According to 2008 data, there are 80.000 patients undergoing replacement opiate programs (RMP) in Spain. However, the clinical therapeutic management and the psychiatric and medical comorbidities have not been well described. Objectives: To describe the current therapeutic management and psychiatric comorbilities of opiatedependent patients undergoing a RMP in Spain. Methods: We carried out an observational, cross-sectional, multicenter study from September 2008 to February 2009. Patients > 18 years, with written informed consent, with a opiate-dependence according to DSM-IV-TR criteria and currently scheduled in a RMP in Spain were included. Results: 624 patients (38.89±7.95 y.o.,84% men) were included in the study from 74 centers. Psychiatric comorbidities were clinically detected in 68% of all valuable patients, most frequently anxiety (53%), mood (48%) and sleep disorders (41%). Patients receiving buprenorphine-naloxone suffered less sleep disorders (19% vs. 43%; p=0.0327) The proportion of patients with at least one psychiatric comorbidity was directly related to methadone dose (p=0.0066). The most frequent replacement therapy was methadone (94%), usually in < 40 mg/day (38%) and 40-80 mg/day doses (40%); mean follow up period being 45.88±51.86 months. Significant differences were found between methadone doses and retention. Patients with HIV and HCV infection received higher doses of methadone (HIV+ patients (p=0.0024) and HCV+/ HIV+ patients (p=0.0250) due to ARV treatment; and showed less PMM retention. Conclusion: Patients present high rates of dual diagnosis, and infectious and non-infectious comorbidities, expecting higher doses of methadone than found (54.04±47.26 mg/day) in the study to assure a proper retention in the maintenance programs.

Introduction:The objective of our study is to describe the prevalence of insomnia during active consumption and hospitalisation for detoxification, and its influence on relapses at 3 and 6 months in drug-dependent patients.Methods:We conducted a prospective study of drug-dependence inpatients admitted to the hospital detoxification unit between June 2008 and November 2012, and performed psychiatric follow-up on an outpatient basis over the six months following discharge. Insomnia prior to admission was measured by clinical interview from the patient concerning sleep habits, and during hospital stay using a sleep log filled out by nurse team. Demographic, clinical and diagnostic variables were recorded and a structured clinical interview (SCID) was conducted to assess psychiatric diagnoses. Relapse was deemed to be renewed use of the substance that brought about admission, which was assessed by alcohol testing and/or urinalysis.Results:We included 434 patients. Insomnia during consumption was reported by 64.3% of patients and 66.1% reported insomnia during hospital stay. Of the patients with preadmission insomnia, 68.3% relapsed at 3 months from discharge, as did 71% of patients with insomnia during hospital stay. Patients who relapsed at 3 months of follow-up showed significantly greater sleep initiation dysfunction prior to and during hospitalisation. Of the patients with preadmission insomnia, 69.2% had relapsed at 6 months from discharge. Patients who relapsed at 6 months of follow-up showed significantly greater sleep initiation dysfunction and global insomnia prior to and during hospitalisation.Conclusions:Sleep disorders should be study as a prognostic factor in drugdependent patients.

Introduction:Little is known about medical students’ interest in their training on drug addiction, their personal experience of consumption and whether these aspects influence the detection of addiction in patients.Objectives:To study the interest of medical students enrolled on the psychiatry course in the area of addictions, and evaluate the influence of such interest, a history of personal consumption and gender on the detection of addiction in patients.Aims&Methods:Voluntary participation was offered to all students from academic years 2008–2009 to 2012–2013. Of the 505 potential students, 336 questionnaires were collected, of which 71.13% were female.Results:Of the respondents, 88.5% considered that drug dependence issues are important to their professional future and 63% that the approach to drug-related diseases is important. A total of 34% of the students had already assessed addicted patients in their previous clinical training. The students report consuming alcohol(69%), cigarettes(19.5%) and illegal drugs(15.8%). The female students consumed fewer illegal drugs than the men(p0.022) and more frequently considered that the list of topics to be covered was appropriate(p0.021). The male students consumed more illegal drugs more frequently(p 0.005), knew more consumers(p 0.023), and those who drink alcohol consumed more illegal drugs than women(p < 0.005). However, the men seemed to have assessed fewer addicted patients in their previous clinical experience(p0.094).Conclusions:Consumption among medical students may have a normalizing role on consumption and prevent the detection of addicts. It is important to educate and raise awareness on drugs, as this may influence detection. The focus should be particularly on the male group.

Genetic factors involved in the susceptibility to drug addiction still remain largely unknown. MiRNAs seem to play key roles in the drug-induced plasticity of the brain that likely drives the emergence of addiction. In this work we explored the role of miRNAs in drug addiction. With this aim, we selected 62 SNPs located in the 3'UTR of target genes that are predicted to alter the binding of miRNA molecules and performed a case-control association study in a Spanish sample of 735 cases (mainly cocainedependent subjects with multiple drug dependencies) and 739 controls. We found an association between rs1047383 in the PLCB1 gene and drug dependence that was replicated in an independent sample (663 cases and 667 controls). Then we selected 9 miRNAs predicted to bind the rs1047383 region, but none of them showed any effect on PLCB1 expression. We also assessed two miRNAs binding a region that contains a SNP in linkage disequilibrium with rs1047383, but although one of them, hsa-miR-582, was found to downregulate PLCB1, no differences were observed between alleles. Finally, we explored the possibility that PLCB1 expression is altered by cocaine and we observed a significant upregulation of the gene in the nucleus accumbens of cocaine abusers and in human dopaminergic-like neurons after cocaine treatment. Our results, together with previous studies, suggest that PLCB1 participates in the susceptibility to drug dependence. Drug dependence is one of the major health problems worldwide. In Europe, about 25% of adults are estimated to have tried illicit drugs at some point in their lives 1. Usually drug consumers use more than one drug at the same time: for example, within the group of European individuals who consumed a psychoactive substance in the last 12 months, 33% had consumed two different substances and 10% had used three 2. This high prevalence of polydrug abuse is due to common and drug-specific genetic and environmental factors 3-5. It is well known that addictions are moderately to highly heritable (from 0.39 in the case of hallucinogens to 0.72 for cocaine), although the specific genetic risk factors involved in its predisposition remain largely unknown 6-9. Transcriptomic studies in animal and cellular models, as well as human studies in postmortem brain samples from addicted individuals, have revealed that both acute and chronic drug exposure produce epigenetic adaptations and changes in gene expression 10. Furthermore, recent studies have shown that some genes whose expression is altered by cocaine also contribute to cocaine dependence susceptibility 11, 12. MicroRNAs (miRNAs) are small regulatory noncoding RNA molecules (about 18-25 nucleotides in length) that control gene expression through direct binding to 3′untranslated regions (3′UTRs) of target mRNAs causing translational repression or mRNA degradation. One single miRNA can target and regulate hundreds of mRNAs

BACKGROUND The stigma associated with mental illness is a global public health problem 3 , having worse consequences than the disorders themselves 4. The objective of this study is to review the literature on the stigma towards mental illness in medical students and know about its presence. METHODS Following the PRISMA 9 methodology, a systematic review is carried out in PubMed, Web of Science (WOS) and Cochrane Library. We proceed to the reading of the abstracts of a total of 67 manuscripts, 38 of which are excluded because they do not comply with the parameters that are the object of the study. Additionally, 9 relevant articles of associated searches are reviewed. RESULTS A total of 38 manuscripts containing a participation of 18,808 medical students are evaluated. The publications come from 20 countries worldwide, without a representative predominance of any of them, led by Great Britain and Canada. 87% of the publications are concentrated in the last 8 years, showing the increase and continued presence of research. CONCLUSIONS The existence of stigma towards mental illness among the target population is corroborated in 97% of the literature. This is a heterogeneous field of study with few studies with large sample sizes. More research is needed to identify interventions which will produce a long-term change in behaviour to reduce stigma among medical students.