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 6 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 improvement (>30%; p< .05) in everyday attentiveness functions (tonic and phasic alertness, divided attentiveness) as did work therapy (precision, endurance), although some patient subgroups are 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.

It is now well known that unaffected first-degree relatives of patients with alcohol disorder have electrophysiological abnormalities (less P3 amplitude). These abnormalities are associated with higher scores in impulsivity self-rating scales and are assumed to reflect central nervous system disinhibition and/or hyperexcitability. However very much less is known about the performance of this population in neuropsychological tests assessing executive functioning and in particular the inhibition process.

Thirty-five first-degree relatives of patients with alcohol dependence were compared to thirty-five healthy controls, matched in terms of age, gender and education level. They completed a self-rating scale of impulsiveness (Barratt Impulsiveness Scale) and a battery of neuropsychological tests. The test battery included the Wisconsin Card Sorting Test, a measure of overall executive functioning, and two performance measures of inhibition process (a Stroop task and a Go-No Go task).

As expected, the Barratt Impulsiveness Scale showed differences between the two groups, with first-degree relatives having higher overall scores and increased scores in the non-planning subscale. Results from neuropsychological testing indicated significant differences among the three tasks (WCST, Stroop task and Go-No Go).

Our findings are consistent with the view that unaffected first-degree relatives of patients with alcohol dependence show decrements in executive functioning and inhibition process. Studies are underway to identify genes associated with the underlying predisposition involved in disinhibitory disorders in this population.

Substance-induced psychoses (SIP) are associated with greater conjugal ties, greater substance dependence, homelessness, parental substance abuse, poorer family support and visual hallucinations, while primary psychotic disorders (PP) have greater symptom severity.

To describe differential characteristics between PP and SIP in a dual diagnosis unit.

We collected sociodemographic, employment data, admission reasons, family substance abuse and main drug of abuse.

• • 23 patients were admitted with psychosis (87% males; mean age 35,6±10,1). Two groups were performed: PP (N=12) and SIP (N=11).

• • Mean length of admission was 17,78±13,17 days. Most prevalent co-occurrent diagnoses were psychotic disorders-cocaine use disorders (43,5%).

• • The only significant difference between PP and SIP was shorter length of admission in SIP (days: mean [s.d]) (26,6±14,9 vs. 13,8±7,5; p< 0.05). Other variables studied were: (1) main reasons for admission: hallucinations/delusions (33,3% vs. 90,9%), suicide ideation (33,3% vs. 0%); (2) main drug of abuse: cocaine (50% vs. 45,5%), alcohol (33,3% vs. 0%), psychoestimulants (0% vs. 27,3%), cannabis (8,3% vs. 18,2%); (3) marital status: married/cohabiting (25% vs. 36,4%), divorced (16,7% vs. 0%), single (58,3% vs. 63,6%); (4) employment: employed (33,3% vs. 50%) and unemployed (66,7% vs. 50%); (5) age, years: mean (s.d): 37,8 (10,6) vs 33,2 (9,5); (6) parental substance abuse (65,7% vs. 83,3%).

• • No significant differences were found between both groups (PP vs. SIP) except for shorter length of admission in SIP.

• • The most frequent co-ocurrent diagnosis was psychotic disorder+cocaine use disorder.

This study was carried out on 149 of Heroin dependent patient that admission for detoxification.

This study is a 10 days double blind placebo-controlled trial.

This study is a 10 days double blind placebo-controlled trial which was carried out on 149 of Heroin dependent patient that admission for detoxification in Mashhad Ebne-sina hospital in 1385-1386 Subjects were randomly divided into topiramate and placebo detoxification groups.

Topiramate group receive topiramate (max 200 mg) for 10 days. The placebo group received usual regimen and placebo. Withdrawal symptoms were assessed by Subjective and Objective Opiate Withdrawal Scale in days 1, 3, 5, 7, 10.information s analyzed by chi-square test for qualities variables and T-test & Mann-Whitney for quantities variables in SPSS software.

22 subjects were excluded from the study. Both groups had no significant differences in age, sex, education, number of previous withdrawal and past history of other drug use. Result indicates decrease in objective withdrawal symptom significant in 3(p=0.000), 5 (p=0.004) and 7(p=0.026) day and subjective withdrawal symptom significant in 3 (p=0.000) day in topiramate groups.

Topiramate can use for control of withdrawal symptom in patient with Heroin dependency.

The study aimed to investigate effects of drug named methadone in treating of addicted on changing of positive and negative mood affect.

19 addicted people were randomly selected and before methadone therapy with a pretest, Watson’s Positive Affect and Negative Affect (PANAS) was administered on them. One month later after methadone therapy, again Watson’s Positive Affect and Negative Affect (PANAS) was administered on them. PANAS assesses: Interest, Distress, Powerfulness, Fear, Enthusiasm, Proud, Agitation, Nervous, Panic. Data was analyzed with independent T test.

Findings showed significant differences between PANAS components. Methadone therapy increase interest, powerfulness, enthusiasm, proud, and decreased distress, agitation, panic. But there is not any differences between fear and nervous in pre and post test.

The findings indicated using methadone drug in addition to reduce physical symptoms can reduce significantly mental problems in addicted and can be regarded a proficient drug for treating of addiction.

Psychiatric disorders and among them depression are common in substance dependant patients. The aim of this study is to compare the clinical characteristics of those that appear to have substance induced depression and those that have independent majordepression.

184 independent and 187 opium induced (OID) depressed male patients that met the DSM-IV criteria for major depressive disorder were randomly selected. Standard demographic data, including age, marital, employment and education status were collected. The primary measure of depressive signs and symptoms was Hamilton Depression Scale (HAMD-21).The two groups were compared with each other for the HAMD total and subscales scores.

The two groups were matched regarding age, educational level and marital status. Opium induced depressed patients were more severely depressed and motor retarded and also they had more social and occupational problems. Gastrointestinal, sexual and somatic complaints were more common among them too. MDD patients had better insight than the other group.

The results demonstrate that it ispossible to differentiate between substance-induced andindependent depression. Such differentiation mightbe important for establishing prognosis and optimal treatment.

Alcohol dependence is a chronic disease connected with disorders of the brain. The aim of this study was to assess cognitive frontal cortex functions in patients with alcohol dependence after discontinuation of alcohol use and after at least, one year of abstinence.

106 patients (28 females, 78 males), aged 26 - 57 (mean 43±7,5) years with alcohol dependence were evaluated. In 53 subjects, an assessment was performed seven to ten days after discontinuation of alcohol drinking and in 53 subjects after at least one-year of abstinence. The control group consisted of 53 healthy persons, matched for age, sex and education to patients from the experimental group. The intensity of alcohol addiction was assessed, using SADD and MAST scales. Neuropsychological assessment included frontal tests: Wisconsin Card Sorting Test (WCST), N-back Test, TMT A&B, Stroop Test 1&2 and Verbal Fluency Test (FAS).

Significant disturbances of working memory and executive functions were noted in patients with alcohol dependence (with short-term and long-term abstinence), in comparison to healthy subjects. No significant differences were observed between the patients with short-term and long-term abstinence on the performance on neuropsychological tests, except better results of TMT B, WCST- the percent of non-perseverance errors and WCST - the percent of reactions compliant with logical concept obtained by the patients with long-term abstinence.

The results obtained indicate core and enduring working memory deficits, connected with prefrontal cortex impairment in patients with alcohol addiction, independent from the duration of the abstinence.

This research was supported by grant 502-16-685 Medical University of Lodz.

Evaluate the utility of Wisconsin test for the detection of errors in the capacity of forming abstracts concepts in chronic cocaine users.

An observational, prospective, cohorts study was carried out, with a control group (n=27). The case subjects (n=24) are patients with cocaine dependence. The patients underwent the Wisconsin cards sorting test, in the 64 cards version.

Among the different results obtained we could remark the differences on the number of errors (mostly the perseverative ones, which would be showing difficulties for finding alternatives and proposals for problems resolutions, more noticeable in the cases group than in the control group) and on the number of conceptual level answers, which shows the comprehension of the basic classification principles, and it would be affected as well in the cocaine users group in comparison with the control group.

These results would show a higher difficulty finding alternatives and different proposals when solving problems in the cases group; as well as on the comprehension of basic classification principles.

According to the estimations offered on the Test's manual, we demonstrate the existence of cognitive impairment on the cases group, although it is not a severe damage, but could be labelled as medium-mild damage.

(Proyecto MSC-2005/465 financiado por DGPNSD)

Taking into account the differences on the basal cognitive performance, pattern of drug use, and the influence of menstrual cycle on cerebral blood flow and neuronal lost, it is expected to find differences on the neuropsychological damage resulting of chronic cocaine use according to the patient's gender.

To know about the influence of the gender factor on the neurophycological damage as a result of chronic use of cocaine.

Using a neurophicological assessment battrery (digit (WAIS-III), Trail Making, Card's, Zoo's (BADS), and Wisconsin Card test), we compare the performance between males (N= 19) and females (N= 5). This assessment is part of a wider observatory prospective study with a control group, to study neurophycology damage caused by the cronic consumption of cocaine (Proyect MSC-2005/465 (DGPNSD).

The mean age on our sample is 36.0 years (ds: 6.3); mean of schooling time was 8.4 years. 83.3% consume cocaine daily, but only 12.5% injected intravenously. The average of daily cocaine consumption is 1.5 gr (ds: 1.3). 87.5% use also other illegal substances.

No statistically significant differences were found between the two groups in any of the tests applied. The adjustment was made considering different patterns of drug use, schooling time and other variables. In the others analysis of the same tests in the group control neither did no find any different evidence in gender factor.

Differences according to gender could not be found. On the statistical adjustment, pattern of cocaine use and previous cognitive function were considered.

There are no published data on how family burden changes over time in alcoholism. We present 6-month follow-up data on the burden of families of alcohol dependent individuals.

The sample comprised 87 caregivers (63 females, 24 males) of alcohol dependent individuals who completed a 4-6 week inpatient alcohol detoxification in the Specialized Drug and Alcohol Addiction Clinic at the Eginition Hospital, Athens University Medical School. During hospitalization, a brief supportive intervention for the relatives took place. After detoxification all participants were followed-up as outpatients for a 6-month period in an affiliated service. Burden and psychopathology of caregivers were assessed with the Burden of Care Scale, and the General Health Questionnaire (GHQ-28). T-tests for paired samples were used for comparisons between different time points (admission-discharge-six months). A logistic regression model was used to identify factors which influence relatives’ relief.

Caregivers exhibited high scores of burden in terms of financial, household, interpersonal relations and parental roles at admission; mild psychopathological symptoms were also recorded. By the end of detoxification scores significantly decreased in most relatives (admission vs. discharge, p< .000); this improvement was determined by the patients’ soberness.

Alcohol dependence may have a considerable impact on family interaction as shown by the high scores of burden and mild psychopathology recorded in the caregivers. Our findings suggest that the relatives’ relief was dependent on the achievement of abstinence and the number of relapses. Therefore, a brief supportive intervention is recommended.

The relationship between immigration and drug abuse and its treatment is complex and poorly understood. The objective of this study is to gain insight into patterns of drug use and service access and how they are influenced by social factors and the migratory process in a population of foreign born drug users in Barcelona, Spain.

An interview protocol was developed for the study which examined drug use patterns, social and health factors, and treatment, and was administered to 118 foreign born users in harm reduction centers. 92% were male and 8% were female. 42% were from Eastern Europe, 35% were from the Magreb, 14% from the European Community, 6% from Subsaharan Africa and 3% from Latin America.

With migration opium use decreased whereas cocaine, heroin, and speedball increased, which also constitute the primary drug used by this sample. Social support was correlated with greater consumption of heroin, cocaine, and alcohol, whereas lower social stress was predictive of higher cannabis use. Hard drug use was predicted by illegal status and a lack of stable housing. Acculturation and acclturative stress were not found to be related to substance use. Treatment was positively evaluated, with no perception of lower quality of care.

Drug use patterns shift with the migratory process, and, it would appear, adapt to the dominant local ones. The unexpecting findings regarding social factors and acculturation and acculturative stress may indicate differences in the Spanish drug use context, and as such warrant further research.

Sample of alcohol and opiate female addicts (30 patients in each group) plus control group (30 women) with no psychiatric diagnosis were questioned with Defense Style Questionnaire - DSQ 40 (Andrews, Singh, Bond, 1993).

There were found no statistically relevant differences between two experimental and one control group concerning mature defense mechanism use. Significant differences were found in neurotic and immature defense mechanism use: alcohol addicts use prevalently neurotic mechanisms and immature mechanisms prevail among opiate addicts.

In our research mostly used neurotic defense mechanisms by alcohol addicts were: pseudoaltruism, idealization, and undoing. The mostly used immature defense mechanisms among opiate addicts were: phantasy, isolation, devaluation, denial and splitting.

Injection drug users (IDUs) frequently suffer from somatic and mental co-morbidity. The effects of different opioid maintenance protocols on these parameters have not been systematically studied yet.

This study was conducted as a 12-month open-label multi-centre randomised controlled trial to test a heroin- vs. methadone based protocol.

515 patients were randomised to the heroin-assisted and 500 to the methadone-assisted treatment program. Baseline scores were as follows: OTI-HSS 19.0 (±5.2), BMI 22.6 (±3.5), pathologic electro-/echocardiogram 20.4% (n=582) / 13.9% (n=491), positive HBV-, HCV- and HIV-serology 65.7% (n=863) / 86.5% (n=855) / 9.2% (n=951), positive tuberculin test 9.1% (n=318), KPS 71.4 (±12.9), Global Severity Index (GSI; SCL-90-R) 69.2 (±10.6), GAF 53.6 (±11.7) (all parameters not significant between treatment groups). Improvement after 12 months of treatment differed significantly between treatment groups (heroin vs. methadone): OTI-HSS 8.1 (±5.2) vs. 10.6 (±6.4), BMI 24.5 (±4.3) vs. 23.7 (±4.1), KPS 78.2 (±12.8) vs. 74.2 (±13.3), GSI 58.6 (±13.7) vs. 62.0 (±13.2), GAF 63.0 (±13.3) vs. 56.2 (±15.0) (ANOVA, all p=.000). The frequency of pathologic echocardiograms after 12 months was significantly lower in the heroin compared to the methadone group. Within the heroin group, completers benefited stronger than drop-outs. The remaining parameters did not differ between baseline and 12 months and between treatment groups.

Integration of severe injection drug users either in methadone or heroin assisted maintenance treatment has positive effects on most change sensitive physical and mental variables. In this patient group heroin assisted treatment showed superior results compared to methadone.

The authors’ aim is to present a clinical case of Delirium by alcoholic withdrawal.

The authors undertake a revision of this topic in the literature and clinical files review.

Delirium is not uncommon in Portuguese emergency rooms, though often misdiagnosed. The knowledge tools should be shared by other specialities besides Psychiatry or Liaison Mental Health for treatment may be life-saving. After crisis, the treatment should proceed, based on maintaining abstinence by medication and therapy.

The purpose of the study was to evaluate issues related to the implementation of a smoking ban with the aim of improving programs to help patients reduce or quit smoking.

At a 410 bed pyschiatric facility, 73 staff and 68 patients completed separate surveys regarding their attitudes towards a smoke-free policy banning all indoor smoking and smoking on the grounds.

55.2% of patient respondents smoked cigarettes and 42% of participants who smoked have either reduced tobacco consumption or have quit. Changes in quality of life that were found to be significant were mood, eating habits, outlook on life, and level of restlessness, anxiety, stress, and concentration. Comfort level and alertness did not change significantly. These symptoms are all associated with nicotine withdrawal. Nicotine replacement therapy (NRT) was percieved as being effective in relieving nicotine withdrawal symptoms. Over half of the patients have not discussed tobacco use with a health care professional. Staff expressed mixed attitudes towards the ban and the use of NRTs. Concerns were raised over patients smoking while using NRT in fear of the patient recieving too much nicotine.

Given that the deleterious health consequences of smoking are well known and given the high prevalence of smoking in the psychiatric population, extraordinary efforts are required to significantly reduce tobacco consumption. The implication of this research is that education on tobacco reduction options ought to be provided to staff as well as patients. Efforts to reduce tobacco usuage must be incorporated into standard patient care.