motivation (Pearson Chi2 11.846, P = 0.003). Poor motivation proved to be a risk factor for future relapse (P = 0.008, 95% CI: 1.266–4.648, SE.332).

The authors have not supplied their declaration of competing interest.

Modern clinical narcology searches for anti-craving programs to overcome psychoactive substances (PAS) pathological addiction with bio-adaptive regulation of systems (BARS).

To develop computer modified biofeedback program integrated with Luscher test.

Twenty-two PAS addicts who were undergoing biofeedback modified psycho-training were examined. Computer rheoencephalogram (REG) was used as an external monitoring module.

Technologically novel biofeedback computer modification was developed with preceding Luscher computer testing for determination of the individual preference colour and the colour producing individual unpleasant associations in respondents. Consequently, biofeedback program was corrected differentially by changing standard colour templates for those personified on monitor. Cerebral hemodynamics condition transferred to individually designed for a particular respondent colour registers is used as a homeostatic parameter reflecting alcohol craving presence/absence: in case of the disordered REG parameters the signal reflects the respondent's unpleasant (negative) colour, and with no craving the screen is filled with positive, pleasant, favourite colour. During BARS auto-training the respondents’ skills to mediate present subjective clinical PAS craving manifestations with unpleasant colour and the experimental auto-training method have been mastered, and those psycho emotional states which displace PAS craving symbolic colour from the screen are selected, and it is substituted with favourite colour (symbol of healthy mode of life motivations).

Usage of combined BARS biofeedback improved effectiveness of the training and allowed to objectivize and control the condition of the patient getting reliable visual and digital information about either regress or activation of PAS craving and potential relapse of addictive behaviour.

The authors have not supplied their declaration of competing interest.

Populations of spice addicts in Ukraine demonstrate distinct tendency for steady spreading, and transitory psychotic episodes, overdosing and fatal cases are being registered in consequence of smoking. “Spice” are synthetic analogues of tetrahydrocannabinol.

To develop an average personified clinical portrait of spice addict for more specified therapy.

Twelve patients who consumed spices systematically for 1–2 years were observed. Methods of examination: clinical psychopathological, psychological testing, clinical laboratory.

Main spice addiction diagnostic criteria were: Spice smoking, obsessive and uncontrolled anosognosic desire and craving to test on themselves effects of their action, pathognomonic tolerance increase, specific post-intoxication consequences. After the first smoke inspiration heavy intoxication with euphoria and loss of surrounding real perception, sexual disinhibition and craving to repeat smoking manifested after the first smoke inspiration. Then, spice smoking became subjectively pleasant, caused condition of intoxication with increased mood, fussiness, was accompanied with feeling of hunger, thirst, and hoarse voice. In the patients rather quickly (for 2–3 weeks) twice reduced duration of intoxication state from 40 to 20 minutes, loss of situation and quantitative control over smoking was observed. Clinical specifics of addiction for spices smoking is rather quick (from 5 to 10 trials) formation of psychic equivalent of addiction, extremely intensive and emotionally saturated craving for smoking, quick rise of tolerance with loss of situational and quantitative control over smoking.

Definite rules in the development and formation of spice dependence is necessary to be considered while developing programs for therapy and prevention in clinical narcology.

The authors have not supplied their declaration of competing interest.

Although psychoactive substances has a long history in recreational settings, research on its composition has focused only on tablets, crystal and powder, even though new formulation for new psychoactive substances are readily available for users.

To describe the presence of psychoactive substances and its characteristics in new formulations which had not previously been found in samples delivered to Energy Control from 2014 to 2015 in Spain.

A total of 8324 samples were analysed from June 2014 to December 2015. Only those samples in gummy formulation were studied (n = 9). Samples were analyzed by energy control, a Spanish harm-reduction NGO that offers analysis of substances to users. Analysis was done by gas chromatography-mass spectrometry.

From 9 samples of psychoactive substances in gummy formulation, the analysis detected that 55.5% contained multiple psychoactive substances: 6 samples contained 25N-NBOMe (66.7%), 1 2C-E (11.1%), 1 2C-D (11.1%). Two allylescaline (20%), 1 cocaine (11.1%), 1 THC (11.1%), 1 canabinol (11.1%), 1 ketamine (11.1%), 1 caffeine (11.1%), 1 MDMA (11.1%), 1 N-acetyl-MDMA (11.1%), 1 metoxetamine (11.1%), 1 N-acetyl-MDMA), 1 2C-N (11.1%). The only substance found in active dosage was 25N-NBOMe. Six samples (66.67%) did not contain the substance expected by the consumer.

Incipient presence of gummies as new psychoactive formulation was found. The most prevalent drug was 25N-NBOMe; 66.7% did not contain the substance expected. This may pose a risk for potential harmful effects. All the gummies were known to be drug-carriers when bought. This could represent the presence of new formulations from June 2014 in the Spanish recreational market.

The authors have not supplied their declaration of competing interest.

Excessive alcohol use has been associated with health, social and legal problems. Studies of alcohol-drinking problems have mainly focused on patients with alcohol-drinking problems and few studies have focused on their family members. The purpose of this study was to explore the perceptions of family members of problem-drinker patients about their own hazardous or harmful alcohol-drinking behaviours.

In this qualitative descriptive study, participants were recruited from three hospitals randomly selected from northern and central Taiwan (2:1). Hazardous-drinker patients and their family members were screened using the Chinese version AUDIT. AUDIT scores > 8 indicated harmful or hazardous drinkers. Data were collected in individual, audiotaped, in-depth interviews using an interview guide. Verbatim interview transcripts were analysed using ATLAS.ti, version WIN 7.0.

The sample of 35 family members with hazardous or harmful drinking behaviours perceived that their own alcohol-drinking behaviours were related to six major patterns: family habits, leisure activities with friends, work pressures, personal taste, a way to forget one's problems and to express happiness.

We recommend that programs to prevent harmful or hazardous drinking should emphasize understanding standard amounts of alcohol in alcoholic beverages, recommended amounts of alcohol consumption for males and females, knowledge about the long-term effects of excessive alcohol consumption; offer strategies to resist social pressure to drink; and build positive strategies for coping with stress.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Anxiety and depression, as well as alcohol use are widespread among teenagers, and constitute a huge public health burden worldwide.

To study the link between alcohol consumption and emotional distress (anxiety and depression) among adolescents.

We conducted a cross-sectional study in May and June 2016. The sample consisted of 314 pupils from 4 colleges and schools in Sfax (Tunisia). Alcohol Use Disorders Test (AUDIT) was used to evaluate alcohol dependence. Anxiety and depression levels were evaluated using the “Hospital Anxiety and Depression Scale” (HADS).

The mean age was 16 years with a sex ratio of 1.08. Among the participants, 18.9% reported having drunk alcohol at least once and 42.37% of them still consume. The main reasons for alcohol initiation were the search of new experiences (78%) or pleasure and well-being (39%) and the curiosity (49.15%). According to AUDIT, 1.7% of alcohol users presented an alcohol misuse and 20% presented dependence.

The prevalence of anxiety and depression were respectively 56.1% and 23.7%. Anxiety was correlated to alcohol experimentation (P = 0.03) and non-supportive environment (P = 0.003). Depression was correlated to alcohol experimentation (P = 0.001), AUDIT score (P = 0.009), somatic histories (P = 0.02), physical abuse (P = 0.02), non-supportive environment (P = 0.016) and graduating class level (P = 0.005).

Our study highlights the close association between alcohol consumption and emotional distress in adolescence, which seems to be bi-directional. When attempting to reduce the risk of alcohol consumption, we should focus a particular attention on adolescents studying in graduating class, reinforce adolescents’ family support and prevent physical abuse.

The authors have not supplied their declaration of competing interest.

The aims of the present study was to investigate the long-term stability of problematic gaming among adolescents, and whether problematic gaming at wave 1 (W1) were associated with problematic gambling at wave 2 (W2), three years later.

Data from the SALVe-Cohort, including adolescents in Västmanland born in 1997 and 1999, at two waves were analyzed (W1, n = 1868; 1035 girls, W2, n = 1576; 914 girls). Adolescents self-rated the Gaming Addiction Identification Test (GAIT), Problematic Gambling Severity Index (PGSI), and gambling frequencies. Stability of gaming using Gamma correlation, and Spearman's rho was performed. General linear model analysis (GLM), and logistic regression analysis were performed, adjusted for sex, age, and ethnicity using PGSI as dependent variable, and GAIT as independent variable, for investigating associations between problematic gaming and problematic gambling.

Problematic gaming was stable over time, γ = 0.810, P ≤ 0.001, and ρ = 0.555, P ≤ 0.001. Furthermore, problematic gaming at wave 1 increased the probability of having problematic gambling three years later, GLM F = 3.357, η2 = 0.255, P ≤ 0.001, and logistic regression OR = 5.078 (95% CI: 1.388–18.575), P = 0.014. Male sex was associated with higher probability of problematic gambling.

The present study highlights the importance of screening for problematic gambling among problematic gamers in order not to overlook possible coexisting gambling problems. The stability of problematic gaming indicates a need for development and evaluation of treatment for problematic gaming and also for coexisting gambling problems.

The authors have not supplied their declaration of competing interest.

Autism and substance use disorder (SUD) is not the co-morbidity that is commonly considered. Yet these conditions have more commonalities than one would suspect.

We will consider the evidence for co-morbidity between ASD and Addiction (Substance Use Disorders (SUD) and explore the influence of gender.

A pilot study of 80 admissions to an adult ASD unit will be presented.

The co-morbidity ASD and SUD in this study was very high (65% of the inpatients). There were no gender differences in prevalence in total but addiction to medication (32% in woman vs. none in man) and eating disorders (24% in women vs. 9% in man) was far more common in women whereas addiction to drugs (13% in man vs. none in women) was far more common in man.

There are clear indications that a possible co-morbidity of substance abuse disorder should be considered in cases of individuals with autism spectrum disorders. There are no gender differences in prevalence of co-morbidity ASD and SUD in total but addiction to medication and eating disorders seems to be much more common in women whereas addiction to drugs probably more common in man.

The author has not supplied his/her declaration of competing interest.

Even though cigarette smoking is a leading cause of preventable mortality, worldwide tobacco is consumed by approximately 22% of population. Smoking is also one of the risk factors for cardiovascular disease and it impacts our brain processing as well as being one of the recognised risk factors for Alzheimer's disease. The tobacco toxins may cause these disorders, e.g., nicotine at high levels, which are inhaled, resulting in preclinical brain changes. Researchers suggest that there are differences in brain volume between smokers and non-smokers. This review examines these differences on the brain grey matter volume (GMV).

In March/April 2015: MedLine, Embasse and PsycInfo were searched using terms: “grey matter”, “voxel based”, “smoking” and “cigarette”.

Studies found brain GMV decreases in smokers compared to non-smokers. Furthermore, gender specific differences were found, while thalamus and cerebellum was affected in both genders decrease in olfactory gyrus was found only in male smokers. Age group differences were also found and these may suggest pre-existing abnormalities that lead to nicotine dependence in younger individuals. Only one study found positive correlation between number of pack-years and GMV.

Smoking decreases the volume of grey matter in most brain areas. This decrease may be responsible for the cognitive impairment and difficulties with emotional regulation in smokers compared with non-smokers.

The authors have not supplied their declaration of competing interest.

Mood dysregulation came to be a hallmark in addiction diseases.

Antiepileptic drugs (AEDs) are used extensively to treat non-epilepsy disorders, such as mood disorder. Addiction disease may be triggered by bipolar disorder. Contemporary theories of addiction focus on pathophysiological mechanisms that imply a misbalance in the area of motivational behaviour, cognitive control, inhibitory function and decision-making processes.

The aim of the study was to confirm the clinical significance of AEDs use in the treatment of opiate addicts during hospital detoxification and in stabilizing period.

The prospective study comprised 70 medical histories of the patients treated in hospital setting over a period August 2015–2016. The study included patients with diagnosis of an opiate dependence and related mood disorders based on the ICD-10 classification. The rate of opiate withdrawal syndrome was measured by Objective Withdrawal Scale (OWS).

Our data uncovered a significant correlation between addiction and bipolar disorders, since 21% of inpatients treatment have co-morbidity. According to a survey, 74% of patients were treated with AEDs during detoxification period and in outpatients setting 1 month later. According to OWS in 65% cases AEDs improved the mood and affect, numbness, sensitivity.

AEDs role in opiate withdrawal syndrome was to normalize the affect, applied as an adjuvant therapy and also used during the recovery, in order to correct mood fluctuations. The high rate of co-morbid mental illnesses between addiction and other mental disorders argues for a comprehensive approach to evaluate each disorder concurrently, providing treatment as needed.

The authors have not supplied their declaration of competing interest.

Psychotic disorders were formerly associated with cannabis use. It could accelerate the course of the illness and thus, constitutes a severity factor in terms of prognosis.

To define the socio-demographic, clinical and therapeutic profiles of patients suffering from schizoaffective disorder (ASD) and who are consuming cannabis.

A retrospective study of 16 patients diagnosed with ASD, who were hospitalized at the psychiatric department of Tahar Sfar Mahdia's hospital, and whose toxicology test results during the hospitalization came back positive for tetrahydrocannabinol.

Sixteen patients were gathered, all male, the average age was 26 years. The average age of first hospitalization was 25 years, 41.9% were unemployed; 76.3% of our sample were single. Three quarters of patients were hospitalized without consent. The average hospital stay was 30.33 days. Our patients had required during their stay an average dosage of antipsychotic, equivalent to chlorpromazine, of 752.42 ± 342.79 mg. The average scores of psychometric scales were: BPRS = 55.72 ± 14.11, SAPS = 41.5 ± 14.80 and 42.11 ± 18.88.

Currently, it is recognized that prolonged use of cannabis is an exogenous risk factor. The association between cannabis and schizoaffective disorder may amend the treatment modalities. It requires, thereby, an integrated and simultaneous treatment of schizophrenia and addictive behavior.

The authors have not supplied their declaration of competing interest.

According to WHO, suicide is a major public health problem and the most affected age group by suicide in Tunisia is that of over 70 years.

To study the perception of the Tunisian elderly of suicide.

A cross-sectional study was conducted during a 3-month period from October to December 2015. Fifty persons aged at least 65 years participated to the study. We used an anonymous questionnaire with a specific scale: “Attitudes Towards Suicide Questionnaire” (ATTS).

The mean age of our patients was 67.5 years. Sex ratio was 1.27. Most of the participants were married (82%), unemployed (63.2%), with a secondary or high educational level (62%), and low income (73.5%). All participants were believers. As for religious practice, 74.5% of the recruited elderly made the fast and 73.5% were prayers. Among women, 70.8% wore the veil. Concerning the perception of suicide, it was on the dimension of “permissiveness” (M = 1.88) that our participants agreed less. Those who made prayers had lower scores of “permissiveness” (P = 0.032). Women who wore the veil had higher scores on the field of “incomprehensibility” than the unveiled ones (P = 0.047). Furthermore, 68% of our participants believed that suicide is stigmatizing.

It might be time to try to lift the taboo and stigma through information and sensitizing campaigns on suicide. In this direction, studies of perception help to identify, somehow, “automatic thoughts” regarding representations of suicide and to try to develop an “alternative thinking” in the general population.

The authors have not supplied their declaration of competing interest.

Self-immolation has been practised for several centuries in some cultures. Tolerated by Mahayana Buddhism and Hinduism. It is practised for many reasons: Sati (rituals), political protests, devotion and renouncement. In addition, it is also observed in some warrior cultures, like Rajputs.

The self-immolation trend began in Tunisia during government protests (“Arab spring” revolution) when a man named Bouazizi set himself on fire and died. Fiery copycat suicides spread throughout other countries. Algeria has also discovered this form of protest and faced a wave of self-immolation considered by some commentators to have reached epidemic proportions.

Our goal is to show the kind of support that political and health authorities, with the help of psychiatrists, are trying to set up in order to achieve efficient prevention.

In a case-control study, 20 consecutive case of deliberate self-inflicted burns admitted to the regional burn centre (Douera Hospital, Algeria) were compared with 20 controls who were selected from the community and matched by sex, age and living area. Diagnostic and statistical manual of mental disorders (DSM IV) Axis I (clinical disorders) and Axis II (personality and mental retardation) diagnoses were assessed via detailed clinical interview.

There have been 69 cases of self-immolation, with an average age of 26 including 87% of men and from which 13% with a psychiatric history. Unemployment and housing crisis are the most common causes. Here, we will provide specific explanations about our country.

It turns out that self-immolation is an extreme form of protest against the social malaise to make things change and does not due in the most cases to mental disease.

The author has not supplied his/her declaration of competing interest.

Suicide in public places is a relatively common emergency in which alcohol use could be a factor involved.

A total of 169 patients were attended for SB in Madrid public places by SAMUR (Municipal assistance service for emergency and rescue) and transferred to FJD emergency room where all of them were assessed by the psychiatrist on duty. For all (but 47 of them), blood alcohol level was measured and other variables were collected: age, sex, history of suicide attempt and characteristic of the attempt. A descriptive analysis was made and then differences between those using alcohol and those not was made.

Our sample comprises 169 patients, 40.2% woman and 59.8% man (median age = 39.36 years). Alcohol was measured in 122 patients, being positive in 52.4% (median alcohol level = 95.09 mg/dL). We found that 64.6% of man had consumed alcohol against the 30.2% of women (P = 0.000). 64.8% of alcohol users were discharged, against the 35.2% that not users. We admitted 28.1% of the alcohol users and 56.8% of the non-users (P = 0.007). We did not found statistically significance differences when compared patients that consumed against patients who did not regarding previous attempts, behavior (ideation, intent, non suicidal self-harm) and method.

When assessed SB, we found that most of the patients were man under the alcohol influence and most of them were discharged after being evaluated. The data does not reflect the seriousness of the SB, which opens the possibility of correlating the levels of alcohol with suicidal risk.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

The complexity of inpatient suicide in a general hospital setting, whether medical or surgical, is not fully understood currently. It is a common sentinel event and an important problem of patient safety. However, its evidence is currently lacking. So, we present a healthcare system approach to enhance the effectiveness of inpatient suicide prevention in Taiwan.

We reviewed available evidence about inpatient suicide. Some risk factors were detected. And we tried to improve our inpatient suicide prevention program with healthcare failure mode and effect analysis (HFMEA), which is a prospective qualitative analysis for numerous medical errors. In this study, HFMEA was used to reduce the likelihood of failure of current clinical practices in preventing inpatient suicide.

The psychiatric consultation rate increased after a series of improvement program. Besides, establishment of an integrated electronic medical system and the improvement of environment and facility safety are our main strategies. The HFMEA indicated that empowering staff with continuing education and case management by a full-time social worker and clinical psychologist were also needed. Furthermore, this hospital-based integrated suicide prevention program was accredited with the symbol of national quality of Taiwan in 2014.

Our study provided systematic intervention to improve inpatient suicide prevention in a general hospital, and in Taiwan. The HFMEA is a useful tool to improve inpatient suicide prevention measures. We still need more information and evidence to promote the importance of inpatient suicide prevention.

The authors have not supplied their declaration of competing interest.

Suicidal behavior is defined as any behavior of self-harm with intent and knowledge of what is done. Suicide ranks among the 10 leading causes of death in the statistics of the world health organization.

The main objective of the study is to determine the sociodemographic characteristics of patients who have attempted suicide and the characteristics of this behavior.

It is a descriptive cross-sectional study.

The sample consisted of 70 patients, with a mean age of 41.17 years, most of them were women (58.5%). In relation to employment status, 31.4% were working, 21.4% unemployed, 14.3% were retired and 32.9% had other employment status. Among the characteristics of suicidal behavior characteristics, mode, forecasting rescue, previous suicidal behavior, previous outpatient follow-up and consumption of toxic evaluated. The most frequent method chosen was the voluntary intake of drugs (77.1%). The 67.1% were diagnosed with depressive disorder followed by personality disorders (20%).

In total there is a predominance of women in achieving some suicidal behavior, as well as a higher percentage among single, divorced or widowed (60%) versus married (40%). Also a higher percentage of patients unemployed, pensioners and others who do not receive income (68.5%) versus the occupationally active (22%). Another condition that must be evaluated in the suicide risk is having previously made a suicide attempt, in our study 54.3%. Since subjects with previous suicide attempt are four times more likely to try again. The results are also consistent with other studies that the most common disorder associated with suicide attempt is depressive disorder (67.1%).

The authors have not supplied their declaration of competing interest.