Osteonecrosis is common after taking Temgesic and Norgesic. This study intended to suggest the preferable surgical treatment in osteonecrosis patients who use these drugs.

Twenty tree patients with hip osteonecrosis who were hospitalized in the Kerman hospitals after using Temgesic and Norgesic were followed for about 14 months from 2008 to 2010 (from a minimum of 2 months to a maximum of 2 years). 65% of patients underwent total hip arthroplasty (THA) and core decompression was performed for 35% of them. Patients were compared based on functional scoring of hip before and after surgery.

Duration of drug use was 38 months on average and injection frequency of drug was averagely 3 months. The average functional scoring of hip was 9.1 before operation and 16 after it (P < 0.001). Recovery rate of patients in THA was very good and in core decompression was good. Conclusion: In treatment of osteonecrosis after taking Temgesic and Norgesic, the THA surgery in comparison with core decompression showed better results and caused significant clinical improvement.

Psychotic disorder due to industrial drug, such as methamphetamine addiction, is one of the important causes for referral to psychiatric hospital. Psychotic symptoms in these patients are varied. A group of researchers believe that methamphetamine-induced psychosis is completely similar to schizophrenia. Others believe that at least some cases of permanent psychotic clinical manifestation due to methamphetamine abuse are different from schizophrenia. In the present study, the existence of differences between psychotic symptoms caused by methamphetamine addiction and schizophrenia is investigated.

This study was a qualitative study. Patients with psychosis due to methamphetamine addiction were selected from among patients who were hospitalized in hospitals of the Kerman University of Medical Sciences, Iran. All patients were interviewed using unstructured interview based on self- reporting. Interviews were recorded and reviewed later.

Based on clinical observations, some of the patients with psychotic disorder due to methamphetamine showed rare symptoms that had been mostly reported in psychosis due to organic disorders and some of them showed symptoms that had not been reported before. Conclusion: This study showed that in a group of patients with methamphetamine-induced psychosis, clinical manifestation is different from schizophrenia.

Chronic pain and problematic alcohol use commonly co-exist, as the use of alcohol is commonly considered a useful pain self-management strategy. The purpose of this study was to characterize pain and pain-related problems in a group of primary alcohol-dependent individuals entering alcohol treatment facilities.

A sample of 366 (73.5% men and 26.5% women) alcohol-dependent subjects was recruited in alcohol treatment centers in Warsaw, Poland. Information was obtained about demographics, social functioning, sexual and physical abuse during childhood, severity of alcohol and sleep problems as well as level of impulsivity and general psychopathology. The study group was divided into a ‘mild or no pain” group and a ‘moderate or greater pain” group.

Among the study group, 34.4% of individuals reported moderate or greater physical pain during last 4 weeks. The statistical analysis revealed that the experience of physical pain was significantly associated with lower level of education, unemployment, experience of sexual abuse before 18 years of age, and also with severity of alcohol dependence as well as other potential predictors of relapse (global impulsivity, sleep problems, general psychopathology). When entered into logistic regression analysis with other dependent variables the level of general psychopathology, severity of sleep problems, age and education were all significantly associated with pain severity.

Physical pain is a prevalent and potentially-impairing experience in adults seeking treatment for alcohol dependence. Therapeutic interventions aimed at reducing pain in alcohol-dependent individuals should be studied to evaluate their impact on improving overall treatment outcomes.

Illicit drug use in India is quite serious and Kashmir is also one of the hardest hit places and the scenario is worsened by the prevailing turmoil. The present study was conducted to find the epidemiological profile of substance abusers visiting De-addiction Centres in Srinagar Kashmir India.

To study the socio-demographic profile of substance use disorder patients seeking treatment and to identify the reasons for starting the use of substance.

The present cross sectional study, was conducted at two Drug De-addiction and treatment Centers in Srinagar. Total of 125 Substance Use Disorder Patients were interviewed by using pretested semi-structured proforma, emphasizing on socio-demographic profile and reasons for starting use of substance.

Majority (50.4%) of patients belonged to young and productive age group. Most of the patients started taking substances in the age group of 10-19 years and more so in case of nicotine (76.8%), volatile substances (76.9%) and cannabis (70.5%). Besides nicotine (89.6%), the most common substances used were cannabis (48.8%), codeine (48%), propoxyphene (37.6%), alcohol (36.8%) and benzodiazepines (36%). Peer pressure was the most common (72.8%) reason for starting the use of substance.

Whether the society views substance misuse primarily as a moral or legal problem; when it creates difficulties for the user, it becomes concern of all people including parents, teachers, doctors, sociologists and psychologists. An integrated approach of early detection, treatment and rehabilitation is essential for preventing and minimizing the long term negative consequences of substance abuse.

Alcohol and other substance use contribute to a major, preventable, international healthcare burden. The evidentiary bases for screening, brief intervention, and referral to treatment (SBIRT) for alcohol are well-established, while research on SBIRT for other substance use is ongoing. In the United States, funding for SBIRT education among medical professionals recently has expanded beyond physicians to include other healthcare providers such as nurses and social workers.

This brief study measured characteristics of nurses, social workers, and physicians at the beginning of the first year of graduate education (nurses, social workers) or post-graduate year 1 (physician residents) to assess potential baseline differences in knowledge, attitudes, beliefs, and behaviors related to SBIRT.

The aim of this study was to inform targeted modification of SBIRT education programs based on baseline differences between professions.

Participants (n = 81 [16 physicians, 27 nurses, 38 social workers]) completed a 36-item assessment of baseline behaviors (modified from Hettema et al., 2012) and knowledge, beliefs, and attitudes predictive of SBIRT performance (Gassman et al., 2003). Differences between groups were assessed using ANOVA and the Tukey or Games-Howell post-hoc test (contingent on homogeneity of variance).

The study identified differences among professionals for 13 of 36 measured variables across several domains: SBIRT behaviors, beliefs about time utilization, satisfaction working with at-risk clients, self-efficacy, and perceived organizational resources.

Preliminary data suggest that SBIRT training for medical professionals might be improved by attending to specific differences among nurses, physicians, and social workers in several key areas.

Our aim was to identify areas of improvement for current Opioid Maintenance Treatment (OMT) approaches, by analysing European Quality Audit of Opioid Treatment (EQUATOR) data from 8 European countries (Austria, Denmark, France, Germany, Norway, Portugal, Sweden, UK).

A standardised face-to-face survey was administered to OMT patients (OMT-P) and active opioid user (AOU). Reasons for entering and staying out of OMT, rules pertaining to OMT, and factors facilitating OMT retention were compared between countries, and between OMT-P and AOU groups. Both groups were divided into those who never had OMT before [un-experienced OMT-P (n=573) and AOU (n=360)] and those who had been maintained at least once [experienced OMT-P (n=746) and AOU (n=377)].

Motives for starting OMT vary distinctly between countries (p≤0.001). Transnationally, experienced AOU reported concerns about their ability to follow treatment rules and negative treatment experiences as decisive reasons for staying out of OMT. Greater flexibility, less pressure to reduce their treatment dose and greater treatment structure were ranked significantly higher by experienced compared to un-experienced OMT-P as factors that might facilitate treatment retention (p≤0.05).

The major strength of this investigation was the homogenous methodology applied in all countries, which enabled new insights in variations between treatment systems and their impact on patient outcome. Treatment systems need to aim an optimal balance between flexibility and structure. Standardised approaches that still permit tailoring treatment to individual patient needs are crucial to yield maximum benefit for patients, and reduce the considerable societal economic burden of addiction.

Alcohol-related deaths (ARD) in the UK have doubled in the last 15-20 years. Thisstudy examines the psychosocial and demographic correlates of alcohol-relatedmorality.

To examine 1) whether stressful life events affect ARD and combined alcohol anddrug related fatality (CDAF). 2) The demographic distributions of ARD and CDAF.3) The difference in the proportion of suicide and accidental death among ARDand CDAF's.

Cross-sectionalcohort study utilising the psychological autopsy method. Data was collected atWest London Coroner's office from 2006-2008. Of 429 autopsies, 278 met inclusioncriteria, of which 48 and 52 were ARD and CDAF respectively.

The majority (96% for ARD and 76.9% for CDAF) were males. For ARD 50% were aged under 44yrs. However, for CDAFthe majority were under 44yrs. Combined the majority (60%) were under 44yrs. CDAF had a normal distribution across the 5 age groups, peaking at 35-44. ARDpeaked in 45-54 and 16-24 age groups.

There is a clear difference in the demographic distribution among ARD and CDAFcases. No statistically significant difference in the proportion of suicide andaccidental deaths were identified. However, further amendments to the SocialReadjustment Rating Scale could provide a better insight as to whether lifeevents have an influence on an individual's suicidal tendencies.

Smoking among adolescents is still a major public health problem and a global concern. Early onset and long-term smoking are associated with physical and psychological health problems.

To identify risk factors and comorbidities for occasional and daily smoking among European adolescents.

In the context of the Europe-wide 'Saving and Empowering Young Lives in Europe” (SEYLE) study we surveyed 12,328 youths at the age of 13 to 17 from 11 countries. We applied questions from the Global School-Based Student Health Survey to determine nicotine consumption as well as other risk behaviors. Psychiatric symptoms were assessed by the Strengths and Difficulties Questionnaire, the Becks Depression Inventory-II, the Zung Self-Rating Anxiety Scale,the Deliberate Self-Harm Inventory and the Paykel Suicide Scale.

On average 30.9% of adolescents reported daily smoking and the onset of smoking was reported by 35.3% between the age of 12 and 13 already. Multinomial logistic regression model showed significant correlations between adolescent smoking and migration background, living in single parent households, no physical activity, parental smoking and physical fights. Further it revealed significant associations of adolescent smoking with alcohol consumption, illegal drug use, anxiety, conduct problems, hyperactivity, suicidal ideation, self-injury and internet-dependence.

Our data show that adolescent smoking is associated with psychosocial factors, especially family setting and parental behaviors. Further, smoking and psychiatric problems are highly correlated. Therefore, early preventive measures are necessary and essential not only for adolescents but also for their parents.

In France alcohol is the second cause of death after smoking, and it is a main cause of absenteeism and disability at work. Over 50% of people who have not returned to work (RTW) after 6 months off never resume their professional activity.

The aim of this study is to identify factors affecting the RTW after a residential alcohol withdrawal.

This is a prospective, non-interventional nested study (within a prognostic study of relapse after inpatient alcohol withdrawal) conducted from September 2013 to February 2014 in the Psychiatry and Addictology department of Bichat University Hospital in Paris. All alcohol-dependent sick-listed workers, admitted for a residential alcohol withdrawal have been included. Baseline assessment included sociodemographic, occupational, somatic, psychiatric and addictologic characteristics. The influence of these variables on RTW after 6 months follow-up have been studied using survival analysis.

Among 107 eligible patients, 30 met the inclusion criteria and were followed up, and 22 (73.3%) had RTW before the end of the follow-up period. The median duration of sick-leave is 58.5 days, and the interquartile range is 15.5-246 days. The independent workers, employees on fixed-term contract, part-time employees and outdoor had shorter sick-leave. Severity of alcoholism, agoraphobia, residential withdrawal history, being sick-listed before hospitalization, longer duration of hospitalization and being transferred to aftercare service increased the duration of sick-leave.

This exploratory study identifies factors that impede and facilitate the RTW process after a residential alcohol withdrawal. Studies on a larger scale are needed to generalize the findings.

Patients with substance use disorders (SUD) represent a significant part of psychiatric emergency. However the clinical characteristics of this population have been poorly documented. The Crisis-unit of the CHR Citadelle (Liège, Belgium) has been admitting patients with SUD for short emergency stays since 2003.

We investigated personality and electrophysiological patterns in Crisis-unit inpatients, as a function of socio-demographic and clinical characteristics (comorbidities, substance of choice).

We aim to describe psychiatric emergency patients with SUD and highlight common and distinct patterns, in order to improve the understanding and treatments provided to this population.

2062 inpatients with a diagnostic of substance abuse or substance dependence (978 males, mean age=35.9) were admitted between 2005-2013; 1262 fulfilled the TCI-R personality questionnaire and 1115 completed an event-related potential examination.

The prevalence of axis-1 disorders other than SUD was 39%, and 46% for axis-2 disorders; 31% of the patients presented either slowed reaction time and/or electrophysiological abnormalities. Low selfdirectedness was found in patients with SUD regardless the presence of comorbidities and the substance of choice. However, other personality dimensions (novelty seeking, harm avoidance, reward dependence and self-transcendence) as well as electrophysiological examination show specific patterns as a function of these characteristics.

Low selfdirectedness is confirmed as a major predictor of poor psychosocial functioning including SUD, stressing the major importance in mental health of self-responsibility, purposefulness and one's ability to regulate and adapt his/her behavior to the situation in accord with his/her goals and values.

Alcohol consumption is a widespread behavior across Europe. It can adversely influence health on a biopsychosocial level, being the leading cause of mortality among young adults. Gender differences regarding drinking patterns are supported by a strong evidence base.

To investigate gender differences regarding drinking patterns of Greek young adults.

207 Greek young adults participated in the study, 75 (36.2%) males and 132 (63.8%) females, with a mean age of 29. Analysis of data was conducted with t-test and chi-square, using SPSS software.

The findings showed clear differences among the two genders with regards to their drinking patterns. Males consumed more alcohol compared to females (t: 3.122 p<0.01), consuming on average 18.64 alcoholic drinks per month compared to 9.80 drinks per month on average for women. Men were also more likely to engage in binge drinking behaviour (x2:18.493 p<0.001), with 13.3% of men (N=10) reporting engaging at least once in heavy episodic drinking. There were also clear differences regarding the preference of alcoholic beverage (x2: 19.967 p<0.01), with men preferring beer (N=27(36%)) and women wine (N=63(47.7%)), over other beverages. There were no differences among the two groups with regards to their drinking motivations (x2: 2.704 p=NS), with most of the participants reporting social drinking motivations.

The results of this research are generally consistent with previous literature on this subject. Further studies on this population could concentrate on gender differences regarding the health effects of alcohol in Greek young adults.

The prevalence of alcohol abuse increased over 10% in the last decade, with special impact in women. It is not known how the characteristics of suicide attempts vary with different forms of alcohol involvement. The aim of this study is to clarify the role of alcohol use disorder and acute alcohol consumption in suicide attempts.

Perform a brief literature review on the alcohol use disorders and suicide behaviours in those patients.

A PubMed database review, with 'alcoholism” and 'suicide attempts” as keywords.

Alcohol abuse and suicide may be intimately linked. This association is related to impulsivity, aggression, social norm transgression, poor judgment, abnormal speech, perceptual blunting and increased pain threshold, which may all contribute to the suicide attempt. Moreover, mental disorders (particularly depression) are often associated with suicide. The lifetime prevalence of suicide attempts in patients with alcohol dependence is about 40% and mortality for suicide is 7%. Thus, patients with alcohol abuse should be screened for psychiatric symptoms and suicidality. Clinicians should assess the severity of suicidal symptoms and other depressive signs and symptoms in patients with alcohol abuse.

Suicide attempts are common in patients with alcohol use disorder. Future studies should contribute to a deeper knowledge of these events and respective treatment.

The antidepressants are very commonly used in the complex therapy of tobacco dependence.

As the model of antidepressant drug the pyrazidol was chosen as having the verified effect on serotonin, dofamin, noradrenalin receptors.

113 tobacco dependent patients with primary (45) and secondary (67) resistance to nicotine replacement therapy (NRT) were involved in double-blind placebo controlled study.

Pyrasidol was given in small therapeutic dosages (100 – 150 mg for a day) in combination with NRT ore varenicline to cure smoke cessation in the course of 6 weeks.

The Assessment Scale for Tobacco Dependence Symptoms Level and Hamilton Depressive Scale were used in longitude dynamic study.

For the patients with primary NRT resistance the result was double regress of somato-vegetative and neurotic symptoms of tobacco craving (from 4 balls to 2,1±0,03 balls). It accompanied by more then 2 times smoking reduction (from 35,5 to 12,3 cigarettes per day).

The results for the secondary resistant NRT resistant were much better. The total regress of tobacco craving symptoms included somatovegetative, neurotic and ideatory signs (from 4 balls each item to 1 – 0,5 balls). All the patients after 6 weeks of treatment stopped smoking.

The reduction of smoking was strongly associated with total regress of comorbid affective disorders in both groups.

The effect of complex therapy for the patients with primary resistance was not so significant as for the secondary resistant ones. So they needed more complicated treatment, including non – medicated approaches – bio-feed-back, hypoxia therapy and so on.</h4>

Chronic alcoholism is associated with impaired cognitive functioning. Over 75% of autopsied chronic alcoholics have significant brain damage and over 50% of detoxified alcoholics display some degree of learning and memory impairment. In clinical practice, it could be difficult to differentiate between the various syndromes associated with chronic alcohol use.

The authors present the various syndromes associated with cognitive impairment induced by chronic alcohol use.

Review of the most recent literature with the following key words: alcoholism, differential diagnosis, cognitive impairment and dementia.

Chronic alcohol use can cause dementia such as chronic subdural hematoma after head injury, hepatocerebral degeneration by cirrhosis and nutritional deficiencies. The thiamine deficiency can originate Wernicke-Korsakoff syndrome. If not properly treated, it can develop as a chronic amnesic syndrome known as Korsakoff's syndrome. It is characterized by episodic memory deficit with confabulations, involvement of semantic memory, nistagmus and ataxic gait. The Machiafava- Bignami disease is rare and usually diagnosed in alcoholics. The symptoms include dementia, muscle stiffness, seizures, dysphagia and less often coma. Finally, diagnostic criteria for alcoholic dementia include dementia diagnosis made at least 60 days after the last exposure to alcohol; minimum of 35 standard doses for men and 28 for women per week for more than 5 years and, ethanol abuse mean within 3 years after the onset of cognitive decline.

Although various syndromes present similarities, the clinicians should be aware of the different symptoms as the treatment may vary according to the pathology.

Excessive tobacco consumption among students has negative repercussions on their health and education. Medical students are no exception. Numerous studies have demonstrated the relationship existing between smoking and depressive disorders.

To study the relationship between depression, anxiety and students smoking.

We conducted a cross-sectional, descriptive and analytical study which included 80 students of the Faculty of Medicine of Sfax in Tunisia: 40 smokers and 40 no-smokers.

We used the Hospital Anxiety and Depression Scale (HADS) for screening depressive and anxious symptoms. The evaluation of tobacco dependence was performed by Fagerstrom test.

The average age of the participants was 23 years with a male predominance (SR=1,66). The smokers were in 80% of cases males and in 55% of cases dependents. Thirty-one percent (31%) of our population were depressed and 28.7% were anxious. A statistically significant correlation was found between smoking and the presence of depression (p = 0.025) on one hand, and anxiety (p = 0.022) on the other hand. Tobacco dependence was related to male sex (p = 0.04) and depression (p = 0.03). There was no link between the same variable and anxiety.

It appears from our study a statistically significant relationship between smoking and anxio-depressive disorders. The degree of dependence is particularly related with depression. This dimension has to be considered in the therapeutic withdrawal project.

Spices-use is continuously increasing in Western Countries, especially for legal reasons. Intoxication has been widely associated with psychotic symptoms.

Here we present a case-report that seems to highlight this possible association between canabimimetics and psychosis, stressing the use of 'Spices” as an instrument of auto-determination in the young patient's opinion.

Find if the supposed relation between certain Life Events and Spices use for people with a use consequent to a Dependent Personality traits can lead to an unmasking of a psychosis.

Clinical interviews, Eri-Raos, drug-use and literature revision.

Diagnostically, these patient presented right after a Spice intoxication psychotic symptoms like delusions, strong distress, the feeling of being observed and considered 'mad”, self-isolation that strengthened the need of Spice use and more difficulty (but self-reported need) to stay with others and to self-determinate herself in meaningful relationships. These symptoms have had a strong relief after the establishment of a relationship with our community mental health center (CMHC) and its multidisciplinary staff, that took care whit the patient of the whole life, in particular of the details that were stressful for her.

This report, being in accordance with others, suggests the necessity of further studies on the relation between Spice-use and psychotic symptoms, in particular for patients with a use that has roots to Dependent Personality Traits.