Use of prescription psychostimulants and nootropics for non-medical purpose is a growing trend, especially in academic environment. Seeing the risks of neuroenhancement we decided to investigate situation in Lithuania.

Analyze the use of cognitive enhancers among medical students in Lithuania.

1. Determine the prevalence of cognitive enhancement. 2. Figure out what drugs are mostly used and reasons for the usage. 3. Evaluate the contributing factors.

A cross-sectional survey study was performed in Vilnius University and Lithuanian University of Health Sciences. Students were asked to fill anonymous paper questionnaires consisting of 13 items concerning prevalence of substance use to enhance cognitive performance, reasons, and correlates during lecture time.

Results are summarized in Table 1. A total of 8.1% of responders indicated that they had used cognitive enhancers. Nootropics were the most frequently mentioned: 59.6%, while psychostimulants were mentioned less frequently: 38.3% (including modafinil, methylphenidate and amphetamine derived drugs), and 23.4% indicated other substances. Improvement of concentration and increased studying time were predominant purposes (55.3% and 48.9% of users). Male students reported 3 times higher prevalence rates than females (14.6% vs. 5.1%, P < 0.05). Prevalence were also higher in students, who knew someone using these substances as compared to those who did not (17.3% vs. 5.1%, P < 0.05); it was the most associated factor with cognitive-enhancing drug taking behavior (Table 1).

In Lithuania, 1 of 12 medical students admits to having used neuroenhancing drugs. Nootropics were the most used drugs. Knowing user was the most important factor for usage.

The authors have not supplied their declaration of competing interest.

Exercise addiction is characterized by increasing exercise amounts, withdrawal symptoms and lack of control. Exercisers with addiction continue to exercise in spite of pain and injury because they use exercise to regulate emotions, identity and self-esteem. How do they react to injuries?

It is hypothesized that exercise addiction is a risk factor for emotional distress when an injury occur due to withdrawal symptoms and lack of identity.

To estimate the prevalence of exercise addiction in exercisers with injuries at the musculoskeletal system and to test the relationship between addiction and emotional distress (depression and stress).

The Exercise Addiction Inventory was used to identify exercise addiction. To measure depression and stress we used the Major Depression Inventory (MDI) and the Perceived Stress Scale (PSS). Participants (n = 694) were regular exercisers with injuries at foot, knee or shoulder at an orthopedic hospital department.

The prevalence of exercise addiction was 7.6%. We found that exercisers with addiction reported more emotional distress in terms of higher MDI-scores 18.0 (SD = 11.0) versus 11.7 (SD = 9.1); P = 0.00 and in total PSS-score 17.6 (SD = 7.2) versus 13.9 (SD = 6.8); P = 0.00. Chi2 analyses showed that 25% of the addicted exercisers met the criteria for clinical depression, while only 11% of the non-addicted exercisers were depressed; P = 0.00.

Exercisers with addiction appear at somatic departments treating musculoskeletal injuries. It is a vulnerable group characterized by elevated levels of depressive symptoms and clinical stress. We recommend to offer psychological interventions focusing on emotional distress and prevention of re-injury by reducing excessive and obsessive exercise patterns.

The authors have not supplied their declaration of competing interest.

Studies 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.

We analyzed subjects treated with aripiprazole injectable to demonstrate its effectiveness on symptomatology, the reduction of craving and consumption of substances.

We 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.

Cannabis 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.

Aripiprazole 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.

The authors have not supplied their declaration of competing interest.

Alcohol 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.

Improving 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.

nalmefene 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.

The authors have not supplied their declaration of competing interest.

Aripiprazole is the firstborn of the new dynasty of antipsychotic called third generation or neuromodulator of dopamine-serotonin system. It has proven to be an effective and well-tolerated antipsychotic. Dual Pathology represents the presence of comorbidity between mental illness and substance use disorders. It is an under-diagnosed problem and it is increasing frequency.

The aim of this study was to determine and describe the clinical profile of the patients admitted to the Dual Pathology Unit (UPD) at The Montalvos Hospital (Part of Salamanca University Teaching Hospital, Spain) treated with oral Aripiprazole.

Descriptive, observational, retrospective study of a sample of patients admitted to the UPD to which oral aripiprazole was prescribed during hospitalization. A number of sociodemographic, clinical, and treatment-related variables are described.

From a sample of 25 patients and according to DSM-5 criteria (APA, 2013) main diagnoses were: 14 cases of substance-induced psychotic disorder, 3 cases of schizophrenia; 3 cases of schizoaffective disorder; 2 cases of bipolar disorder; 1 case of schizophreniform disorder; 1 case of borderline personality disorder; 1 case of personality syndrome. The most used drugs before the admittance were cocaine, cannabis and opioids. The average dose of aripiprazole was 9 mg and no side effects or drug interactions were reported.

Apart from its well known efficacy in treament of psychosis, oral aripiprazole may be a first line treatment for Dual diagnosis patients, specially those with problems of non-compliance, due to high level prolactine side effects.

The authors have not supplied their declaration of competing interest.

Dual Diagnosis (DD) refers to coexistence of a psychiatric disorder, which is often a Personality Disorder (PD), and a Substance Use Disorder (SUD). Despite DD is a topic of interest in recent years, few studies have focused on the temperament and character traits of PD patients with or without a comorbid SUD. Anyhow, the assessment of personality traits may be helpful to understand the relation among psychiatric disorder, drug use and environment in patients with addictive behaviors.

The aim of this study is to compare two subgroups of PD patients, with and without a comorbid SUD. Sociodemographic, clinical and personality profile, as assessed with the Temperament and Character Inventory, will be compared.

We are recruiting patients with a PD diagnosis referring either the psychiatry ward or outpatient service of the AOU “Maggiore della Carità”, Novara, Italy; secondly, we will group them according to the presence/absence of SUD. Cloninger's TCI-R will be administered together with a structured interview to gather sociodemographic and clinical information.

Data collection is ongoing; we expect to find a different personality profile in PD and DD Patients.

Temperament, which is the biological part of the personality, seems to have an important role in addictive behavior; therefore assessing the personality traits of DD patients can help to improve the differential diagnosis and to establish strategies for treatment and prevention. In particular, sensation seeking and impulsivity are temperamental characteristics that may favor SUD in patients with psychiatric disorders.

The authors have not supplied their declaration of competing interest.

The American Psychiatric Association introduced in Internet Gaming Disorder (IGD) in the appendix as a tentative disorder in the last edition of the Diagnostic and Statistical Manual of Mental Disorders. However, currently no systematic review exists about excessive gaming viewed from a clinical perspective.

To review clinical studies on gaming addiction in order to ascertain characteristics of both clinical and research studies to provide retrospective evidence in relation with the proposed IGD classification (including criteria, measures and therapies).

A systematic literature review of studies published from 1980 to 2015 has been conducted using three major psychology databases: Academic Search Complete, PsycInfo, and PsycArticles. A total of 5033 results from peer-reviewed journals were obtained, where 32 were identified as empirical clinical papers focused on gaming addiction.

The clinical research studies on gaming identified were published between 1998 and 2015, most of which included patient samples. Categorizations identified in the research papers included: (i) patients’ characteristics (e.g., socio-demographics), (ii) criteria and measures used (e.g., scales to diagnose), (iii) types of gaming problems (e.g., game genre), (iv) and treatments (e.g., type of therapy).

Findings will be discussed against the background of the controversial IGD diagnostic criteria proposed in the DSM-5 in order to assess the extent to which previously published clinical knowledge matched the current proposal for including gaming addiction as behavioral addiction in the next diagnostic manual.

The authors have not supplied their declaration of competing interest.

A 25-year-old man was attended in multiple times at Emergency Department by referring abdominal pain and vomiting. No organic disease was found and he was referred to Psychiatric Emergency to assess him. He had history of cannabis use (4–5 times/day) during last 5 years. He referred recurrent episodes of abdominal pain and vomiting since 4 years ago, he had found that having hot showers alleviate his symptoms. Urine screening was positive for THC and negative for other drugs. In results of blood tests, abdominal X-ray, abdominal ultrasonography, abdominal tomography and fibrogastroscopy didn’t find any abnormality. He was diagnosed from suffering a somatoform disorder. Treatment with Setraline 50 mg/day was prescribed and cannabis abstinence was recommended. He was referred to Mental Health outpatient service. He maintained cannabis abstinence for 1 month and some symptoms disappeared. However, 2 months later, he relapsed in cannabis use and all symptoms reappeared. Later he achieved cannabis abstinence again and he got full recovery, then he was diagnosed from cannabinoid hyperemesis syndrome.

Cannabinoid hyperemesis syndrome is characterized by recurrent nausea, vomiting and colicky abdominal pain in patients with long-term cannabis use. These symptoms have been reported to be alleviated temporarily by taking a hot shower or more permanently by abstaining from the use of cannabis. The phenomenon of cannabinoid hyperemesis and clinical diagnosis remained obscure until recently. For this reason, it is necessary to take it into account in order to recognize it and help provide these patients early and better approach.

The authors have not supplied their declaration of competing interest.

It is well known that certain personality traits are more linked to drug abuse than others. Psychiatrists are more likely to emphasize the importance of impulsivity in the connection with substance disorders but in the following study we found an important percentage of patients that have a substance abuse were linked to anxiety through impulsiveness as a personality trait.

Most youths admitted for a substance abuse are highly impulsive. Our quest was to differentiate what component of impulsivity was more frequently linked to a substance use disorder.

In the study were included 50 patients admitted in the 3rd Psychiatric Clinic, Substance Dependences Department, Cluj-Napoca. For the identification of the drug abused we used the multitest screening kit in correlation with the results from the Forensic Medicine Institute of Cluj-Napoca. Each patient completed the Barratt Impulsivity Scale and the Swedish Universities Scales of Personality.

High scores on BIS-11 strongly correlated with attentional impulsiveness (Pearson's r correlation = .838) which means high inattention and cognitive instability this being linked with anxiety disorders. Cognitive Instability was correlated with Psychic Trait Anxiety (r = 0.29) and Motor Impulsiveness with Somatic Trait Anxiety (r = 0.3). Normal 0 false false false EN-US X-NONE X-NONE.

The underrecognized anxiety disorders in young adults whom are admitted for an addictive disorder prefrontal cortex is known to be the source of both impulsivity and could be linked to anxiety as well (valence asymmetry hypothesis). Normal 0 false false false EN-US X-NONE X-NONE.

The authors have not supplied their declaration of competing interest.

Range of drugs has largely increased the past few years, especially with the emergence of the New Psychoactive Substances (NPS) sold online. In front of serious risks they cause on human health, they are more and more regulated by the law.

To describe cases of extreme behavioral disorders and highlight risks of potential forensic complications linked to these consumptions.

We present a case series of serious auto or hetero-aggressive behavioral disorders related to NPS abuse and notified to the Parisian addictovigilance center.

Twenty cases were identified between 2010 and 2015. Users were exclusively men, with mean age of 35.5 years (min: 20, max: 51). Synthetic cathinones are the predominant class of reported NPS (65%). An association between NPS and sexuality is found in 60% of cases (12); among them cathinones are used by 11 men. We observed 6 deaths among which, 5 were associated to sexual practice. Two cases of consumptions of cathinones induced torture and barbarian acts. Concerning aggressive behavioral disorders, we quote 3 cases of hetero-aggressivity (one by stab wound and 2 others developed an hypersexuality ± exhibitionism) and 9 cases of auto-aggressivity characterized by genital mutilations (1), defenestration (3), suicidal attempt (3), and acute psychiatric disorder with endangering life (2). Only four cases have been confirmed by toxicological analysis.

Behavioral disorders inducing forensics complications exist with NPS and particularly with cathinones. The problematic is certainly undervalued. A collaboration between addictovigilance and forensic services has to be improved.

The authors have not supplied their declaration of competing interest.

Describe the distinguishing characteristics between patients with early onset of alcohol use (EARLY, age < 15) and late onset of alcohol use (LATE, age > 16), both affected of acute non-substance use psychiatric disorders (non-SUD) and any substance use disorder admitted in a dual diagnosis unit.

Data on demographic, family, and clinical factors were gathered among subjects admitted to our dual diagnosis unit along three years, all of them meeting DSM-IV criteria of any non-substance related Axis I or II disorder and comorbid substance use disorder (SUD). Statistical analysis was performed by using SPSS program.

We show results of 748 patients (437 of EARLY group and 311 of LATE group). Predominantly male (73,53%) with a mean age of 39,60 ± 9,7 years. Most prevalent non-SUD psychiatric disorders were psychotic disorder (39,97%) and personality disorder (39,30%). In our sample, most common substances of abuse were Alcohol (45,05%) and Cocaine (30,35%). EARLY patients had an earlier first contact all substances as well as an earlier age of problematic consumption of cocaine, alcohol, opioids and nicotine; they also had major prevalence of opioid SUD, sedatives SUD and amphetamines SUD (see Tables 1, 2 and 3).

Patients who began earlier their consumptions of alcohol had major prevalence of opioid, sedatives and amphetamine use. They also had earlier consumptions of other substances and earlier problematic consumptions of cocaine, alcohol, opioids and nicotine, what probably means greater severity of drug addiction in the long run.

The authors have not supplied their declaration of competing interest.

Changing cultural values and increasing economic stress are leading to initiation into substance use. Despite religious and legal constraints on Muslims against the consumption of drugs, drug addiction is a widespread problem and is destroying the lives of many individuals and families, in Tunisia.

To examine the socio-demographic characteristics of Tunisian addicts and to identify the drugs commonly used.

This was a cross-sectional study, which included 200 patients at the addiction treatment center “Aide et Ecoute” in Sfax (Tunisia). The survey was conducted during the month of January to September 2014.

Only males were found to get treatment in the addiction center for various addictions. The mean age was 33.32 years and the mean age for starting substance use was 17.30 years. More than half (65.9%) were not married and 59.5% had involvement with criminal justice. Substance dependence was commonly seen in poor and middle socioeconomic class. The most common substance used was buprenorphine (34.8%). There was a significant relation between buprenorphine consumption and immigration (P= 0.013). Peer pressure was one of the most important factors for trial of substance in our study.

As the mean age of initiation of substance abuse was early twenties, in liaison with schools and colleges, some recreational activities can be generated to prevent diversion of youth towards the devil of drug abuse.

The authors have not supplied their declaration of competing interest.

Zolpidem is a non-benzodiazepine hypnotic drug for treatment of insomnia and is generally believed that is a safe medication. Therefore has been introduced as a lower potential agent for dependency and abusive effects however its safety and dependence potential are of great concern.

A 63 years old male patient had consulted a general physician in January 2015 for his insomnia. He started on zolpidem 10 mg at bedtime. Over the next few months he had gradually increased the dose as he found the prescribed dose to be having no significant effect. After abrupt discontinuation of zolpidem, he presented to a center for drug users “AIDE ET ECOUTE” with severe anxiety, impatience, loss of energy, insomnia, irritability, headaches, and increased craving for higher dosage of zolpidem. There was no history of any other substance abuse and he was diagnosed simultaneously a case of zolpidem dependence and major depressive disorder.

Zolpidem has a potency to be abused with high risk of dependency and withdrawal syndromes particularly among elderly patients with comorbid anxiety and depressive disorders.

The authors have not supplied their declaration of competing interest.

Nalmefene may be helpful in the treatment of several other addictions by blocking the positive reinforcements of the drugs.

The authors have not supplied their declaration of competing interest.

Share psychotic disorder “folie à deux” is a rare condition characterized by the transmission of delusional aspects from a patient to another linked by a close relationship. We report the case of two Spanish men who have experienced a combined delusional episode induced by mephedrone.

Describe a case of share psychotic disorder induced by mephedrone. Make a review on scientific literature about the use of mephedrone (little is known about the psychiatric consequences of the use of these compounds). The patients had no psychiatric history.

Show the danger of these novel drugs that are often bought as apparently safe and legal.

Share psychotic disorder was first introduced by Lasegue and Falret who hypothesized that transmission of psychiatric disturbance from one person to another was possible under certain circumstances. The correlation of symptoms with the intake of these substances is supposed in the light of a negative psychiatric history and no other concomitant medical treatments. An important number of case reports documented deaths related to the ingestion of mephedrone. Another problem is that these substances are not detected by standard blood and urine test so that the diagnosis of intoxication is often delayed.

The authors have not supplied their declaration of competing interest.

The number of novel psychoactive substances (NPS) available is increasing. Synthetic cannabinoids (SC) are one of many NPS sold. SC aim to emulate the effects of natural cannabis by acting on cannabinoid receptors. Despite much research into pharmacology, there is limited data on the user experience of SC.

It is useful for psychiatrists, to understand what experiences people have whilst on illicit substances. The aim of this qualitative study is to gain an initial understanding of what characterizes the experiences of those who use SC.

Fourty anonymously written online reports were collected from the “Erowid experience vaults” and analysed using the Empirical Phenomenological Psychological Method.

The analysis yielded 488 meaning units (MU). These were grouped into 36 categories revealing 5 broad themes: (1) physical affects; (2) sensory distortions and distortions of perception; (3) emotional and psychological effects; (4) re-dosing, addiction and comedown effects; (5) similarities to other substances.

Synthetic cannabinoids have a mixed effect on users with a myriad of experiences reported. Some experienced positive results from their usage such as euphoria and relaxation, however these were counter balanced by those who experienced some serious negative emotional and physical side effects such as anxiety, paranoia, palpitations and convulsions. SC appear to often emulate that of their natural counterpart, yet there is an unpredictability to them which can end with serious consequences. Online forum content gives us a strong base understanding of users experiences of SC. Further research is required to elucidate a more nuanced understanding.

The authors have not supplied their declaration of competing interest.

Hallucinogen Persisting Perception Disorder (HPPD) is a syndrome characterized by prolonged or reoccurring perceptual symptoms, reminiscent of acute hallucinogen effects. HPPD was associated with a broader range of LSD (lysergic acid diethylamide)-like substances, including cannabis, MDMA (methylenedioxymethamphetamine), psilocybin, mescaline and other psychostimulants. Symptomatology mainly comprises visual disorders (i.e., geometric pseudo-hallucinations, halos, flashes of colours/lights, motion-perception deficits, afterimages, micropsy, more acute awareness of floaters, etc.), even though depressive symptoms and thought disorders may be comorbidly present.

Although HPPD was firstly described in 1954, it was definitely established as a syndrome in 2000 with the revised forth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). However, neuronal substrate, risk factors, aetiology and pathogenesis of HPPD remains still unknown and under investigation. Furthermore, there are still open questions about its pharmacological targets.

A critical review on psychopathological bases, etiological hypothesis and psychopharmacological approaches towards HPPD was here provided.

A systematic literature search on PubMed/Medline, GoogleScholar and Scopus databases without time restrictions, by using a specific set of keywords was here carried out. In addition, a case report was here described.

Pharmacological and clinical issues are here considered and practical psychopharmacological recommendations and clinical guidelines here suggested.

The authors have not supplied their declaration of competing interest.

Dandy Walker “syndrome” (DWS) was firstly defined by Dandy and Blackfan, and then described by Hart et al. [1] as a series of neurodevelopmental anomalies in the posterior fossa, including Dandy-Walker (DW) malformation, DW variant (cerebellar hypoplasia/aplasia of the cerebellar vermis and cystic dilatation of the fourth ventricle), mega-cisterna magna and posterior fossa arachnoid cyst. Mental symptoms have been associated with DWS in previous reports, but the spectrum of mental symptomatology widely varies between clinical cases, ranging from psychotic/schizophrenia-like to mood/cognitive symptoms [2].

Here we describe a case of psychosis and polydrug abuse in a 27-year-old man with DW variant a 4-year history of polydrug abuse, sporadic alcohol abuse, epilepsy and psychotic symptoms including delusions of reference/persecution, suspiciousness, associated with obsessive thoughts, mood lability and persistent anxiety.

He was recovered for a 28-day program of detoxification from drug addiction/stabilization of psychiatric symptoms. Family history of Bipolar Disorder, gambling disorder (father) and depression (mother). The mental status examination at baseline revealed slowness of thought, psychomotor retardation, aboulia/anhedonia/apathy/hypomimic facies/asthenia/social withdrawal/deflected mood/poor thought content/blunted affect/self-neglect/poor insight, cognitive impairment and oppositive and partially collaborative attitude and behaviour. Borderline intelligence activity was found on WAIS-R (IQ = 79). At the baseline, he was taking carbamazepine 400 mg BID (baseline serum level: 6.720 μg/ml), gabapentin (400 mg BID), paroxetine (20 mg/d), olanzapine (10 mg/d) and methadone (70 ml/d), with a poor response/control both on psychotic and seeking drug symptomatology.

References not available.

Further DWS clinical cases should be evaluated in order to better investigate the role of this variant to addictive and psychotic symptoms.

The authors have not supplied their declaration of competing interest.

The Norwegian Municipal Health Care Act opens for mandated treatment for persons with severe and life-threatening substance use disorder. This study aims to examine substance use related outcomes at six-month following in-patient treatment and to analyse factors associated with improved outcomes and abstinence.

This prospective study followed 202 hospitalised patients with SUD that were admitted voluntarily (n = 137) or compulsorily (n = 65). The European Addiction Severity Index was used at baseline and at follow-up to assess socio-demographics and substance use variables. Regression analysis was conducted to investigate factors associated with abstinence at six-month follow-up.

The frequency of use of preferred substance showed markedly improvement for both voluntary admitted (VA) and compulsory admitted (CA) patients (61% and 37% respectively) at follow-up. Seventy-five percent of VA patients using amphetamine reported improvement compared to 53% of CA patients. At follow-up, the CA group continued to have a higher rate of injection use. The CA group had experienced higher rates of overdose the past six months and lower abstinence rates (24% versus 50%) at follow-up. Lower severity of drug use at intake (non-injection drug use), voluntary treatment modality and higher treatment involvement during follow-up all were significant factors associated with abstinence at follow-up.

Voluntary treatment for SUD generally yielded better outcomes; nevertheless we found improved outcomes also for CA patients. It is important to keep in mind that the alternative to CA treatment in reality is no treatment at all and instead a continuation of life-threatening drug use behaviours.

The authors have not supplied their declaration of competing interest.

Although psychiatric diagnosis is based on the clinical features and the exclusion of associated medical conditions, in this case the workup provided support to our clinical suspicion, favouring recognition of the problem and willingness to treatment by the patient.

The authors have not supplied their declaration of competing interest.