Our findings suggest that patients and providers have a variety of options for choosing an effective treatment for PTSD. Substantial differences in study design and study participant characteristics make identification of a single best treatment difficult. Not all medications or psychotherapies are effective.

IntroductionAlcohol abuse causes dopamine release in the mesolimbic system, which activates the reward circuit. This is linked to an interdependent opioid, serotonergic and endocannabinoid system. Nalmefene is a modulator of the endogenous opioid system, with antagonistic effect on mu and delta receptors, and a partial agonist activity kappa. This means that reduces the reinforcing effects of alcohol consumption through the cortical-mesolimbic system. Therefore, when a patient takes nalmefene, the satisfaction obtained when he drinks is lower, which increases the possibility to have more control over drinking.The efficacy of nalmefene was evaluated in two profiles of patients: 1. No abstinence in alcohol dependence disorder and continuous relapses, 2. Cocaine dependence disorder associated to alcohol abuse.ObjectivesImproving the quality of life and compliance rates due to the difficulties of following a strict treatment to achieve the abstinence. Furthermore, in cases of patients with cocaine dependence disorder and alcohol abuse, the objective is to avoid cocaine use by reducing previous alcohol consumption.Conclusionnalmefene offers the possibility of treating the addiction from a new perspective. Our current clinical experience has been able to treat subjects with conventional treatments failures and those who need to achieve the necessary control to reduce cocaine use.Disclosure of interestThe authors have not supplied their declaration of competing interest.

INTRODUCTION: patients with dual pathology have worse clinical evolution and worse therapeutic response. The repeated administration of substances sensitizes the dopaminergic systemwith downregulation of the reward circuit. When the drug use stops, the exposureto stimuli produces a dopamine increase and craving appears. AIMS: to prove usefulness of paliperidone in dual pathology for craving andfor drug abuse.MATERIALS AND METHODS: 18 patients diagnosed with dual pathology. They were treated with paliperidone and all of them were interviewed about craving andsubstance use. RESULTS: 4 groups: Cannabis (5%). Cannabis and cocaine (16.66%). Cannabis andother two or more substances (16.66%). Cocaine and alcohol (16.66%). All ofthem were diagnosed of dual pathology: induced psychotic disorder (33.33%),personality disorder (27.77%), conduct disorder (16.66%), paranoid schizophrenia (11.11%), bipolar disorder (5.55%), and dysmorphic disorder(5.55%). 38.89% achieved abstinence. 50% reduced significantly substance use.77.78% verbalized a decrease in craving.DISCUSSION: cannabis disables the gabaergic interneurons, which stop inhibiting the dopaminergic neurons and a large amount of dopamine is released from the accumbens nucleus. Cocaine increases dopamine and 5-HT levels on thebrain. Paliperidone presents an affinity for D2 and 5TH2a receptors, so this might explain the results, because it blocks the enhancer effect, which contributes to the craving decrease and to the drug withdrawal. CONCLUSIONS: paliperidone seems to be a good choice in dual pathologydue to the improvement on craving and drug abuse

IntroductionStudies describe patients with dual pathology as subjects with worse clinical evolution and worse therapeutic response. These subjects have high percentages of worse therapeutic compliance and low adherence to psychopharmacological treatment. The conventional antipsychotics can induce dysphoria and worse craving and drug use. The long duration-injectable antipsychotics could serve as a good therapeutic alternative because they combine efficacy and tolerability.ObjectivesWe analyzed subjects treated with aripiprazole injectable to demonstrate its effectiveness on symptomatology, the reduction of craving and consumption of substances.Materials and methodsWe studied subjects with dual disorders at a Center for Attention to drug addicts treated with aripiprazole extended-release injectable. All of them met criteria for the diagnosis of disorders for cannabis and cocaine use. All of them had been previously treated with oral antipsychotics and/or injectable of long duration. Evolution of craving and consumption were evaluated through clinical interviews and urine analysis.ResultsCannabis was the main substance for all the patients. Three of them also often abused of cocaine. All of them were taking other treatments previously. The main causes of the change were: side effects and/or poor compliance. Only one patient discontinued follow-up. The rest of them showed good therapeutic adherence and better tolerability with aripiprazole injectable. The monthly dose was 400 mg.ConclusionsAripiprazole extended-release injectable is a good choice for dual disorders. A good therapeutic adherence involves not only a psychopathological improvement but also respect to craving and consumption, which makes aripiprazole injectable a suitable therapeutic option.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionRecent epidemiological studies suggest that the prevalence of bipolar disorder might be misdiagnosed initially as unipolar depression due to the difficulty to detect episodes of hypomania. The Hypomania Checklist (HCL-32), validated in Spanish, is a self-report questionnaire with 32 hypomania items designed to screen for hypomanic episodes.ObjectivesTo examine the prevalence of hypomania in patients with unipolar depression. Corroborate the efficacy of the HCL-32 to detect symptoms of hypomania.MethodsThe presence of hypomanic symptoms was assessed by the HCL-32 in a sample of 128 subjects diagnosed with bipolar I disorder (n = 30), bipolar II disorder (n = 1), unipolar depression (n = 57), and anxiety disorder (n = 15) according to DSM-IV-TR criteria. A control group of healthy subjects was selected (n = 25).ResultsThe discriminative capacity was analyzed by the ROC curve. The AUC was 0.65 which did not indicate a good capacity. The sensitivity (S), specificity (E) and prevalence (P) of hypomania in unipolar patients for the following cut-off points were :14: S = 81.6%,95%CI(69.8, 93.5); E = 30.1%,95%CI(19.7,40.6); P = 74.1%; 15: S = 77.6%,95%CI(64.9,90.3); E = 37.4%,95%CI(26.3,48.4); P = 67.2%; 16: S = 59.2%,95%CI(44.4,73.9); E = 55.4%,95%CI(44.1,74.0); P = 51.7%; 17: S = 55.1%,95%CI(40.2,70.1); E = 57.8%,95%CI(46.6,69.1); P = 48.3%.ConclusionsThe HCL-32 has a high sensitivity but a low specificity as screening instrument. This might explain the high proportion of hypomania found in this study. The difference with previous studies is that our sample was heterogeneous, unstable and serious. This suggests that the HCL-32 is not valid for any psychiatric sample. Future research should develop more specific instruments with better external validity.

IntroductionThe studies about the comorbidity of major depressive disorder (MDD) and bipolar disorder (BD) have increased in the last years. The comorbidity with Axis I psychiatric disorders complicates the diagnosis, prognosis and treatment.ObjectivesTo analyze the prevalence of affective disorders associated with another Axis I psychiatric disorders to treat correctly from the beginning of the diagnosis and to improve the course of the disorder and the quality of life of these patientsMethodsThe subjects who participated in the study were diagnosed of bipolar I disorder, bipolar II disorder and MDD, according to DSM-IV-TR criteria. The sample (n = 114) was divided into three groups: MDD (n = 58), BD (n = 31) and a control group of healthy subjects (n = 25). The diagnosis and stability were assessed using the MINI International Neuropsyquiatric Interview and the Hamilton Depression Rating Scale (HDRS).ResultsBD had a significantly association with risk of suicide (38%), anxiety disorder (3.3%) and social phobia (12.9%). It was also reported a significant association between MDD and risk of suicide (71%), manic/hypomanic episodes (25.9%), anxiety disorder (37.9%), social phobia (25.9%) and generalized anxiety disorder (37.9%).ConclusionsIt is necessary for clinical practice an integrative model which takes into account the comorbidity of affective disorders to improve the response to treatment and the prognosis of these mental disorders

Introduction While it is well known that there is an interaction between sleep disorders and substance abuse, it is certainly more complex than was previously thought. The effects on sleep depend on the substance used, but it has been shown that both during use and in withdrawal periods consumers have various sleep problems, and basically more fragmented sleep. We know that sleep problems must be taken into account to prevent addiction relapses. Objectives To explain the different sleep disorders caused by substances such as alcohol and cannabis Methods As an example of this, two cases are introduced: the first one, a 17-year-old boy, who is diagnosed with ADHD with daily cannabis use since the age of 14. As a result of reducing consumption, he presents an episode of sleep paralysis that he had not previously had. The second one is a 50-year-old man diagnosed with a personality disorder and with dependence on cannabis and alcohol for years. He currently has abstinence from alcohol for months and maintains daily cannabis use. However, he has long-standing sleep pattern disturbances and frequent depersonalization phenomena at night. Results Alcohol at low doses has no clear effects on sleep architecture. At higher doses it decreases sleep latency, as well as awakenings. In chronic alcoholic patients, a decrease in deep slow sleep, and more fragmented sleep have been found. Cannabis withdrawal reduces sleep quality, increases latency, and produces strange dreams. Conclusions There is a positive relationship both between having a substance use disorder and suffering from a sleep disorder. Disclosure No significant relationships.

IntroductionPatients with dual pathology have worse clinical evolution and worse therapeutic response. Drugs modify the functioning of certain neurocerebral transmission systems, producing cognitive, emotional and behavioral changes. Vortioxetine (Brintellix®) is used as a treatment for major depressive disorder (MDD) and it is considered a new multimodal antidepressant. Preclinical data suggest that the effects on numerous serotonin receptors result in regional increases in noradrenaline and dopamine as well as glutamatergic transmission.ObjectivesThis analysis assessed the efficacy of vortioxetine (Brintellix®) in patients with affective disorders and abuse drugs (dual pathology).MethodsEfficacy was assessed with a study of patients who were recruited in a qualitative and observational study. They were treated with vortioxetine (Brintellix®). Outcome measures included changes from baseline to endpoint in Hamilton Depresion Rating Scale (HDRS). They were also interviewed weekly about craving and substance use. Urine test controls were done to corroborate results.ResultsA total of 11 vortioxetine-treated patients improved their depressive and anxiety symptomatology. Seven of them (64%) were males and four of them (36%) were women. Cocaine was the main drug of abuse (n = 9, 82%). The doses were between 5 and 20 mg/day. After the clinical evaluation and 12 weeks of treatment, they achieved to reduce significantly the drug use and verbalized a decrease in craving. Two patients dropped out of the study.ConclusionsVortioxetine (Brintellix®) was shown as efficacious in reducing depressive and anxiety symptoms in patients with dual pathology.Disclosure of interestThe authors have not supplied their declaration of competing interest.