Treating addiction is more challenging when there are co-addictions. Tobacco smoking is commonly associated with substance abuse, alcohol use disorders, excessive caffeine intake and pathological gambling among other addictions. Smoking reduction and cessation programmes´ objectives benefit from interventions targeting co-addictions.

Difficulties arising from smoking reduction and cessation in the context of co-use of cannabis prompt literature review and reflection of a smoking cessation programme team.

Pubmed and Google Scholar literature search using terms smoking cessation / tobacco cessation and cannabis.

Co-use of tobacco and cannabis is: 1) very common, 2) associated with greater prevalence of morbidity and social problems, 3) associated with greater dependence of the other substances, 4) negatively influences quit outcomes of either, 5) increases the risk of relapse. Co-users are more likely to perceive the harmful effects of tobacco, have greater motivation and are more likely to quit tobacco than cannabis, which may be perceived as low risk. Treatment of either tobacco smoking or cannabis use may lead to compensatory increase in use of the other substance. There is a significant lack of literature on co-use treatment strategies.

Co-use of tobacco and cannabis makes cessation and relapse prevention of either addiction more difficult and should be taken into account in smoking reduction and cessation programmes and in cannabis treatment interventions. Treatment targetting both tobacco and cannabis use, either simultaneously or sequentially, is likely more successful than interventions targeting only either one. Much remais to be studied on how to treat co-use of tobacco and cannabis.

Europe’s drug situation is facing an increasing trend.

To compare the psychoactive substance use pattern in Romania and Hungary.

Data was collected from the electronical databases of the 3rd Psychiatry Clinic of Cluj County Emergency Hospital, Cluj-Napoca, Romania and from the Psychiatry Department of Kenezy Gyula Hospital Debrecen, Hungary. We included adult patients who had at least one hospital admission for mental and behavioral disorders due to psychoactive substance use between 01/01/2013 and 31/12/2016.

96 patients from Romania (80.2% males, mean age 27.8 years (18, 82)) and 816 from Hungary (71.93% males, mean age 47 years (18, 90)) were included. Romanian patients consumed more opioids (31.52% vs 4.34%, p<0.05 Chi-square Test), cannabinoids (66.3% Ro vs 13.04%, p<0.001 Chi-square Test), and synthetic drugs (declared 73.91% vs 8.21%, p<0.001 Chi-square Test), an underlying personality disorder (52.08% vs 34.06% p=0.001 Chi-square test) was more often diagnosed. Hungarian patients consumed more alcohol (89.46% vs 30.43%, p<0.001 Chi-square Test), a comorbid bipolar disorder (18.75% vs 5.2%, p=0.001 Chi-square Test), a major depressive disorder (40.8% vs 16.6% p<0.001, Chi-square Test) or an anxiety spectrum disorder (55.26% vs 7.29%, p<0.001 Chi-square test) were more often diagnosed. Overall, more than 85% had a dependence use pattern, more than 65% having multiple admissions.

Romanian drug users are younger, prefer opioids, cannabinoids and synthetic drugs and have more often a comorbid personality disorder than Hungarian patients, who consume more alcohol and have a comorbid affective disorder.

Classic psychedelics have been administered in sacramental contexts since ancient times. They were of prominent interest within psychiatry and neuroscience in the 1950s to 1960s, but the association between classic psychedelics and the emerging counterculture put an end to their research. Modern research with classic psychedelics has reinitiated interest in the treatment of both cancer-related distress and addiction, with really promising results.

We aim to provide a review about history and new insights regarding research with psychedelics specially as treatment of addictive disorders.

A framing analysis of articles, searched on Pubmed (articles between 2010-2020) with the key words: “ psychedelics”, “psilocybin”, “substance use disorder”, “addiction”.

Classic psychedelics are 5HT2AR agonists such as LSD, mescaline, and psilocybin. They were shown to occasion mystical experiences, which are experiences reported throughout different cultures and religions involving a strong sense of unity. These experiences are scientifically important because they appear to cause abrupt and sustained changes in behavior and perception, that can be very useful in the substance use disorder field. From this analysis is possible to understand that the use of psychadelics in the treatment of some addictions is currently at an early stage of research. However, they show interesting results with no clinically significant adverse events when risk individuals are excluded.

In comparison to psychedelic research about cancer-related psychological distress, studies with addictions are less developed, but if they continue to suggest safety and efficacy, may be the use of psilocybin for the treatment of specific addiction can happen in a close future.

Substance use disorder (SUD) in patients with ADHD symptoms is associated with a poorer treatment prognosis. The study is aimed to investigate psychosocial risks factors for developing SUD in patients with ADHD.

To examine the associations between self-reported weak academic performance, repetition of a grade, single – parent family, self-reported quality of parent – child relationship, conduct problems in childhood and SUD in adulthood in a sample of outpatients with ADHD symptoms of an addiction medicine clinic in Riga, Latvia.

Self-report surveys, containing Adult ADHD Self-Report Scale (ASRS-v I.I), were completed by outpatients of addiction clinic, including healthy control subjects (adults without addiction, formally assessed for fitness to drive, firearms licensing etc.). Patients then were examined in relation to childhood risk factors.

Survey was compleated by 341 outpatients – 98 (28,7%) healthy controls and 243 (71,3%) patients with SUD (mean age, 36,8 and 37,7, respectively; 76,4% males). 62 (18,1%) patients were tested positive for ADHD, of whom 12 (19,4%) were healthy subjects and 50 (80,6%) were with SUD. Data shows connection between conduct problems in childhood (p=0,010), single - parent family (p=0,010), repetition of a grade (p=0,026) and SUD in adults with ADHD symptoms. Comparing patients with and without ADHD symptoms, there was found no significant association between these factors, except for conduct problems (p=0,015).

The study found preliminary evidence that adults with ADHD symptoms who experienced single – parenthood in childhood, had conduct problems or repeated a grade are more likely to develop SUD. Futher investigation is required.

Current classification systems are not sure where to place the internet use disorder. Is it an addiction, an impulse control disorder, a consequence of another psychiatric morbidity or a consequence of personality trait/personality disorder?

We intended to study which personality traits associated with online cognition may contribute towards Problematic internet use(PIU). We also analysed the relationship between number of hours of use/week of internet and PIU along with its relation with two ‘screening’ questions.

Online cognition scale and Abbreviated Eysenck Personality questionnaires were our measurements of choice in addition to demographic measures and some questions pertaining to online behaviour patterns.

Total 163 responses were analysed. The demographic pools consisted mostly of young adults who had, on average, used the internet for 5.2 years at present rate of 21.81hours/week. We observed significantly higher mean OCS scores in men, in people who thought that the internet interfered with their lives and in those who felt the need to ‘cut-down’. A moderate positive and significant correlation was observed between hpurs/week of internet use and OCS scores. Also, significant positive correlation was observed between Neuroticism and OCS, impulsivity, and loneliness/depression scores. Significant negative correlations were observed between the Lie trait and impulse control. Neuroticism and Lie together contributed to 21.8% of variance in OCS scores.

Neuroticism and Lie traits (representing need for social acceptance) were found to the causing significamn varience in the OCS scores of the subjects. High number of hours/week use of internet was related to the feeling of ‘need to cut down use’.

The intentional use of drugs before or during sexual intercourse (chemsex), due to its impact on mental health, is a phenomenon of high importance in men who have sex with men.

We report the case of a patient with polysubstance acute intoxication, including 2C-B, in order to review the evidence about the mechanisms of action of 2C-B, its efects on sexual pleasure, toxicity, patterns of abuse and somatic and mental health related consequences it may present.

Case report and narrative review.

We present the case of a patient using 2C-B as a substance in chemsex practice. As the patient presented in our emergency with psychotic symptoms, he was diagnosed with “stimulant acute intoxication” and “acute psychotic symptoms induced by stimulants”. 2C-B increases dopamine (DA) serotonin (5-HT) and norepinephrine (NE) and cause stimulating and hallucinogenic effects.

MSM is a group vulnerable to the problematic use of drugs in a sexual context. Several mental health problems have been associated with chemsex users such as psychotic sypmptoms, suicidal ideation, encephalopaty, delirium. Polysubstance use is common in chemsex practice and it can be difficult to identify the drugs used in states of acute intoxication but psychiatrists must explore the use of differents drugs from the “classic chemsex drugs” (mephedrone, GHB and metanphetamine) including 2C-B and other substances such as cocaine, MDMA, ketamine, and other cathinones different from mephedrone.

N-acetylcysteine (NAC) is a precursor of cysteine and glutathione, widely known as an antidote to paracetamol overdose. Its role as precursor of an antioxidant and modulating agent of glutamatergic, dopaminergic, neurotropic and inflammatory pathways, raised interest in its application in psychiatric disorders. NAC emerges as a promising therapeutic agent in substance use disorders (SUD) and provides a treatment option in a field with limited and suboptimal therapies.

To describe the use of NAC in SUD (tobacco, cocaine, cannabis, methamphetamine and alcohol), its potential mechanisms and clinical application.

The literature was searched using the Pubmed database with the following keywords “N-acetylcysteine”, “Substance use disorders” and “Psychiatry”. Retrieved papers (2011-2018) were selected according to their relevance.

SUD results in disruption of glutamate system, in nucleus accumbens, a critical brain area in the rewarding system. NAC reestablishes glutamate homeostasis restoring function of the cysteine-glutamate exchange in glial cells and reversing the downregulated GLT-1 receptor. Concerning its properties, evidence suggests that NAC is able to decrease drive, craving or compulsion to consume, making it particular useful in relapse prevention after achieving abstinence.

NAC has revealed itself as a promising therapeutic agent in SUD and its safety profile and favourable tolerability, as well as being an over-the-counter medication, adds to its interest. Data is still preliminary for the use of NAC in psychiatry disorders, due to the relatively small number of trials and their heterogeneous methodology. Larger studies are needed to confirm efficacy, optimal doses, long-term tolerability and side effects.

A standardized approach to reduce or decrease the tobacco consumption is not performed. It is being used as a medium to socialize having an educational character on nursing and medical relationship.

Current cessation program are thought for patients without relevant cognitive impairments. Evidence about alternative management for this patient subgroup was collected.

This investigation examined the state of the implementation of nicotine cessation therapy for chronic psychiatric patients in Germany, Austria and Switzerland. German- and English-speaking publications since 2010 were selected. 12 different reviews and control trials were included.

Inpatient experiences from maximum hospital care in Germany have been published in the last 10 years, but mostly by oncologist departments in collaboration with pulmonologists and cardiologists showing a poor interest from psychiatrists, not even for harm reduction strategies in patients with severe mental illness. Therefore, the identification and treatment of nicotine addiction remains very low in patients with mental health conditions. Cognitive and pharmacological interventions are not covered by the German health system.

Latest evidence suggests that more flexible, open-ended, combination approaches of pharmacotherapy and counselling may be more successful. It will hence contribute to redressing the significant health and social inequities experienced by this. population sub-group as a consequence of tobacco smoking.

Medical studies have always been considered as very stressful. Although these students are generally among the most academically successful students, they are not spared from developing both substance and behavioral addictions, particularly pornography cyberaddiction.

To evaluate the pornography cyberaddiction in a group of tunisian students, to study their impulsivity and determinate the link between these two entities.

A descriptive and analytical cross-sectional study including 155 medical students. We used the S-IAT sex : to evaluate pornography cyberaddiction and Barrat bis 10 : to evaluate impulsivity.

The average age of students was 25.8 ±3.5 years old. The sex ratio (M/W) was 0,72. This medical students were single in 76.8%, had a high socio-economic status in 99.4% of case. They had a personal psychiatric history in 15.0%. They are smokers in 20%, consume alcohol in 30.3% and cannabis in 9% of case. The mean score of : the BIS 10 was 63.3 and the S-IAT was 15.6. The viewing of pornographic movies started around the age of 15 years old. Pornographic sites are the most frequently used tool (58.2%). The factors correlated with this addiction are: male sex (p=0.014), tobacco consumption (p=0.012), alcohol consumption (p=0.02) and impulsivity (p=0.03).

It resort from our study that medical students may suffer from pornography cyberaddiction. This increased use may be associated with impulsivity and substance use. Psychological support aimed specifically should be used to protect medical students.

Synthetic Cannabinoids were recognized as drugs of abuse since 2008, they are sold under various names (Kush, K2, Spice).

The Patient N., 17 years old male was admitted to the hospital with a first-time psychotic episode. He is fond of extreme sports (ski jumping, gymnastic and acrobatic elements).

The patient was fully examined.

Then he was taken to the admission department. About a week before admission he fell, injuring his leg and head. After that he did not sleep, became excited, aggressive, “said strange things”. During the admission patient showed disorganized behavior, agitation, paranoid ideation, beliefs that others were inserting thoughts into his head (“thought insertion”) and that his thoughts could be read by others (“thought broadcasting”), imperative “voices”, bizarre delusional thoughts. The UDT showed positive K2 analysis. The patient was prescribed Diazepam, Zuclopenthixol, Valproic acid. No improvement observed. Haloperidol was prescribed next day. Then Haloperodol was changed to Quetiapine, and after 10 days of treatment no improvement was observed. The patient started to show catatonia symptoms such as elective mutism, mild rigidity, signs of cog-wheeling or clasp-knife rigidity. He experienced anxiety, fear, did not take care of himself. Every day he started to be aggressive, impulsive, started to experience auditory hallucinations. Due to that fact it was decided to prescribe Haloperidol, Chlorpromazine, Phenazepame, Diphenhydramine.That treatment improved behavior.

Thus, the intensive treatment with antipsychotic medications in combination with benzodiazepines and diphenhydramine is much more preferable for the management of the cases of oneiroid catatonia due to the usage of Spice.

Teenagers’ Internet addiction can be supported by a wide variety of Internet content.

To study the structure of the content consumed by Siberian adolescents with Internet addiction.

200 (69 boys and 131 girls) Internet addicted adolescents aged 11-18 years and living in the urban area of Central Siberia (Krasnoyarsk) were surveyed. Content consumption was studied using Game Addiction Scale for Adolescents and The Social Media Disorder Scale.

19.0% of adolescents were addicted to Internet games, 22.5% of adolescents were addicted to social media. A combination of both types of addictions was found in 23.5% of adolescents. Other types of content addiction was found in 35% of adolescents. Boys prefer Internet games (62.3% of boys vs. 32.1% of girls), while girls prefer communication on social media (55.0% of girls vs. 29.0% of boys), p <0.001. Combined addiction is observed equally in both sexes (23.2% and 23.7% respectively). For older adolescents, there is observed a decrease in the interest to Internet games (from 48.4% at 11-14 y.o. to 37.6% at 15-18 y.o.) and to social media (from 49.5% to 43.1%). At the same time, interest to other types of content is growing (from 27.5% to 41.3%).

Boys with internet addiction are more likely to be addicted to internet games, while girls are more likely to get engaged in social media. Older adolescents show a decrease in the interest both to Internet games and social media, while their interest to other types of content increases. The study was funded by RFBR project № 18-29-2203218.

The study was funded by RFBR project № 18-29-2203218.

Knowing the leading patterns will help timely predict that addictive behavior is being formed.

To identify the leading patterns of addictive behavior in adolescents in Central Siberia according to the results of the CIAS test.

200 adolescents aged 11-18, 69 males and 131 females, with Internet addiction living in an urban area (Krasnoyarsk) were surveyed. The patterns of addictive behavior were assessed using the CIAS test, which includes scales of key symptoms: “Com” (compulsive symptoms), “Wit” (withdrawal symptoms), “Tol” (tolerance symptoms); and negative consequences scales: “IH” (intrapersonal and health problems), “TM” (problems with time management).

The mean results (M) of key symptoms were obtained at 14.56 on the “Com” scale, 15.27 on the “Wit” scale, 12.23 on the “Tol”. The mean indices of negative manifestations were obtained at 17.00 on the “IH” scale and 13.94 on the “TM” scale. When comparing the mean results of the scales of addicted behavior by the method of one-way analysis of variance (ANOVA), statistically significant differences between representatives of different sex and age groups were not revealed (p> 0.05).

The leading key symptoms of Internet-addicted behavior in Central Siberia adolescents include withdrawal symptoms: decreased mood, anxiety and irritation in the absence of access to the Internet. Symptoms of negative consequences include decreased social contacts, reduced communication with family members, and problems at school. When such symptoms emerge, one should suspect the formation of Internet addiction and carry out the necessary diagnostics for timely intervention. The study was funded by RFBR project № 18-29-22032\18.

The study was funded by RFBR project № 18-29-22032\18.

Internet addiction (IA) is associated with personal peculiarities, psychosocial characteristics, and physiological factors. Excessive daytime sleepiness (EDS) is one of the most common sleep disorders in adolescents associated with social behavior patterns.

To evaluate the association of IA with EDS in Siberian adolescents.

4637 urban Siberian (Krasnoyarsk, Abakan) school-based adolescents (aged 12-18; boys/girl ratio 2215/2422) were tested with Chen Internet Addiction Scale (CIAS). Internet users were categorized into three groups: adaptive Internet users (AIU) (scoring 27–42); maladaptive Internet users (MIU) (scoring 43–64); and pathological Internet users (PIU) (scoring ≥65). EDS was assessed by Pediatric Daytime Sleepiness Scale (PDSS); cutoffs for EDS were PDSS 95% percentiles for each age group: 12 y.o. – 20 points, 13 y.o. – 21 points, 14-16 y.o. – 22 points, 17-18 y.o. – 23 points. Quantitative data are shown as median (25-75% quartiles). Chi-square and Kruskal-Wallis tests were used.

EDS prevalence increase with IA severity: AIU group (n=2402) – 1.4%, MIU group (n=1905) – 3%, and PIU group (n=330) – 12.4% (pAIU-MIU=0.001; pAIU-PIU<0.001; pMIU-PIU<0.001). Positive association was detected between IA severity and PDSS score: AIU group – 10 (6-13), MIU group – 14 (10-17), and PIU group – 17 (13-21), p(K-W)<0.001).

EDS is associated with IA in Siberian adolescents. The possible explanations of this relation may be: (1) the higher rate of night activity, (2) night sleep disturbances and (3) the presence of common pathogenic factors in IA and EDS, such as personality characteristics, depression, anxiety. The study was funded by RFBR project № 18-29-2203219.

The reported study was funded by RFBR according to the research project № 18-29-22032\19.

Adolescent self-harm in Europe is a major public health challenge and shares a risk continuum with suicide. Recent research demonstrates a strong risk correlation with attempting suicide in the community-based adolescent self-harm population group, similar to research findings for populations in health setting-based research. In the UK increasing rates in hospital admissions represent the “tip of the iceberg” within the community, with potentially two thirds of the population group not accessing health services for support. This brings many health risks, including an increased suicide risk. Finding a solution to these issues requires a preventative intervention approach for young people, including community-based delivery to address service access barriers. Secondary schools are posited as key settings where this type of support could be delivered. But emerging UK research demonstrates challenges in completing adolescent self-harm research with young people in schools.

This paper centres on a current adolescent self-harm preventative intervention research project in Cardiff University. It focuses on ethical research practice in community-based adolescent self-harm research.

This paper appraises some of the core ethical issues, challenges and their management in completing adolescent self-harm prevention intervention research in secondary school settings in Wales. It also provides an overview of the project’s innovative safety protocol design.

This project was successful in managing the potential risks to the school-based adolescent research participants.

This work helps address some of the current research barriers to completing adolescent self-harm prevention intervention research in schools, to facilitate shared solutions to the urgent public health challenge of adolescent self-harm.

Suicide is the third leading cause of death in adolescents (15-19 years). Physical pain is an important risk factor for suicidal thoughts and behaviors, especially in a delicate phase as adolescence.

Several studies investigated this association and the aim of this meta-analysis was to synthesize data in literature about this topic in adolescents (11-20 years).

We started from a systematic review published by Hinze and colleagues in 2019 and we searched on PubMed (January 2019-June 2020) studies comparing rates of suicidal outcomes (Suicidal Ideation, Suicide Plan, Attempt, Self-Harm: SI, SP, SA, SH) in individuals with any type of physical pain (head, back, neck, chest, stomach, abdomen, muscle, joint, arthritis) vs. those without it. Data were analyzed with Comprehensive Meta-Analysis software (CMA, version 3).

Of the 16 included studies, eleven focused on SI (68.8%), six (37.5%) on SA, four (25%) on SH and two (12.5%) on SP. Adolescents with physical pain were more likely to report SI (p < .001), SH (p < .001), SA (p = .004) and SP (p = .006). In all analyses, the between study heterogeneity was high. The presence of publication bias has been detected in SI (k≥10).

Results are in line with previous literature on this topic. Future research should investigate the specific impact of: acute vs. chronic pain; different types and intensities of pain; planned vs. impulsive action and therefore suicidal intent; role of psychological factors (in particular sensitivity and tolerance to physical pain).

Multiple epidemiologic and clinical studies have explored the relationship between physical pain and suicidal thoughts and behaviours.

The aim of this meta-analysis was to provide an update of the data already present in literature about this specific association in adults.

Starting from a meta-analysis published by Calati and colleagues in 2015, 28 studies were included in this work. After searching on Pubmed (until March 2020), data were extracted from articles comparing the rates of current and lifetime suicidal thoughts and behaviours (death wish, suicidal ideation, suicidal planning, suicide attempt and suicide death: DW, SI, SP, SA, and SD) in adults with any type of physical pain and in individuals who did not report this condition. Data were analysed using Cochrane Collaboration Review Manager software (RevMan, version 5.4).

Although high between-study heterogeneity was detected in most analyses, results suggested that adults with physical pain are more likely to report any form of suicidal outcome, except for death by suicide, compared to individuals not affected by pain. No evidence of publication bias was reported in the main analysis (lifetime SA).

Collected data are therefore in line with previous literature on this topic, which considered physical pain an extremely relevant risk factor for suicidal thoughts and behaviours. Future studies should specifically focus on alternative types of physical pain (such as medically unexplained pain or psychogenic pain) or explore the different impact of acute versus chronic pain in terms of increased suicide risk.

Suicide is the second most common cause of adolescent mortality worldwide.

To study the characteristics of a sample of adolescents (<18years of age) who died by suicide in Greece.

We investigated all suicides that took place within the area of the Piraeus Department of Forensic Medicine (population covered ~700,000) for the period 1992-2016, based on the victims’ forensic records.

During the 25-year period, 16 adolescents (and 1162 adults) died by suicide. They were mostly males (11/68.75%) and of Greek Nationality (14/87.5%). The mean age was 15.56 years (range: 12-17, standard deviation: 1.46). Two (12.5%) were under psychiatric medication (an antipsychotic and an antidepressant, respectively); none was receiving a benzodiazepine or a mood-stabilizing antiepileptic. None had used amphetamine, cannabis, cocaine or heroin. Two (12.5%) -one girl one boy- had consumed alcohol. The suicides took place primarily at home (12/75%), followed by outdoors (3/18.75%); one (6.25%) took place in a correctional facility. Hanging was the most prevalent method (6/37.5), followed by jumping (5/31.25%), shooting by a firearm (2/12.5%), drowning (1/6.25%), medication overdose (1/6.25% -amitriptyline poisoning) and a case of suffocating death (1/6.25%). Most suicides happened in September (5/31.25%) and April (3/18.75%). No significant differences were noted with the adult sample.

The methods chosen by the adolescents who died by suicide in our sample differ strikingly from those of usual suicide attempts at that age (medication overdose/self-cutting). The periods when the suicides took place may imply a role for school stress. Our study was retrospective and focused primarily on a large urban area.

Among medical students the rate of depression varies between 5-32% and it is known that the suicide rate is higher than in the general population.

Clear and current data are needed to design studies for the diagnosis and treatment of students and residents of Medicine with psychological and psychiatric disorders in order to reduce rates of suicidal behavior in this population group.

A systematic search for articles on the UpToDate, PubMed and Mendeley platforms has been conducted with the keywords “suicide”, “suicidal behavior”, “suicidal ideation”, “medicalschool” and “medical students”. We found 435 items from which a total of 42 items were selected.

The prevalence of depression is 27.2%, of which only 15.7% of them are under treatment. Burnout, has a high prevalence of 45-50%. The prevalence of suicidal ideation in the last year is 11.1%. The most commonly used method is medication overdose. Suicidal behavior is greater among students who choose to choose Psychiatry or Family and Community Medicine as a specialty.

The rate of suicidal ideation among medical students is 11.1%. Nearly one out of every three medical students suffers from depression in some degree, and only one in five is treated. The similar prevalence of burnout at all levels supposes poor management of stress from the faculty. Medical schools should reduce the associated stigma and should encourage depressed students to seek treatment.

Patients with substance use disorders (SUD) have higher alexithymia levels and present frequently suicidal ideation (SI) and suicide (SA) [1,2]. Beside, alexithymia has been related to suicidal behaviors in several psychiatric disorders[3]. Although, there are some studies on alexithymia and suicidality in SUD patients, to our knowledge there are no studies on this issue in Spanish population.

To compare the alexithymia levels in SUD patients with and without SI and SA in an outpatient addiction treatment center in Spain.

This is a cross-sectional study performed on 110 patients (74.3%males; mean age 43.6±14.5years old) for whom we had information from the Toronto Alexithymia Scale(TAS-20) and the presence or not of lifetime SI and SA.

Lifetime SI and SA were present in 55.5% and 35.5% of the sample respectively. The mean score of TAS-20, difficulties identifying feelings (DIF), difficulties describing feelings (DDT), and externally-oriented thinking(EOT) were 57.2±13.3, 20.0±7.0, 14.7±4.5, and 22.5±4.5 respectively.

SI and SA may be related to alexithymia levels. Hence, alexithymia should be further analyzed in SUD patients in longitudinal studies in order to analyze the bilateral association with suicidal spectrum behaviors. REFERENCES Rodríguez-Cintas L, et al. Factors associated with lifetime suicidal ideation and suicide attempts in outpatients with substance use disorders. Psychiatry Res. 2018;262:440-5. Morie KP, et al. Alexithymia and Addiction: A Review and Preliminary Data Suggesting Neurobiological Links to Reward/Loss Processing. Curr Addict Rep. 2016;3(2):239-48. Hemming L, et al. A systematic review and meta-analysis of the association between alexithymia and suicide ideation and behaviour. J Affect Disord. 2019;254:34-48.

Although suicide showed an association with personality disorders, few studies focused on narcissism. This association is interesting, especially in what authors called a “narcissism epidemic”, considering narcissistic wounds to which subjects could be subjected.

To systematically review studies investigating the association between narcissism and suicidal risk.

We focused on the association between narcissism (NPD, narcissistic traits) and suicide (Suicidal Ideation (SI), Non-suicidal Self-Injury (NSSI), Deliberate Self-Harm (DSH), Suicide Attempt (SA) and Suicide (S)). Studies were identified through a PubMed-based search. Reference lists were examined to extract additional articles. This review was performed according to PRISMA Statement.

We included 33 studies. Most studies evaluated narcissism through DSM, showing heterogeneous results. NPD was associated with low impulsivity and high planning, but also with a higher number of SAs. Studies evaluating narcissism as a trait were more coherent. SI, NSSI and DSH showed an association with vulnerable narcissism. These associations were explained by mediation and moderation models including shame and dissociation. The grandiose component was associated with severe repetitive NSSIs and S in high suicidal risk samples. Impulsivity showed no effect.

It is possible to develop hypothesis, even if not causal relationships, on the association between narcissism and suicidal risk. Grandiose narcissism seemed to be protective for suicidal outcomes with low intent to die, while vulnerable narcissism seemed to be associated. However grandiose narcissism seemed to be a risk factor for suicidal outcomes with high intent to die, showing low impulsivity and high planning and severity. New studies, differentiating between narcissistic components, are needed.