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.

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Mean follow-up 20.4 days. Main diagnosis was schizophrenia (40%) and mean dose of aripiprazole was 25 mg/d. Resistant patients received initially multiple psychotropics (mean 3.3) and their functional status was very low. A significant functional improvement was observed after admission in most (12) of them. Only three patients experienced mild to moderate improvement; another three patients showed extrapyramidal symptoms. No dermatological reactions or adverse effects were observed with lamotrigine association. DISCUSIONS: The combination of aripiprazole with other psychotropics was well tolerated. No significant new adverse reactions were observed. In a short term follow-up, our results show a good tolerability of aripiprazole in combination with other psychotropics of different groups.

The Panic Disorder Severity Scale (PDSS) is a well-established measure of panic symptoms but few data exist on this instrument in non north-American samples. Our main goal was to assess the psychometric properties (internal consistency, test re-test reliability, inter-rater reliability, convergent and divergent validity) and the factor structure of the Spanish version. Ninety-four patients with a main diagnosis of panic disorder were assessed with the Spanish version of PDSS, the Anxiety Sensitivity Index-3 (ASI-3), the Panic and Agoraphobia Scale (PAS), the Beck Anxiety Inventory (BAI), the Beck Depression Inventory-II (BDI-II) the PDSS self-rating form and the Clinical Global Impression-Severity scale (CGI). The Spanish PDSS showed acceptable internal consistency (α = .74), excellent test-retest (total score and items 1-6: α > .58, p .90) and medium to large convergent validity (r = .68, 95% CI [.54, .79], p < .01; r = .80, 95% CI [.70, .87], p < .01; r = .48, 95% CI [.28, .67], p < .01; BAI, PAS and ASI-3 total scores respectively). Data on divergent validity (BDI-II total score: r = .52, 95% CI [.34, .67], p < .01) suggest some need for refinement of the PDSS. The confirmatory factor analysis suggested a two-factor modified model for the scale (nested χ2 = 14.01, df = 12, p < .001). The Spanish PDSS has similar psychometric properties as the previous versions and is a useful instrument to assess panic symptoms in clinical settings in Spanish-speaking populations.

Introduction: Sleep disturbances have been described in drugdependent patients and mainly, in alcoholics. Few studies describe the hypnotic treatment used in this setting. Aims: Describe the prevalence of insomnia in drugdependent inpatients. Describe the hypnotic treatment, according to the substance abuse and the psychiatric comorbidity. Material and methods: Descriptive study performed in drugdependent inpatients between June, 2008 and August, 2011. The Structured Clinical Interview for DSM Disorders was obtained in order to ensure the clinical diagnosis. Hypnotic treatment was dispensed to those patients who complain of insomnia according to the Psychiatric prescription. Demographic data, type of abuse drug and the hypnotic dispensed was obtained. Results: 298 patients fulfilled inclusion criteria (71.8% men, 39.22±10.13 years). The principal substances of consumption were stimulants(36.2%), followed by alcohol(34.9%), heroine(14.4%), cannabis(9.4%) and benzodiazepines(5%). 60.4% of the patients complained of insomnia during the hospital admission. The most used drugs for insomnia were mirtazapine(19.8%), trazodone(14.8%), quetiapine(14.1%), clotiapine(7.4%) and olanzapine(4.4%). Alcohol, cocaine and benzodiazepines addicted patients were treated with antidepressants as mirtazapine(17.3%, 18.5% and 40% respectively); heroin addicts were treated with antipsychotic drugs as quetiapine(27.9%). Cannabis addicts took antidepressant and antipsychotic (mirtazapine (21.4%) and olanzapine(21.4%)) 61.7 % of the patients fulfilled diagnostic criteria of dual diagnosis. Patients with psychotic disorder used quetiapine(17.4%); those with depressive and bipolar disorder were treated with trazodone(30.2% and 33.3% respectively), those who complain of anxious disorder and personality disorder took mirtazapine(50% and 17.4% respectively). Conclusions: Sleep disturbances are frequent in drugdependent inpatients. Mirtazapine was the most frequently used drug to treat insomnia.