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Alcohol Use Disorders (AUDs) are highly prevalent psychiatric disorders with often a poor treatment outcome in terms of high dropout rates and relapses. A vulnerability to disinhibition or a lack of self-regulation/low Effortful Control (EC) seems to be a core risk factor associated with both the initiation and continuation of AUDs. EC is the regulative dimension of temperament that involves attentional control, inhibitory control and activation control, and reflects self-regulation abilities that develop later in life parallel with the maturation of the prefrontal cortex.
In this study we want to investigate whether EC, operationalised in terms of self-report and in terms of behavioral measures, can predict relapse. When a low EC indeed turns out to be a significant contributor to relapse, treatment interventions aiming at strengthening EC could result in better treatment outcomes and less relapse in AUD patients.
The sample consisted of 75 adult patients with AUD (68.9% males, mean age 47,4y) admitted at a specialized, inpatient treatment unit for addiction. To assess the regulative temperament dimension, we used the Effortful Control Scale (ECS) from the Adult Temperament Questionnaire Short-Form), a self-report questionnaire as well as five behavioral/neuropsychological tasks using the Cambridge Neuropsychological Test Automated Battery: Cambridge Gambling Task (CGT), Stop-Signal Task (SST), Intra-Extradimensional Set Shift (IED), Spatial Working Memory (SWM) and Spatial Span (SSP).
We performed binary logistic regression analyses with EC/CANTAB measures as predictors and relapse/no relapse (during treatment and after 3 months follow up) as dependent variable. According to these analyses, the self-report measure of EC nor the behavioral tasks CGT, SST, SWM and SSP (CANTAB) were able to significantly predict relapse neither during treatment nor after 3 months follow-up. Only the IED (outcome measure stages completed) was significant in predicting relapse (p<0.05) during follow-up.
In our study we investigated whether self-regulation as measured by self-report questionnaires and behavioral tasks could predict relapse during treatment and after 3 months follow-up in a sample of inpatients with AUD. In contrast to some findings in literature, in our sample most of the used measures were not able to predict relapse. One hypothesis for these findings is that our sample of inpatients at a specialized addiction treatment unit is too homogeneous, all presenting lower levels of self-regulation. Future research should thus focus on larger samples and less homogeneous population. Only the IEC (outcome measure stages completed) was able to predict relapse during follow-up.
Alcohol, psychoactive substance abuse, and burnout are areas of significant problems within health care professionals and medical doctors. In 2011 we did a survey (n = 1601) in Belgium among the medical specialists. Beginning of 2021, exactly 10 years after the first survey, we repeated the survey this time among both medical specialists, general practitioners, and pharmacists. The results of this survey (N = 4361) will be presented and tendencies compared with international findings. We discuss the findings from both the longitudinal perspective using our 2011 data and also from the perspective of the impact of the Covid19 pandemic on health professionals.
Alcohol and (illicit) substance abuse are among the most common psychiatric disorders within the general population and their impact can not be underestimated. Reputedly for these disorders, there is a large treatment gap and treatment delay, i.e. large numbers of afflicted individuals never receive appropriate treatment and if they do so often many years after the onset of the disorder. The Covid19 pandemic has only aggravated these gaps. In many countries, due to the Covid 19 pandemic and its associated restriction measures telepsychiatric tools have become increasingly implemented (and funded) as regular parts in the possibilities in delivering interventions. With respect to substance abuse treatment, a vast body of research already showed promises both in the field of telepsychiatry as broader the use of digitalization (e.g. the use of virtual reality designed treatment interventions, digital monitoring). In the current presentation, an overview will be presented of both telemental health interventions and digital tools/interventions in the field of substance abuse treatment.
Background and aim: Temperament and personality traits are important factors underlying the vulnerability for both initiation and continuation of addictive behaviors. In SUDs there is a high comorbidity with mood and anxiety disorders and personality disorders. As there is a growing interest in the possible transdiagnostic role of Effortful Control in both SUDs as in their comorbid disorders the current study therefore investigates the influence of reactive (Behavioral Inhibition System and Behavioral Activation System, BIS/BAS) and regulative (Effortful Control, EC) temperament and their interaction in relation to clinical symptomatology and PDs in adult inpatients with SUD. Methods: The EC, BIS/BAS, SCL-90-R and ADP-IV questionnaires were administered to 841 patients (age between 17 y and 71 y) with a SUD admitted at the treatment unit for addiction of a psychiatric hospital. Results: Hierarchical regression analyses showed that both, clinical symptomatology and PDs were related to low levels of effortful control (EC). Furthermore, cluster C PDs were related to high levels of BIS and low levels of EC; whereas cluster B PDs were related to low levels of EC and high levels of BAS for the narcissistic and histrionic PD. An interaction effect (BIS*EC) was found for the Schizotypal PD, all other interactions (BIS*EC and BAS*EC) were not significant. Discussion: We found that low EC is involved in all clinical symptomatology and PDs in a sample of inpatients with SUDs. Therapeutic interventions aiming at strengthening effortful control can possibly result in better treatment outcomes for both the addiction as the comorbid psychopathology
Understanding the factors that play a role in the initiation of alcohol use and the subsequent transition to later alcohol abuse adolescence is of paramount importance from the context of developing better-targeted types of secondary (“pro-active”) prevention interventions (Hendriks VM, Dom G., 2021). Peer and family influences together with temperament traits have been suggested to be of cardinal importance regarding the initiation of alcohol use. In addition to these factors neurobiological and genetic factors play a major role in the risk of developing alcohol abuse upon initiation. The presentation will highlight the different psychological, neurobiological, and social factors underlying the risk of the transition to abuse and dependence in adolescence. In addition, examples of targeted prevention interventions will be highlighted.
The COVID-19 pandemic and its associated restriction measures have a great impact on patterns of substance use throughout the general population. Interestingly, in contrast to initial expectations on an overall negative impact, data of large surveys show a differentiated picture of impact. A recent systematic review (Roberts et al., 221) showed mixed tendencies towards increased alcohol consumption, contrasting with a clear trend towards the use of other psychoactive (illicit drugs and prescription drugs) substances. patterns of use before COVID-19 (e.g. habit of drinking at home) and availability (illicit drug traffic changes) are among the significant factors. In addition, mental health factors (depression, anxiety) and social isolation are common correlates with substance use. These factors may be of specific importance impacting substance use in adolescents during the COVID-19 pandemic. Exemplary is an increase in the use of sleeping medication among Belgian adolescents and young adults. In the current presentation data of national (Belgium) surveys on substance use in adolescents will be presented and discussed within the context of findings in international surveys.
The concept of “race” and consequently of racism is not a recent phenomenon, although it had profound effects on the lives of populations over the last several hundred years. Using slaves and indentured labor from racial groups designated to be “the others,” who was seen as inferior and thus did not deserve privileges, and who were often deprived of the right to life and basic needs as well as freedoms. Thus, creation of “the other” on the basis of physical characteristics and dehumanizing them became more prominent. Racism is significantly related to poor health, including mental health. The impact of racism in psychiatric research and clinical practice is not sufficiently investigated. Findings clearly show that the concept of “race” is genetically incorrect. Therefore, the implicit racism that underlies many established “scientific” paradigms need be changed. Furthermore, to overcome the internalized, interpersonal, and institutional racism, the impact of racism on health and on mental health must be an integral part of educational curricula, from undergraduate levels through continuing professional development, clinical work, and research. In awareness of the consequences of racism at all levels (micro, meso, and macro), recommendations for clinicians, policymakers, and researchers are worked out.
Compulsory admission procedures of patients with mental disorders vary between countries in Europe. The Ethics Committee of the European Psychiatric Association (EPA) launched a survey on involuntary admission procedures of patients with mental disorders in 40 countries to gather information from all National Psychiatric Associations that are members of the EPA to develop recommendations for improving involuntary admission processes and promote voluntary care.
The survey focused on legislation of involuntary admissions and key actors involved in the admission procedure as well as most common reasons for involuntary admissions.
We analyzed the survey categorical data in themes, which highlight that both medical and legal actors are involved in involuntary admission procedures.
We conclude that legal reasons for compulsory admission should be reworded in order to remove stigmatization of the patient, that raising awareness about involuntary admission procedures and patient rights with both patients and family advocacy groups is paramount, that communication about procedures should be widely available in lay-language for the general population, and that training sessions and guidance should be available for legal and medical practitioners. Finally, people working in the field need to be constantly aware about the ethical challenges surrounding compulsory admissions.
Pathological gamblers (PG) are often compared to substance dependent patients. Analogous to research into relapse into chemical addictions, a longitudinal outcome design was created to evaluate the impact of impulsivity measures on one-year relapse of pathological gamblers.
Twenty-two PG without comorbid substance use disorders and 31 healthy controls (HC) were compared on measures of impulsivity (Baratt Impulsiveness Scale, Delay Discounting Task, Iowa Gambling Task, Sensitivity to Punishment and Sensitivity to Reward Questionnaires, Stroop Color Word Task). The associations between these impulsivity measures and one-year relapse of pathological gambling were examined.
PG_Abstainers (N = 9) had a later age of onset and gambled for a shorter period than PG_Non-abstainers (N = 13). The PG groups did not differ in impulsivity measures. Healthy controls and PG differed on the Barratt Impulsiveness Scale and the Stroop Color Word Task, but not on the other impulsivity measures.
The present data show that PG are not always impulsive and that gambling histories, rather than impulsivity measures, predict one-year relapse.
Polysubstance dependent alcoholics (PSA) show a high risk of relapse. Decision-making deficits might be predictive of relapse so that high-risk relapse PSA are easily identified and novel more effective treatment interventions can be found.
To evaluate the effect of decision-making as measured by neurocognitive measures like the Iowa Gambling Task (IGT) and the Delay Discounting Task (DDT) on short-term relapse in PSA. The possible confounding effects of personality disorders (PD) are also examined.
Forty-one PSA following an inpatient addiction treatment were questioned about their substance use. After two weeks of stable abstinence they performed self-report questionnaires (Barratt Impulsiveness Scale - Sensitivity to Punishment and Sensitivity to Reward Questionnaires) and neurocognitive measures of decision-making (DDT - IGT). Thirty-seven PSA were retrieved three months after treatment completion and questioned about their current substance use. Thirty-one healthy controls (HC) were also asked to perform the self-report questionnaires and neurocognitive measures.
All PSA showed decision-making deficits in comparison to the HC. Abstinence was associated with better IGT performances, an older age at onset, and a greater likelihood of a cluster C PD.
IGT performances but not DDT performances are associated with short-term relapse in PSA. It is assumed that the processes involved in the DDT are more important to the initiation of the addiction while the processes involved in the IGT are more important to the maintenance of and the relapse in the addiction.
There is growing evidence that cognitive deficits play an important role in the development, course and relapse of substance use disorders. In particular, functions that involve control over one's own behaviour (impulsivity), and over behaviour when confronted with motivationally relevant drug cues (craving) are related to relapse in recent studies. So far, pharmacological manipulations of cognitive deficits are rare and relapses after treatment are the rule rather than the exception.
Therefore, we performed a randomized, double-blind, placebo-controlled trial with modafinil, which is a known cognitive enhancer and a wake-promoting agent.
At first, the interaction between impulse control, overall cognitive functioning, motivational strength of drug cues, and vulnerability to relapse, will be elucidated in order to disentangle new treatment possibilities. Second, the effectiveness of a long term treatment with modafinil on impulse control and relapse will be explored.
83 abstinent alcohol dependent inpatients were randomized to a single morning dose of modafinil (300 mg/d), or matching placebo, for 10 weeks. Both neurocognitive tests (on impulsivity, craving and overall cognitive functioning) and self-report questionnaires were administered before, during and after treatment. Patients were followed up 6 months after treatment, to measure relapse rate. Primary outcome variables are test performance, craving ratings and relapse.
Data will be unblinded after finalizing the follow-up data collection. Therefore, results will be available from January 2012.
It is expected that modafinil improves cognitive functioning, increases time to first relapse and reduces relapse rates and relapse severity, compared to placebo.
The European Union Free Movement Directive gives professionals the opportunity to work and live within the European Union, but does not give specific requirements regarding how the specialists in medicine have to be trained, with the exception of a required minimum of 4 years of education. Efforts have been undertaken to harmonize post-graduate training in psychiatry in Europe since the Treaty of Rome 1957, with the founding of the UEMS (European Union of Medical Specialists) and establishment of a charter outlining how psychiatrists should be trained. However, the different curricula for post-graduate training were only compared by surveys, never through a systematic review of the official national requirements. The published survey data still show great differences between European countries and unlike other UEMS Boards, the Board of Psychiatry did not introduce a certification for specialists willing to practice in a foreign country within Europe. Such a European certification could help to keep a high qualification level for post-graduate training in psychiatry all over Europe. Moreover, it would make it easier for employers to assess the educational level of European psychiatrists applying for a job in their field.
Neurobiological bases of substance addictions and behavioral addictions.
Recent years research has increasingly unraveled the neurobiological processes underlying addictive behaviors. Of importance, these pathogenetic mechanisms are hypothesized to play a role in many, non-chemical, types of addictive behaviors. This has been most explicitly documented in the case of pathological gambling, which has been included recently into the section on addictive behaviors of the DSM5. For other types of behavioral disorders such as obesitas, online gaming, and ‘sex-addiction’ findings on their underlying neurobiological basis remain limited. Within the scope of this presentation an overview will be presented of the current state of the art reflecting the neurobiological basis of addictive behavior. Specifically the non-chemical types of addictive behavior will be focused.
Cognitive Bias Modification (CBM) has opened up new ways to treat addiction by retraining relatively automatic, maladaptive processes implied in the onset and maintenance of addiction disorders (Wiers et al., 2013). Many CBM interventions can, in principle, be administered online, thus showing potential of being a cheap addition to conventional treatments.
The recent re-framing of pathological gambling (PG) as a behavioural addiction and its inclusion in the substance and addictive disorders diagnostic section of the new DSM-5 questions whether PG could also be explained by recent dual-process models of addiction and, consequently, whether CBM interventions can be potentially effective in the treatment of PG. Furthermore, the online delivering of CBM is believed to be of great value for PG treatment, since providing interventions via the Internet can increase the accessibility to help resources for gamblers by also circumventing many of the barriers associated to traditional in-person treatment (Ladoucer, 2005).
In this talk we will go through the premises and the design of the first Randomised Clinical Trial exploring the effectiveness of two web-based CBM interventions targeting automatic selective attention and approach tendencies towards gambling-related cues in a sample of Dutch and Belgian problematic and pathological gamblers. Finally, preliminary results of the ongoing RCT are here presented for the first time.
Increasingly patients present themselves to psychiatrists and other care providers with a specific request for treatment of one or more behavioral addictions. From a pathogenic point of view impulsivity and compulsivity are important drivers of these behavioral disorders, and as such may represent a target of pharmacological and broader neurobiological, e.g. Neuro-stimulation, treatment. Although currently treatment as usual has a focus on psychosocial and cognitive behavioral interventions, interest is growing toward the pharmacological interventions. In the presentation a state of the art will be presented regarding the pharmacological treatment of behavioral addictions, with a focus on Gambling Disorder and Gaming Disorder.
Disclosure of interest
Member Advisory Board Lundbeck - Belgium.
Received funding from Belgian LOTTO for research into Cognitive Behavioral Therapy for Gambling Disorder.
Gambling Disorder (GD) is a complex psychopathological phenomenon, characterized by the interaction of multiple etiological factors and a very heterogeneous symptomatological expression. Currently many questions remain concerning the best way of treating GD. Indeed, the traditional used (cognitive) behavioral interventions have at best a modest effect size. In addiction, there remains a large treatment gap, i.e. less than 10% of pathological gamblers ever seek help and enter treatment. E-health interventions could potentially help to close this gap. Cognitive bias modification (CBM) refers to a class of cognitive training paradigms that target specific automatic attentional, behavioral or evaluative biases triggered by addiction-related cues. These biases have repeatedly been shown to play an important role in addiction. Recently a number of studies have shown that modifying these biases has been effective in the treatment of different types of addictions, e.g. alcohol use disorders. An online Approach Bias Modification program, testing both Attention Bias Modification (ABM) and Approach Bias Modification (AppBM), is currently tested with Belgian and Dutch problem and disordered gamblers. Personalized motivational feedback has been added to the training program, to increase training adherence and prevent dropout. The same research group is also launching a second web-based study combining online AppBM with an online standard, protocoled, cognitive behavioral Therapy (CBT) program with guidance of a trained therapist. Participants receive nine CBT sessions through online chat with the therapist and, concurrently, nine sessions of AppBM. Preliminary results will be discussed.
Disclosure of interest
Member Advisory board Lundbeck-Belgium.
Received grant from LOTTO- Belgium to conduct behavioural study that will be discussed in presentation
Background Attention-deficit/hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that often persists into adulthood and old age. Yet ADHD is currently underdiagnosed and undertreated in many European countries, leading to chronicity of symptoms and impairment, due to lack of, or ineffective treatment, and higher costs of illness.
Methods The European Network Adult ADHD and the Section for Neurodevelopmental Disorders Across the Lifespan (NDAL) of the European Psychiatric Association (EPA), aim to increase awareness and knowledge of adult ADHD in and outside Europe. This Updated European Consensus Statement aims to support clinicians with research evidence and clinical experience from 63 experts of European and other countries in which ADHD in adults is recognized and treated.
Results Besides reviewing the latest research on prevalence, persistence, genetics and neurobiology of ADHD, three major questions are addressed: (1) What is the clinical picture of ADHD in adults? (2) How should ADHD be properly diagnosed in adults? (3) How should adult ADHDbe effectively treated?
Conclusions ADHD often presents as a lifelong impairing condition. The stigma surrounding ADHD, mainly due to lack of knowledge, increases the suffering of patients. Education on the lifespan perspective, diagnostic assessment, and treatment of ADHD must increase for students of general and mental health, and for psychiatry professionals. Instruments for screening and diagnosis of ADHD in adults are available, as are effective evidence-based treatments for ADHD and its negative outcomes. More research is needed on gender differences, and in older adults with ADHD.
Huntington's disease (HD) is an autosomal dominant disorder of the central nervous system, characterised by neurological, cognitive and psychiatric pathology. Recently the causative genetic defect was discovered. We present a retrospective study of 59 HD patients, investigating correlations between molecular and clinical data.
The correlation between CAG-repeatlength and age at onset is confirmed. No correlations between this biological marker and other clinical features are found (symptoms at onset, mode of progression of the disease).
The consequences of these findings for predictive testing are discussed. Furthermore, a short overview of the predictive testing procedure in the Center for Human Genetics in Leuven (Belgium) is given.