Dual diagnosis of posttraumatic stress disorder (PTSD) and substance use disorder (SUD) is reported to be both highly prevalent and highly challenging in therapeutic sense. Comorbidity of PTSD with SUD is complex, since substance abuse may often develop as an attempt to self-medicate the painful symptoms of PTSD while consequential withdrawal states exaggerate PTSD.Although there is a significant degree of comorbidity between PTSD and SUD, understanding of causal relationships between these disorders remains scarce.

We present the case of twenty-five year old male with PTSD (according the criteria of both ICD-X and DSM-IV) developed after trauma. Traumatic event included patient being witness to infliction of serious injuries to another person and also experiencing severe threat to personal safety. Three weeks after this occasion, suffering with clear symptoms of PTSD, patient started self-medication with benzodiazepines. Aside from temporary relief shortly after medication usage, PTSD symptoms generally worsened, particularly during periods of withdrawal. Five months after starting with substance use, patient was admitted to our Center. Treatment consisted of psychotherapy and medications (antidepressive, mood stabilizers, non-benzodiazepine hypnotic) with good response.

The addition of SUD to PTSD represents complication that needs to be appropriately addressed during treatment. Further research is necessary to ascertain which treatment could be most effective solution for this frequent association.

Mental patients constitute a vulnerable group for the smoking habit, with higher prevalence and addiction levels than in the general population. Free time at psychiatric institutions can contribute for hospitalized patients to smoke. Difficulties to control smoking during hospitalization include non-integration of anti-smoking strategies into service routines, disbelief in addiction treatments and the view of smoking as an instrument that appeases and facilitates social interaction.

Get to know patients’ opinion on tobacco use during hospitalization and the smokers’ addiction level.

Get to know the circumstance of the smoking habit during psychiatric hospitalization.

Exploratory-descriptive quantitative and qualitative study, carried out at the Psychiatric Ward at Ribeirão Preto Medical School Hospital of the University of São Paulo, Brazil. A semistructured interview was applied to all subjects and the Fagerström questionnaire to the smokers.

Out of 25 patients, 44% suffered from mood disorder and 28% from schizophrenia; 52% had been ill for ten years or more; 64% had been hospitalized between one and five times; 24% were smokers; 83.3% with a high addiction level. Most non-smokers agreed with a smoking prohibition in collective rooms, without privileges for mentally ill patients. The smokers were opposed to anti-smoking policies, but favorable to nicotine replacement therapy (NRT) during hospitalization.

These findings can support future research and permit suggestions on studies to assess the NRT used at this or other services, as well as the possibility for patients to give up smoking.

Individuals who engage in drugs abusing are more susceptible to a variety of physical, social and psychological health problems.

This study describes mental disorders of patients with opium and heroin addiction before taking MMT.

Participants included 172 addicts (162 men and 10 women), referring to Fanoos addiction relief center, whose age ranged from 16–66 with mean age of 32.8. All participants were asked to complete a questionnaire about their bad feelings experienced during past month before taking methadone maintenance therapy.

The average age of the first drug abusing was 20.5 with range of 10–60. The most frequent bad feelings that were reported by participants were sensation of anxiety, hopelessness and aloneness. 68.6% of patients had a history of depression, 56.4% were aggressive and 26.3% of them had ideas of suicide.

Exploring of mental status of addict people before taking MMT can be used for evaluation of treatment effects and designing more effective interventions.

Non-adherence in alcoholics is one of the major problems of contemporary Russian psychiatry.

To investigate the prevalence and structure of non-adherence in Russian men alcoholics receiving treatment in psychiatric hospital.

Forty five men(mean age 39.5 yrs) with alcoholism were randomly selected from narcology department and week after the last alcohol use enrolled in the subsequent survey including questionnaires on knowledge about the disease on treatment and health behavior. Patients with neurological deficit and any another psychiatric disorders in anamnesis were excluded.

We have shown that only 4% of patients demonstrated adherence to treatment. 93% felt significant deterioration in physical well-being in the last 2–5 years, only 83% attributed it to alcohol use and only 67% were agree with diagnosis. The remaining 29% denied the alcohol dependence, but recognized the need for detoxification and general medical examination to improve the physical well-being. 96% thought unnecessary to work with a psychologist or a therapist or referral to a rehabilitation center or opioid receptor antagonist in spite of repeated failures of self-termination of drinking. They attributed this to the low efficiency of these methods and their high cost or absence problems and diseases.

Non-adherence is very prevalent in Russian men alcoholics. Severe non-adherence to treatment including illness denials is observed in 29% of patients. Non-adherence to treatment including most part of proposed methods is observed in 67%.

To identify neuromorphologic and neurochemical patterns of prenatal exposure to alcohol of developing brain of man as risk factor for development of mental pathology in offspring of mothers with alcoholism.

We studied brains of embryos and fetuses (7–12 weeks). There were obtained 53 embryos: 23 - from alcoholics and 30 - from healthy women. Age of patients was 26–39 years, disease duration - from 3 to 13 years. All cases were diagnosed with stage II alcoholism (F 10.201; F 10.202). To evaluate the properties of benzodiazepine receptors in brains of embryos sinaptoneurosomas we used method of radio receptor binding of selective ligand 3H-flyunitrazepame.

Damage to cytoplasmic membrane and internal cell membrane systems, emergence and subsequent transformation of different types of spherical formations in perinuclear space, variety of options of mitochondria as a normal structure, and with signs of functional and structural pathology, increased development of Golgi complex, appearance of lipofuscin, multi-vesicular cells and myelin formation, delay of development of synaptic contacts of vesicular type, manifested in decreasing length of postsynaptic density of synaptic contacts, reducing area and perimeter of presynaptic terminals in main study group, changing nature of vascularization of brain tissue, what was expressed in reduction of average area of vessels, an increase in their number per unit of area and reducing perimeter of brain.

We have found that alcoholism during pregnancy results in decrease of affinity of synaptosomal receptors of brains of embryos. This may affect overall neurotransmitter processes in brain.

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.

So far, the smoking relapses after quitting have not been studied clinically. Psychological research emphasizes the role of stress and mood disorders in tobacco dependence relapse.

Our investigations showed that not only emotional changes but some clinico-psychopatological factors (signs) of tobacco dependence are very important in predicting the smoking relapses.

165 tobacco dependent patients, age 47–76, 105 women, 60 men, smoking period more than 25 years, were examined and anamnestically investigated from their first attempts to start smoking. All of them had therapy resistance appeared after several successful quittings.

Factor analysis was made to find out the prognostic signs for smoking recidives.

100% patients had at least 2–3 “unfull” therapy remissions after smoking cessations with the persistence of ideatory component of craving for tobacco: the impossibility to control the mental ideas of smoking.

The less meaningful factors were, such as:

1. • depressive mood at the time of remission with anxiety and sensibility in women (73%) and disphoria and irritability in men (89%);

2. • indifferent attitude towards tobacco smoke smell (72%);

3. • indifferent attitude to own health condition (56% women, 93% men);

4. • short time quitting periods before relapses in smoking anamnesis ;

5. • passive smoking in family (at work) (72 women, 43%men);

6. • slowly disappearing symptoms of smoking cessation at the process of treatment (86% both sexes).

These data have preventive and prognostic benefit for diagnosis and planning therapy intervention.

Pathological gambling and alcoholism are more common. In recent literature many factors may increase the risk for both conditions (social, cognitive, genetic, psychopharmacological).

Experts talk about problematic behavior linking gambling and alcoholism and the terms „disordered gambling behavior“ and „disordered alcoholics behavior“ occurrence like common behaviour. Most gamblers drink alcohol during gambling.

Our paper show that some kind of disordered or dysfunctional behavior among pathological gambling and alcoholism presented common behavior frame for both of them.

We observed 25 male inpatients/outpatients, range of age between 20 – 50, for six months period of time who were treated in Department of Alcoholism in Special Hospital On Addictions, Belgrade, Serbia.We used the ICD-X diagnostic criteria for pathological gambling and alcohol dependence (excluded other disorder and co morbidity), data collected by medical history of illnes, psychiatry interview and check list for behavior disorder for both conditions.

All the patients have negative consequences of their pathological gambling and alcoholism like loss the money, loss the job,disfunctonal family and partners relationships, loss of friends, avoid school and other peer activities, improve criminal behavior, sleep disorder, anxiety, depressive mood disorder. Also, occurrences the impulsivity behavior and lack of control as common factor for both behavior.

According the available literature and ICD-X do not meet the diagnostic criteria for common behavior disorder co-occurrence of pathological gambling and alcoholism yet, but determine „event-level“ like co-occurrence of gambling and drinking behavior. Some paper like this shows that exist common behavior linking gambling and alcoholism.

To study the effect of baclofen in preventing drug use in persons with cannabis misuse.

An open label study to asses the effect of baclofen in treating persons with cannabis dependence (ICD-10 criteria) with assessments of outcome every month for a period of three months.

20 male subjects (mean age of 29.70 ± 10.19 years) with a mean age at development of dependence of 20.75 ± 09.34 years and mean duration of cannabis use of 89.40 ± 57.41 months, were treated with baclofen (mean dose of 33.75 ± 04.83 mg./day). At three months 12 subjects (60%) completely stopped, 6 subjects (30%) decreased the frequency and 2 subjects (10%) continued the same frequency of the cannabis intake.

Our findings provide preliminary support for the use of baclofen in maintaining abstinence and improving outcome in patients with cannabis dependence.

Substance use among females showing an increasing trend in India. Though there is an increase in the rate of women approaching Deaddiction centre for treatment it is lower than the community prevalence of women with substance use.

This study aims to look at the barriers preventing women from seeking treatment.

To assess the self reported barriers to seek treatment for women with substance users.

A total of 50 substance using women were included among 52 visiting our de-addiction centre from Oct 09 till early part of Jan 10. All of them were self rated on barrier to care questionnaire specially prepared for the study.

The mean age of the sample was 42.32 (SD 12.37). Majority of them were married, house wives studied up to primary. The most common substances used were Alcohol and tobacco (36%), followed by alcohol (26%) and tobacco (26%). The common perceived barriers to care are substance use has a solution to their problem (80%), disadvantage life circumstances (70%), lack of information on treatment options (64%), limited knowledge about treatment available (64%), shame/guilt of using the substance (64%) and limited knowledge about substance use problems (62%).

Findings highlights the areas that require attention for women with substance use. Handling these issues in a better way may increase the treatment seeking in women substance users.

Extrapyramidal side-effects (EPS) related to the use of neuroleptics are an limiting factor to patients’ compliance during the treatment with this group of drugs.

The aim of this study was to identify which drugs are mostly prescribed for cocaine, crack and alcohol addicts’ psychotic symptoms.

This study selected 31 patients with mean age of 33.61 ± 1.90 enrolled with psychotic disorders related to use of illicit drugs in an public mental health service.

Patients under this study were addict to alcohol (61,29%), cocaine or crack, associated (38,71%).

The percentage of patients addicted to alcohol treated with typical neuroleptic-(typical-neurol) was 42,11%, with atypical neuroleptic-(atypical-neurol) was 26,32%, with association of typical and atypical neuroleptics-(typical/atypical-neurol) (21,60%), and with benzodiazepines associated with serotonin-reuptake-inhibitors (BZD-SSRI) (10,00)%. The cocaine or crack associated or not with alcohol patients were treated with typical-neurol (41,67%), atypical-neurol (41,67%), typical/atypical-neurolol (8,33%) and BZD-SSRI (8,33%).

The EPS related to the use of neuroleptics in patients addicted to alcohol were given biperiden (52,65%), promethazine or anticolvulsant (Prometh/Anticonv) (42,11%) and no-treatment (5,26%). For those patients, addicted to cocaine, crack and alcohol altogether were given biperiden (58,34%), Prometh/Anticonv (25,00%) and no-treatment (16,67%).

In the case of using neuroleptics, the EPS should be reversed with biperiden in an dose combined with the neuroleptic prescribed to each individual, in an effort to minimized hallucination. Also, if sedation was indicated using Prometh/Anticonv to patients that are taking neuroleptics, then the health care professional team in charge must be aware of consciousness level-reduction.

Cocaine abuse continues to be epidemic, and yet there are no FDA approved medications for the treatment of cocaine use disorders. A previous pilot study conducted by this author suggested that quetiapine may help reduce the cravings for cocaine in 22 individuals with cocaine dependence.

This 12-week, prospective, intent-to-treat, double-blind, randomized, placebo-controlled study examined the effectiveness of quetiapine (Seroquel SR™) versus matched placebo for the treatment of cocaine dependence in non-psychotic individuals. Sixty individuals with a diagnosis of cocaine dependence were randomized in this study, 29 into the quetiapine arm, and 31 into the placebo arm. Those who were randomized to quetiapine were titrated up to a target dose of 400 mg/day of quetiapine, while those on the placebo arm were given a matched placebo. All subjects had weekly clinic visits for a cognitive-behavioral therapy group session. Outcome measures included questionnaires of cocaine use, cravings for cocaine, and urine drug screen.

Initial analyses indicate that the intensity, frequency, and length of cocaine cravings were reduced over 6 weeks in both the quetiapine and placebo groups. All hazard analyses indicated that the total money spent on cocaine also decreased in both groups, with a trend toward greater decrements in cocaine use the longer they remained in the study. Data analyses are ongoing to determine the potential effect of quetiapine on treatment of cocaine addiction.

Conclusions regarding the use of quetiapine as a treatment for cocaine dependence will be discussed.

The drug dependency are chronic disorders of enamel relapse resulting from the interaction between a living organism and a psychoactive substance.

The aim of our study is to evaluate the effectiveness of a comprehensive treatment plan for drug dependency at the center through drug addiction treatment using Annaba a semi-structured interview by direct multidimensional exploring different psychoactive substances.

Our methodology is based on an observational study of a cohort of 100 patients, aged 17 to 54, having a substance-related disorders according to DSM IV-TR, followed by the CIST Annaba since 2008.

The age group most affected is between 21–30 years, predominantly male (96%), singles (68%), inactive (58%) and residing in the region of Annaba (77%), duration average consumption is higher (10 + 3 years) in 33% of cases, poly drug at doses above therapeutic in 90% of cases. The personality assessment is made by the Rorschach projective test of objectifying the presence of borderline personality disorder in 68% of cases. The establishment of a therapeutic project (motivational interviewing, drug substitution treatment and symptomatic treatment with cognitive behavioral psychotherapy) of drug dependency at the CIST Annaba could positively reinforce the assumption by reducing or stopping use toxic products. Cases of remission were found in 48%, but relapse was concerned that a quarter of cases.

The mal-adaptative use of alcohol represents independent psychiatric pathology, but the social and professional disability and the co-morbidity with other psycho-pathologic disorders gains the value of a phenomenon.

The research was done clinically and catamnestic, both analytically and retrospectively over a period of 12 years on a group of patients with mal-adaptative consumption of alcohol, making the correlation between the clinical forms and the age of its debut.

The group included 644 patients with diagnosis of alcohol induced disorders..

The information obtained from the observation sheets (anamnesis, psychiatric interview and psychological examination) were statistically processed depending on the debut age, age groups and clinical forms.

There is a vulnerability of early debut for alcohol consumption, with the development of secondary symptomatology predominantly in the age interval 35–40 years old (29,97%).

The early debut of alcohol consumption (16–25 years) was correlated with acute intoxication 11,49%, withdrawal syndrome 31,68%, anxiety disorders 28,26% and psychotic disorder 18,57%.

Clinical boards in over 45 years old patients were characterized by alcohol induced depressive disorders 72%, personality disorders 11,80%, cognitive disorders 16,2%, alcohol use being released by psycho-stressing factor (76%)

In advanced ages, the use of alcohol was correlated with depressive and behavioural disorders (68%).

The patients with early debut of alcohol consumption developed psycho-pathologic disorders secondary to it, before 30 years old.

The consumption debut at young ages is correlated with the severe addiction type and the behavioural model, and in advanced ages with depressive disorders.

To determine the pattern of alcohol dependence among medical impatients who requires Psychiatric Interconsultation, with the purpose of achieve a better understanding of the problem and to suggest prevention strategies.

Sample studied was collected among all inpatients with diagnosis of alcohol dependence (DSM-IV-TR) admitted in our hospital during a study period of 3 years, from january 2007 to may 2010, who required psychiatric interconsultation.

101 admissions with diagnosis of alcohol dependence were reviewed. There were 80 men (79,20%) and 21 women (20,8%). The mean of age was 53,13 years. The mean days of stay was 14,13. In this study, 60 subjects (59,40) there are medical history of alcohol dependence and 58 (57,42%) psychiatrc history.

Alcohol deprivation 13 cases (12,87%); convulsion 6 (5,94%); acute agitation 5 (4,95%); cranioencephalic trauma 5 (4,95%); alcohol intoxication 5 (4,95%); fracture 4 (3,96%); suicide attempt 6 (3,96%); psychiatric indication 10 (9,9%); primary care indication 3 (0,029%); organic problem secondary to alcohol 32 (31,68%); other 12 (6,11%). 42 patients were admitted in Unidade Medica de Alta precoz (41,58%); Medical 21 (20,79%); Traumatology department 4 (3,96%); Gastroenterology 12 (6,11%); Neurology 3 (0,029%); Other departments 19 (18,81%).

The main cause of medical admission are somatic complications of alcohol, finding that only 9.9% of the income was indicated by the psychiatrist and to 0.029% for the primary care physician. Primary, secondary and tertiary prevention 1, 2 and 3 of these complications should be a target of psychiatry.

Pathological gambling (PG) is a relatively prevalent psychiatric disorder, which is included in the category of Impulse Control Disorders of the DSM-IV TR. It's prevalence is 1%. Dopamine is the main neurotransmitter involved in it. Attentional bias (AB) is a phenomenon whereby attentional channelling is directed toward personally valued stimuli, despite an individual's efforts to ignore them. AB have been previously described in several Substance Use Disorders (SUD) such as alcoholism and cocaine use disorders.

The objective of this study was to investigate the current evidence of the presence of AB associated to PG.

We performed a systematic search in PubMed (1980-Present) to identify publications that examined the existence of AB in PG.

To date, two studies have found the existence of an AB in pathological gamblers. Both studies have been performed using a modified Stroop procedure, and report that gamblers show an automatic interference when naming the color of gambling-related words.

PG could be conceptualized as an addictive behavior and we can hypothesize a link between addiction and automaticity. There is a relationship between AB (cognitive dimension) and subjective craving (emotional dimension), so that high levels of craving can be both, a cause of, and a consequence of, an elevation of AB of gambling-related cues. Even so, there is little research in this field to date. Further studies are warranted using new paradigms for the assessment of AB in PG.

There is a growing trend to consider pathological gambling (PG) as an addictive behavior. Attentional bias (AB) occurs when the attentional channeling is directed towards emotionally valued stimuli despite an individual's effort to ignore them. This paradigm has been widely used to assess other addictions such as alcoholism and cocaine misuse. AB has been assessed in PG using the modified Stroop procedure. Despite that, to date, other procedures such as the dot-probe task have not been used.

To develop a dot-probe task to assess AB in PG.

We selected 38 gambling-related pictures that were validated using the Self-Assessment Manikin Visual Analogical Scale (SAM-VAS). This scale measures the pleasure, arousal, and dominance associated with a person's affective reaction to a wide variety of stimuli. We applied the scale to 20 subjects who met DSM-IV criteria for PG and to 20 matched control subjects.

From 38 preselected pictures, 25 had an affective valence and enough intensity to be selected for the subsequent development of the dot-probe task.

To date, the modified Stroop procedure has been the only task carried out to assess AB in gamblers. These gambling-related pictures will be used to develop a dot-probe task to assess AB in pathological gamblers. In addition, we will assess the Eye movement task and Event-related Potentials, as direct measures of AB.