The motivation of the patient may affect response to treatment and prognosis.

The objective of this study was to compare the various types of application of patients in terms of their motivation and sociodemographic variables.

To demonstrate that patients who apply for treatment themselves have greater motivation and less depression and anxiety.

Patients who applied or were referred for treatment of addiction to the Elazig Hospital for Mental Disorders were included in this study. Patients diagnosed according to DSM-IV criteria, giving written informed consent and who did not have severe comorbid psychopathology were enrolled. Beck Depression and Anxiety Scales, and Motivation for Treatment Scale (MfT) were used in evaluation. p was set at 0.05.

Forty five male patients with a mean age of 37.9 (S.D. 11.2) were enrolled in the study. The mean scores for Beck Depression and Anxiety Scales and the Motivation for Treatment Scale were 27.7 (S.D. 12.8), 25.2 (S.D. 15.2) and 67.4 (S.D. 11.4); respectively. When the socio-demographic and clinical variables of the patients who applied voluntarily and those who were referred for treatment involuntarily were compared by Mann-Whitney U test, only the total score on the Motivation for Treatment Scale as well as those of its subscales for seeking help and being ready for treatment differed betwen groups (p: 0.01, 0.05 and 0.01; respectively).

Types of application for treatment may affect levels of motivation in patients for treatment. Techniques for motivational interview may especially be important for patients applying involuntarily.

Identification of clinical differences of formation and prognosis of severity of associated forms of alcoholism in relevant variants of co-morbid brain impairment.

With clinical-psychopathological method we examined inpatient samples with stage 2 alcoholism with co-morbid traumatic (group I, n = 105); hypertensive (group II, n = 45) and vertebrogenic (spinal cord artery syndrome) (group III, n = 37) brain impairment. Control - 30 patients with alcoholism without co-morbid pathology.

In group I alcoholism is forming at early age in persons with pre-morbidly problematic social adaptation - in 62,2% conditioned by presence of excitable traits of the character. Dominance of dysphoria in intoxication and in alcohol withdrawal syndrome (AWS) predetermines formation of psychopath-like degradation with total and persistent social disadaptation. Beyond AWS, reactive lability, lingering asthenic-sub-depressive states with inclusion of dysphoric, hysteric-excitable components remain during low quality of remission. In group II later formation of alcoholism in 26,7% of cases was preceded by psychodisadaptive disturbances conditioned by pre-morbidly anxious constitution of personality. In structure of AWS anxious-phobic modality of depressive disorders against the background of cardiovascular manifestations of toxicogenic effects of ethanol determines development of torpid asthenic-depressive states (with cardiophobic and hypochondriac components). For patients from group III we have identified intermediary tempo of increasing of progression of alcoholism with obligate diencephalic psychovegetative, psychosensory and severe psychoorganic cognitive disorders against the background of asthenic, more seldom dysphoric variants of change of the personality.

Prognosis of associated forms of alcoholism is various in distinguished variants (traumatic, hypertensive, vertebrogenic) comorbid brain impairment.

The effect of pharmacotherapy of substance-related disorders is moderate at best.

Therapeutic drug monitoring (TDM) could be an instrument to improve the outcomes. TDM is for most of these drugs not established yet.

The authors built a literature based rating scale to evaluate the necessity of TDM for these pharmacological agents.

A literature research was performed for TDM related properties of acamprosate, bupropion, buprenorphine, clomethiazole, disulfiram, methadone, naltrexone, and varenicline. A rating scale was established for evaluation. It included 28 items related to five categories (efficacy, toxicity, pharmacokinetics, patient characteristics and cost effectiveness). For comparison, three reference substances with established TDM were similarly assessed: clozapine, lithium and nortriptyline.

The three reference substances, lithium, clozapine and nortriptyline, achieved scores of 15, 18, and 14 points, respectively. Rating of methadone (19 points), bupropion (14 points), buprenorphine (14 points), disulfiram (13) and naltrexone (12 points in the indication opioid-dependency and 10 points in the indication alcohol dependency) achieved more than 30% of the reachable points, whereas acamprosate (9 points), clomethiazole (9 points), and varenicline (5 points) had fewer points especially in the main characteristics in favor of TDM.

These results suggest this rating scale is sensitive to detect the appropriateness of TDM for drug treatment. Literature based rating and clinical experience give evidence that TDM has the potential to optimize the pharmacotherapy of substance related-disorders with different rank orders of the single substances.

To evaluate, in a sample of pathological gamblers, the effects of personality traits and psychiatric comorbidity on the severity of this condition.

40 patients were evaluated with the following instruments: EuropASI, modified for pathological gambling; MINI; TCI, and BIS-11. Univariate linear regression analyses were conducted to evaluate the relationships between different scales.

Age of onset was influenced by Novelty Seeking and NS-1 subscale, with higher scores related to earlier onset, Harm Avoidance 2 subscale, with higher scores related to a later onset; the presence of a lifetime panic disorder was related with a later onset; A positive correlation was found between age of onset of pathological gambling and both cigarette and cannabis smoking. Higher NS1 scores were related to a higher amount of money spent during the last month, while higher scores on the HA2 and Cooperativeness 5 subscales were related to a lesser number of days in which the patient had gambled during the last month. Moreover, higher scores in Gambling severity scores are related with the presence of a comorbid alcohol or substance abuse or dependence, dysthymia, post traumatic stress disorder, bipolar II mood disorder, and with higher BIS-11 Motor Impulsiveness, Non-planned Impulsiveness and total scores.

Personality traits and psychiatric comorbidity influence the age of onset of gambling, the severity of gambling and the functional and economic impact of the disease on the patient’s life. An evaluation of these aspects is needed to determine treatment options with a greater understanding of the phenomenon.

Individuals who grow up in alcoholic families seem to have a family environment and climate different from those who grow up in non alcoholic families.

Data on expressed emotion and parental attitudes in alcoholic family are lacking.

Study the level of expressed emotion and the parental attitudes in children of alcoholics (COAs) compared with children of non alcoholics (non COAs).

The Level of Expressed Emotion Scale (LEES) and the Parental Attitudes Scale (PAD) were used to measure respectively the expressed emotion and the family climate. The LEES was filled by the COAs or by the non COAs; the PAD was filled by their significant parent. COAs and non COAs were matched for age and gender.

COAs perceived a statistically lower level of intrusiveness from their parents and a significantly higher emotional response and attitudes toward illness from their parents than non COAs. According to the PAD, there was no difference in the family climate between the two groups. When correlations between LEES and PAD were evaluated, among COAs high level of expressed tolerance (LEES tolerance/expectation subscale) was significantly correlated with a low dominance in the children (PAD Dominance/Submissiveness); among controls, high level of expressed emotion (LEES total score) was significantly correlated with lower pleasure in the children (PAD Pleasure/Displeasure subscale).

COAs and non COAs seem to perceive the emotion expressed in their family environment differently and correlate it with their parental attitudes according to a different pattern.

evaluation of medical consequences of intoxication with spice plants (Bonsai, “magic charge”, “mariciuca”, Salvia divinorum, Mitragina speciosa and others). The precise composition of substance used was not clear but the known drugs were excluded. Material and method: all patients with diagnosis of intoxication of spice plants, admitted for at least 24 hours in Department of Drug Dependence, in a 3 months period, in 2010 were evaluated, not only concerning psychiatric psychopathology but also for other medical symptoms or diseases.

We excluded the patients who have used other known drugs, and had positive results in blood and urine analysis. 17 patients used spice plants associate with alcohol less then 0.5%0, coffee or tobacco, 7 patients used only spice plants. The cardiovascular symptoms were present in 53%, gastrointestinal symptoms in 73%, neurological symptoms in 53%, renal symptoms 5%. We verified the personal history of diseases and also co-morbid acute diseases. Psychiatric symptoms were characteristic to substance induced psychotic disorders.

This study wanted to define and underline the specificity of clinical presentation of intoxication with spice plants, being useful to be known in emergency settings. These medical implications of use of this legal spice plants should also involve community, administrative or political actions for prevention of these medical consequences.

Suicide is a major and preventable public health problem. Risk factors may vary with age, gender, or ethnic group, being substance abuse one of the most frequent.

To investigate the relation of substance related disorder and suicide attempt.

Review of the suicidal attempts of patients with personal history of substance related disorder attended during the year 2010.

We identified 85 cases.

Alcohol (64″3%) and cocaine (47″7%) were the two most identified substances. Cannabis (17″2%) and heroin (23″06%) were less consumed. Benzodiacepines abuse was very frequent among the patients attended (38″2%).

Previous attempts were found in 43″8% of the patients.

Drug overdose was the most commonly method used (98″4%), especially with benzodiacepines and antidepressants, but non psychiatric drugs were also frequent. Substance overdosage or intoxication was the second most frequent method used (23%), and poisoning the third (9%). Most of times these methods were presented with concomitant drug overdose.

Defenestration threats were very rare (2″34%), and always associated with hospitalization request by the patient.

We did find significant differences when studying triggers (family, partnership, economical or others) compared with non substance abusers suicidal attempts.

• - Chronic substance misuse and acute substance abuse is associated with a higher risk of suicide, what may be explained by the disinhibiting effects of psychoactive substances.

• - As benzodiazepine misuse is associated with suicide, special care must be taken when prescribing to at risk patients such as substance abusers