Patients with dual diagnosis, major depressive disorders and cluster B personality disorders, must be carefully monitored because of the refractory cases high incidence to either psychotherapeutic or pharmacologic therapy, when applied alone. In histrionic patients the the emphasis during psychotherapy must be on the collaborative therapeutic relationship and on the goals operationalizing process.

We prospectively evaluated 12 patients, female, mean age 35.5 years, diagnosed with major depressive disorder and histrionic personality disorder (according to DSM IV TR criteria) treated with antidepressants (fluoxetine 30 mg/day, n=5, paroxetine 30 mg/day, n=4, mirtazapine 45 mg/day, n=3) and weekly sessions of cognitive-behavioural therapy, for 6 months. We used Beck Depression Inventory (BDI)- 21 items form initially and every two weeks until the endpoint. The Global Assessment of Functioning (GAF) was used also, with the same frequency. The specific schemas of histrionic personality disorder had been addressed simultaneously with depressive specific dysfunctional beliefs.

There were 4 cases of discontinuation after a mean duration of 10.6 weeks. These patients presented at 6 months a higher score on BDI (+6.5) and a lower degree of social and professional level of functioning (-15 on GAF); a follow-up evaluation (after one year from baseline) observed more residual symptoms or recurrence of depression than patients that participated in all study sessions (mean BDI score 15.6vs.9.5, GAF 78vs.89, 2vs.0.5 depression episodes incidence).

Adressing dysfunctional schemas of histrionic personality disorder improves the long term prognosis in depressed patients with dual diagnosis.

One of the main goals of psychotherapy should be increasing the patient's quality of life. This purpose is of extreme importance in patients diagnosed with cancer that have to fight with anxiety, depression, social and occupational adjustment difficulties.

We included in a 3 months weekly sessions program of cognitive psychotherapy a number of 12 patients, 8 female and 4 male, mean age 52.4, diagnosed with malignant tumors (lung cancer 2 cases, ovarian cancer 2 cases and stomach cancer one case). The assessment included Cancer Coping Questionnaire (CCQ)- 21 items version, Hamilton Rating Scale for Anxiety (HAM-A), Beck Depression Inventory-21 items (BDI), Global Assessment of Functioning (GAF) and the dysfunctional beliefs monitoring throughout all the 3 months of this trial. Therapy focused on working with “realistic” negative automatic thoughts, attention switch on resources instead of loses, stimulating emotional expression of frustration, anger or blaming, involving in planning activities and isolation prevention. Inclusion criteria: CCQ baseline value under 42, either anxiety or depressive symptoms, or both, that interfere with daily functioning (HAM-A score over 20, BDI over 15, GAF under 75).

All patients that reach the endpoint (two drop-outs recorded) improved their cognitive approach to cancer because their coping methods improved and dysfunctional beliefs decreased in frequency and strength. CCQ score improved with 34.5%, HAM-A decreased with 15+/-2.5%, BDI decreased with 18+/-1.5% and GAF increased with 10+/-1.1% at endpoint.

Cognitive therapy is an usefull approach in oncologic patients, helping them to focus on resources, activity and relational support.

The aim of this study is to determine prevalence of tobacco-smoking and nicotine dependence among psychiatric patients; peculiarities of tobacco smoking and addiction according to diagnosis.

A population of 198 psychiatric inpatients and 211 psychiatric outpatient were surveyed using a detailed smoking self-questionnaire for smoking habits, Fagerström Questionnaire, questionnaire for estimating type of smoking behavior and HAD (Hospital Anxiety and Depression) scale.

Smoking prevalence was higher among psychiatric patients than in general population. Correlations between level of nicotine dependence, types of smoking behavior and ICD-10 diagnoses were estimated. A significant proportion of psychiatric patients recognize that smoking is a problem, want to quit and would like attend smoking cessation therapy.

It was found that a majority of the patients wished to quit smoking, and that they would like to participate in a smoking cessation course.

There are many reasons why mentally ill persons may find it more difficult to quit smoking than mentally healthy smokers. Among the important reasons are: severe nicotine dependence, neurological vulnerability, self-medication with nicotine, lack of support from the surroundings, use of ineffective smoking cessation methods.

The aim of this study is to determine prevalence of tobacco-smoking and nicotine dependence among psychiatric patients; peculiarities of tobacco smoking and addiction according to diagnosis.

A population of 198 psychiatric inpatients were surveyed using a detailed smoking self-questionnaire for smoking habits, Fagerström Questionnaire, questionnaire for estimating type of smoking behavior and HAD (Hospital Anxiety and Depression) scale.

Smoking prevalence was higher among psychiatric patients than in general population. Correlations between level of nicotine dependence, types of smoking behavior and ICD-10 diagnoses were estimated. A significant proportion of psychiatric inpatients recognize that smoking is a problem, want to quit and would like attend smoking cessation therapy.

It was found that a majority of the patients wished to quit smoking, and that they would like to participate in a smoking cessation course.

There are many reasons why mentally ill persons may find it more difficult to quit smoking than mentally healthy smokers. Among the important reasons are: severe nicotine dependence, neurological vulnerability, self-medication with nicotine, lack of support from the surroundings, use of ineffective smoking cessation methods.

The present study examined whether recreational use of cannabis affected prospective memory ability in teenagers and young adults.

An independent measures design utilising pre-existing groups of cannabis users and non-users was employed in which an opportunity sample of 90 undergraduates studying at universities in the north east of England completed an objective video-based prospective memory task and a series of self-report questionnaires assessing failures in prospective memory, levels of anxiety and depression, use of strategies to assist remembering and recreational drug use.

Analysis of covariance (ANCOVA) revealed no significant differences in the number of self-reported failures in prospective memory. Cannabis users, however, correctly recalled significantly fewer location-action combinations during the video-based prospective memory task than non-users. These findings were observed after controlling for age, level of anxiety and depression, use of strategies to assist remembering, and the use of other recreational drugs including alcohol, nicotine and ecstasy.

The findings from the objective prospective memory task in the present study suggest that recreational cannabis use has a detrimental effect on prospective memory ability in teenagers and young adults.

Gender differences have been reported among pathological gamblers populations. These differences concern variables such as type of gambling (men are more likely engaged in “strategic gambling” whereas women prefer “non-strategic” gambling), evolution of the gambling problem (faster progression for women) and suicidal behaviours (more attempted suicide by women).

The aim of the present study is to investigate the relationship between gender and clinical status in a Swiss sample of treatment seeking pathological gamblers.

Prospective descriptive study of 260 new outpatients entering treatment between October 1999 and October 2007 at the Center for Excessive Gambling Studies, Lausanne, Switzerland. Data are issued from standardised medical records. Gender differences were examined (Chi-squares and ANOVAs) on interval between first gambling behaviours and first specialized treatment, interval between pathological gambling onset and first specialized treatment, purpose of consulting, type of gambling (« strategic gambling » vs « nonstrategic gambling ») and suicidality.

In line with international findings, gender differences were observed on type of gambling, suicidality and interval between pathological gambling onset and first specialized treatment. A tendency emerged on interval between first gambling behaviours and first specialized treatment. As a new finding, we observed a difference on the purpose of consulting, with emotional crisis more reported by women whereas men are more likely to report familial crisis. Gender seems to be relevant in the context of pathological gambling and should be integrated in prevention and clinical strategies.

To study influence of gender specific of formation of heroin addiction (HA) on prognosis and therapy in adolescents.

We have examined 140 patients with HA (15-20 years), among these we have distinguished 4 groups with various gender types (GT). Control – healthy adolescents.

clinical and sexological scales, W. Stephenson's Q-sorting scale, cluster analysis of gender parameters (biological sex, valuable orientations, sexual experience, and social status. We have studied efficacy of paroxetine at week 2, 4 of application at dose 20 mg a day.

In cluster analysis of gender parameters we have distinguished 4 masculine and 4 feminine types of formation of HA. Masculine types of HA: 1. Gender-dominant type (GDT). 2. Gender-independent type (GIDT). 3. Gender-partner type (GPT). 4. Gender-integrating type (GIT). Feminine types of HA: 1. Gender-repressive type (GRT). 2. Gender-independent type (GIDT). 3. Gender-partner type (GPT). 4. Gender-utilitarian type (GUT). Therapy: Efficacy of the paroxetine is maximal from post-withdrawal period in masculine GPT and GIDT. Number of patients with 50% reduction of scores according to scales HAM-А and HAM-D(17) was at visit 3 - 62,8% (in group of comparison – 31,7) and 32,6% (27,3%), at visit 4 – 81,3% (59,1) and 69,8% (54,2%), respectively. Addicted boys have more favorable prognosis than girls. Prognostically favorable for boys are GIDT and GIT, in co-dependent girls - GRT. Adverse type in boys is GDT and in girls – GUT.

Formation of HA in adolescents has gender-associated types with different prognoses and therapy.

The alcohol is the most frequent substance, which become use of and abuse between the adolescents.

The aim of this study is the recording, the estimate and the cross-correlation with social - demographic elements for the behaviors of adolescents as long as it concerns the consumption of alcohol.

The sample constituted 225 adolescents students that studied in the 1st and 2nd Professional Lycea-schools of Tripolis, Greece, which had mean of age the 16,8 years. The questionnaire that was used has as base the equivalent that uses Youth Risk Behavior Surveillance System of American Center for Disease Control.

The attendance in the research was anonymous and voluntary.

Almost the total of adolescents (94,7%) reports that tried some alcoholic drink.

The half students percentage 50,7%) report that they have drunk 40 or more times alcohol.

The consumption of alcohol is bigger in the boys.

The mean of first contact with alcohol they are the 13,1 years. The boys drink the first glass in smaller age than the girls.

Systematically consume alcohol the 39,2% of school population and in particular the boys drink systematically more often from the girls.

Excessive consumption alcohol reports that made at least 3 times the last month of the 23,8% of school population with proportion between the boys and girls 3:1.

The consumption alcohol is moved in worrying high levels. The results that show the make are the small age of first contact, as well as the high rates of use and abuse alcohol.

Quetiapine is a novel antipsychotic, which is efficacious in the treatment of positive and negative symptoms in schizophrenia. Research has shown that Quetiapine also reduce the craving and consumption for stimulants and alcohol. We set out to examine the tolerability and efficacy concerning relapse prevention of withdrawn alcoholics suffering from additional symptoms.

Our case observations attempted to evaluate nine alcoholics after withdrawal suffering from persisting craving, sleep disorder, excitement, depressive symptoms or anxiety symptoms. We followed the patients up in our outpatient clinic.

Eight out of nine patients were abstinent under quetiapine over a period of 2 to 7 months. One of these patients relapsed after he stopped taking the preparation at his own initiative after 10 weeks. The ninths patient stopped taking the preparation immediately because of swollen nasal mucosae. All target symptoms disappeared in the patients after an average of [mean ± SD] 24.5 ± 18.1 days. The overall tolerability was considered to be very good, however initial sleepiness appeared in four patients.

The tolerability has proven to be very good and patients reported to be very satisfied with the medication. Reports about clearly reduced craving seem particularly worthy of attention. A double-blind placebo-controlled study is in preparation to confirm these preliminary findings. Quetiapine may hold the potential for preventing alcohol relapse in alcoholics suffering from additional above mentioned symptoms, or as an alternative in alcoholics who do neither tolerate acamprosate nor naltrexone.

Although the use of drugs by medical students is not different from that of the majority of other college students, they will be the professionals in charge of diagnosing and treating dependence in the future. The objective of this study is to describe evolutional patterns of drug use in a distinguished Brazilian medical school(UNIFESP). Different patterns might guide preventive strategies tailored for specific sub-groups of students.

Recent use of psychoactive substances among 456 medical students throughout the six grades was surveyed by way of a self-report questionnaire using World Health Organisation criteria.

Among male medical students, the most frequently used substances were alcohol (80.5 %), cannabis (25.3 %), solvents (25.2 %), and tobacco (25.2 %), whereas among female students the most frequently used drugs were alcohol (72.6 %), tobacco (14.6 %), solvents (10.5 %), and tranquillisers (7.5 %). Male students showed a progressively increasing use of cannabis from the first (13.6 %) to the fourth (38.4 %) academic years. Contrastingly, the proportion of female students using cannabis markedly decreased during the same period (12.9 % to 0%), although they reported at the same time an increasing proportion of tranquilisers use (from 3.4% to 11.1 %). Switch from illegal to legal drugs were observed only among female students. Male students tended to alternate cannabis and solvents throughout college years.

Interventions aiming to influence patterns of drug consumption among medical students must consider both gender differences and evolutional patterns of substance use throughout medical course.

The Miroya Foundation specializes in Anesthesia Assisted Rapid Opiate Detoxification (AAROD) for opiate addiction. After psychosocial and medical intake patients are hospitalized for 24hours for AAROD. A subcutaneous naltrexone implant is inserted. We start with an 8week implant and advise patients to use 6months Naltrexone implants for at least one year. We prescribe Naltrexone tablets to patients who cannot afford implants. All patients are offered one year psychotherapy.

To evaluate the effectiveness and risks of Naltrexone Implants.

Retrospective descriptive study of all patients with naltrexone implants.

July 2007 there were 159 Naltrexone implants used in 80 patients. 26 patients are in the first year of treatment with a 1st, 2nd or 3rd implant. 3 patients used heroine while having an effective implant. 54 patients finished the treatment year.

Reason for stopping Naltrexone implant treatment in 54 patients:

159 implants used in 80 patients.. Only 1 severe complication occurred. Relapse rate in 80 patients 3,75% suggests that naltrexone implants are very effective. Most common reason for stopping use of naltrexone implant: lack of money 46%.

Table 1Complications:

Narcotics addiction has commonly been regarded as a single-substance phenomenon.

Follow-up interviews on a sample of 32 heroin addicts who had been in nonmethadone treatment for narcotics addiction at our Institute (spring 2007) were used to examine alcohol use and substitution of alcohol for heroin. Groups were classified as: no use of alcohol, irregular consumption and daily consumption, with aim to identify background and baseline factors related to substitution. We analyzed data relevant to the aims of our research in two stages of addiction career (before the treatment and 6 months after the beginning of treatment)

One fourth of the sample (8 patients) used alcohol as a substitution pattern. The substitution was found to be related to higher levels of alcohol problems before addiction. The results showed a strong relationship between substitution and parental alcohol problems and family quarrels which had existed before the treatment, as well as 6 months after they entered the treatment Aggressive behavior of the subjects who used alcohol in the substitution pattern caused problems with law in the both stages of addiction career. All 8 patients fulfilled criteria for depression (HAM/D below 21).

The results confirmed the validity of substitution as a powerful construct in identifying behavioral differences before and after addition.The phenomenon of substance substitution during the treatment should be considered not as evidence of the treatment failure but as an additional aspect of the addiction that must be addressed within the therapeutic framework.

Modafinil was tested for efficacy in facilitating abstinence in cocaine-dependent patients, compared to placebo.

This is a double-blind placebo-controlled study, with 12 weeks of treatment and a 4-week follow-up. 210 treatment-seekers with DSM-IV diagnosis of cocaine dependence consented and enrolled. 72 participants were randomized to placebo, 69 to modafinil 200mg, and 69 to modafinil 400mg, taken once daily on awakening. Participants attended the clinic three times per week for assessments and urine drug screens, and had one hour of individual psychotherapy once per week. The primary outcome was the increase in weekly percentage of non-use days. Secondary outcomes included: decrease in the weekly median log of urine benzoylecgonine, subgroup analyses of balancing factors and co-morbid conditions, self-report of alcohol use, addiction severity, craving, and risk behaviors for HIV.

125 participants completed 12 weeks of treatment (60%). The GEE regression analysis showed that for the total sample, the difference between modafinil groups and placebo in the weekly percentage of cocaine non-use days over the 12-week treatment period was not statistically significant (p=0.95). A post-hoc analysis showed a significant effect for modafinil, only in the subgroup of cocaine patients without alcohol dependence. Modafinil 200mg also showed significant effects of an increase in the total number of consecutive non-use days for cocaine (p=0.02), and a reduction in craving (p=0.04).

These data suggest that modafinil, in combination with individual behavioral therapy, was effective for increasing cocaine non-use days in participants without co-morbid alcohol dependence, and in reducing craving.