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Cannabis and synthetic cannabinoids (SC) are related to several neuropsychiatric symptoms and disorders, especially psychotic symptoms and disorders. Interestingly, catatonia-like symptoms associated with cannabis and SC have been generally neglected in research and scarcely described despite the clinical repercussions. Hence, this review aims to analyze current clinical publications on catatonia induced by cannabis or SC in a systematized way.

Alexithymia is highly prevalent in patients with substance use disorders (SUDs) and has been implied in SUD pathogenesis and treatment outcomes. However, the psychometric properties of the most-used instrument for evaluating alexithymia (the 20-item Toronto Alexithymia Scale, TAS-20) have been scarcely studied in relation to SUD patients.

Objective: The objective of this study was to compare psychiatric comorbidity and consumption-related variables in ADHD patients seeking treatment for cocaine, cannabis, or both. Method: Assessment was conducted using European Addiction Severity Index (EuropASI), Conners’ Adult ADHD Diagnostic Interview (CAADID), Structured Clinical Interview for DSM Disorders (SCID), Adult Self-Report Scale (ASRS), Wender Utah Rating Scale (WURS), Barratt Impulsiveness Scale-11 (BIS-11), and FIDI, with statistical analyses of analysis of variance (ANOVA), Student’s t test, chi-square test, and multinomial regression model. Results: In total, 1,538 patients with substance use disorder (SUD) were evaluated for ADHD; 239 (15.5%) had ADHD, with cannabis 41, cannabis/cocaine 36, and cocaine 74. Men represented 80%, with mean age of 32.9 ± 10 years. Significant variables were—in bivariate analysis—more years of cannabis use in cannabis group and younger age for cocaine use disorder in cannabis/cocaine group, and—in multivariate analysis—lifetime anxiety disorder and younger age at onset of any SUD in cannabis group and working affected scale in cannabis and polysubstance use in cannabis/cocaine group. Conclusion: Groups with cannabis use had higher severity. ADHD features were similar in all groups. The assessment of ADHD and comorbid disorders is important.

Background: Hepatitis C virus (HCV) management is a challenge in patients with substance use disorder (SUD). This study aimed to describe an HCV screening and linkage to care program in SUD patients, and analyze the characteristics of this population in relation to HCV infection, particularly the impact of psychiatric comorbidities (dual diagnosis). Methods: This study was a prospective clinical cohort study using a collaborative, multidisciplinary model to offer HCV care (screening, diagnosis, and therapy) to individuals with SUD attending a dedicated hospital clinic. The characteristics of the participants, prevalence of HCV infection, percentage who started therapy, and adherence to treatment were compared according to the patients’ consumption characteristics and presence of dual diagnosis. HCV screening, diagnosis, treatment initiation, and sustained virologic response were analyzed. Results: 528 individuals attended the center (November 2018–June 2019) and 401 (76%) accepted screening. In total, 112 (28%) were anti-HCV-positive and 42 (10%) had detectable HCV RNA, but only 20 of the latter started HCV therapy. Among the 253 (63%) patients with a dual diagnosis, there were no differences in HCV infection prevalence versus patients with SUD alone ( p = 0.28). Dual diagnosis did not lead to a higher risk of HCV infection or interfere with linkage to care or treatment. Conclusion: This study found a high prevalence of dual diagnosis and HCV infection in SUD patients, but dual diagnosis was not associated with an increased risk of acquiring HCV or more complex access to care. Despite use of a multidisciplinary management approach, considerable barriers to HCV care remain in this population that would need more specific focus.

Introduction The impact of psychiatric comorbidity and addiction features throughout the course of addiction has been widely studied. This is a naturalistic study conducted in an outpatient unit, where treatment follow-up studies are scarce compared to studies including inpatients or those under experimental conditions. Therefore, this follow-up study aims to analyze the treatment adherence and abstinence of outpatients with SUD (Substance Use Disorders) according to addiction severity and psychiatric comorbidity. Methods The current six-month follow-up study examined 404 SUD outpatients. Psychiatric comorbidity, addiction severity, substance consumption and treatment adherence were systematically evaluated using semistructured interviews. Survival analyses were conducted to compare the time of treatment adherence and abstinence in a bivariate and multivariate level. Results A progressive dropout was observed, reaching 32.2% of dropouts at the six-month follow-up. More than 50% achieved abstinence during the first month and similar percentages were found until the six-month follow-up. At the multivariate level, treatment adherence, cannabis use disorder and polyconsumption were independently associated with earlier dropout. ADHD was the only mental disorder significantly related with dropout. Regarding substance consumption, the time of abstinence was independently associated with months of treatment adherence and the achievement of abstinence before starting treatment. In general, dual diagnosis was associated with less time of abstinence, but only depressive disorder across the lifespan was related to less time of abstinence in the multivariate model. Conclusion These findings highlight the importance of an accurate diagnosis at the beginning of treatment, especially in an outpatient setting, addressing the treatment needs and promoting strategies that improve treatment adherence and reduce the risk of relapses.

Quinolones are an antibiotic group widely used due to their antimicrobial action and security profile, however, it has been described neuropsychiatric adverse effects, being induced-psychotic episodes one of the most clinically relevant. Nevertheless, this secondary effect has been scarcely studied. A literature search using PRISMA guidelines was performed between 01/01/1962 and 01/31/2019 on PubMed and ScienceDirect, including manuscripts which described substance-induced psychotic disorder according to DSM-5 and in which the symptomatology was not attributable to an acute confusional state (delirium) or to other induced psychiatric disorders. 459 articles were found, but only 27 manuscripts fulfilled inclusion criteria (n=27 patients, median age of 36.15±16.96 years). Ciprofloxacin, levofloxacin and ofloxacin were the main antibiotics implicated. Quinolone- induced psychosis is a clinical relevant issue due to the high prescription of these antibiotics and the severity of this clinical syndrome. In general, this syndrome can remit in a few days with the withdrawal of the quinolone and performing symptomatic support if it is necessary. Finally, it is important to perform further research on this issue. Keywords: Quinolones, Psychosis, Ciprofloxacin, Levofloxacinn, Psychotic Induced.

IntroductionPatients with substance use disorders (SUD) have higher alexithymia levels and present frequently suicidal ideation (SI) and suicide (SA) [1,2]. Beside, alexithymia has been related to suicidal behaviors in several psychiatric disorders[3]. Although, there are some studies on alexithymia and suicidality in SUD patients, to our knowledge there are no studies on this issue in Spanish population.ObjectivesTo compare the alexithymia levels in SUD patients with and without SI and SA in an outpatient addiction treatment center in Spain.MethodsThis is a cross-sectional study performed on 110 patients (74.3%males; mean age 43.6±14.5years old) for whom we had information from the Toronto Alexithymia Scale(TAS-20) and the presence or not of lifetime SI and SA.ResultsLifetime SI and SA were present in 55.5% and 35.5% of the sample respectively. The mean score of TAS-20, difficulties identifying feelings (DIF), difficulties describing feelings (DDT), and externally-oriented thinking(EOT) were 57.2±13.3, 20.0±7.0, 14.7±4.5, and 22.5±4.5 respectively.ConclusionsSI and SA may be related to alexithymia levels. Hence, alexithymia should be further analyzed in SUD patients in longitudinal studies in order to analyze the bilateral association with suicidal spectrum behaviors. REFERENCES Rodríguez-Cintas L, et al. Factors associated with lifetime suicidal ideation and suicide attempts in outpatients with substance use disorders. Psychiatry Res. 2018;262:440-5. Morie KP, et al. Alexithymia and Addiction: A Review and Preliminary Data Suggesting Neurobiological Links to Reward/Loss Processing. Curr Addict Rep. 2016;3(2):239-48. Hemming L, et al. A systematic review and meta-analysis of the association between alexithymia and suicide ideation and behaviour. J Affect Disord. 2019;254:34-48.

OBJETIVOS Analizar diferencias sociodemográficas y clínicas entre consumo de cocaína vs. speedball (cocaína+heroína) en pacientes de una sala de consumo de drogas inyectadas. MÉTODOS Estudio transversal realizado en una sala de consumo de drogas inyectadas admnistrándose una entrevista semiestructarada a todos los pacientes. Se recogían datos sociodemográficos y clínicos, haciendo énfasis en diferencias entre el consumo de cocaína o de speedball y en síntomas de la esfera psicótica. RESULTADOS Hubo 1111 usos de la sala que se relacionaban con uso de cocaína o de speedball, el 89.8% fueron hombres. La edad promedio fue 40.47±5.33. Las diferencias entre uso de cocaína y de speedball se relacionaban principalmente con: sexo (p

Introducción Hay pocos estudios sobre uso de antipsicóticos en pacientes que presentan trastornos psicóticos y uso de sustancias comórbidos (psicosis duales) a pesar de ser una presentación frecuente en los centros de atención de estos pacientes (1). En relación a antipsicóticos modernos, la literatura científica es escasa a pesar que los nuevos antipsicóticos (como la cariprazina) tienen perfiles prometedores en el manejo de psicosis duales. Objetivos Se describe una serie de casos de pacientes con trastornos psicóticos y uso de sustancias asociados a quienes se les ha prescrito cariprazina. Métodos Series de casos Resultados 7 casos con una edad media de 38.719.32 años. La cariprazina fue prescrita en todos los casos para manejo de síntomas psicóticos o por presencia de síntomas extrapiramidales secundarios a otros antipsicóticos. En general hubo buena tolerancia, un caso tuvo acatisia y otro caso tuvo náuseas y cefalea. La dosis media de cariprazina fue 3.640.80. En relación al uso de sustancias, parece no aumentar el consumo de sustancias, y al contrario algunos casos disminuyeron o llegaron a abstinencia. Conclusiones La cariprazina parece eficaz en el manejo de síntomas psicóticos en pacientes con trastornos psicóticos duales. Asimismo, parece tener utilidad clínica en el manejo del consumo de sustancias. Aún así, es necesario más investigación. 1. Beckmann D et al. Substance-induced Psychosis in Youth. Child Adolesc Psychiatr Clin N Am. 2020;29(1):131-143. doi: 10.1016/j.chc.2019.08.006.

Objetivos: Estudiar las diferencias en la gravedad de la adicción, variables clínicas y afectación en la calidad de vida en personas con Trastorno por Consumo de Cannabis en función de si presentan o no un Trastorno de Ansiedad comórbido. Métodos y materiales: Se realizó una evaluación psicológica completa siguiendo un protocolo estandarizado a los pacientes que acudieron a tratamiento al CAS Vall d’Hebron. Se evaluó la presencia de Trastorno por Consumo de Cannabis y Trastorno de Ansiedad mediante la entrevista diagnóstica SCID-I. Se recogieron variables sociodemográficas y se evaluó la gravedad de la adicción (EuropASI) y variables clínicas mediante cuestionarios autoaplicados (BDI, STAI, SF-36, Barrat y FIDI). Resultados: 446 pacientes fueron diagnosticados de Trastorno por Consumo de Cannabis de los cuales 53 (11.8%) cumplieron criterios para Trastorno de Ansiedad en el momento de la evaluación. En relación a la gravedad de la adicción, se observaron diferencias significativas en las áreas familiar y psicológica, presentando una mayor gravedad los pacientes con Trastorno de Ansiedad. Asimismo, los pacientes con Trastorno de Ansiedad presentaron mayor deterioro en el componente mental de la calidad de vida que los pacientes sin Trastorno de Ansiedad. Por otro lado, los pacientes sin Trastorno de Ansiedad presentaron significativamente más síntomas depresivos. Conclusiones: La presencia de un Trastorno de Ansiedad comórbido al Trastorno por Consumo de Cannabis se relaciona con una mayor gravedad a nivel psicológico y familiar y una mayor repercusión en el componente mental de la calidad de vida del paciente. Se sugiere realizar investigaciones futuras longitudinales para estudiar la evolución.

INTRODUCTION Impulsivity and Alexithymia are related to substance use disorders (SUD) as risk factors (1,2), several cognitive skills are implied in both traits (1,2). However, few researches are published on their mutual relationship in SUD patients. OBJECTIVES To describe the correlations between alexithymia and impulsivity in SUD patients. METHODS Patients with SUD (according to DSM-5) were evaluated with invited to participate in an addiction treatment Ad-Hoc questionnaire, Toronto Alexithymia Scale-20 (TAS-20), Barratt impulsivity scales (BIS-11) and Dickamn functional dysfunctional impulsivity scale (FIDI) were performed in all patients. RESULTS 93 patients completed the full evaluation, the total score of TAS-20 was significantly related to total scores of BIS-11 and FIDI. Analyzing subscales, Difficulty Describing Feelings subscale describe better the association between total TAS-20 scores and impulsivity, and it may be the link between dysfunctional impulsivity and alexithymia. Externally-Oriented Thinking subscale was fewer correlated to any BIS-11 factor compared to the other subscales of TAS-20. Interestingly, cognitive impulsivity is not related to total TAS-20 scores and the TAS-20 subscales. CONCLUSIONS Alexythimia and impulsivity are related in SUD (especially some subfactors are better associated), and hence these relations should be considered when conducting therapeutic approaches. REFERENCIAS 1. Morie KP, Yip SW, Nich C, Hunkele K, Carroll KM, Potenza MN. Alexithymia and Addiction: A Review and Preliminary Data Suggesting Neurobiological Links to Reward/Loss Processing. Curr Addict Rep. 2016;3(2):239-248 2. Shishido H, Gaher RM, Simons JS. I don't know how I feel, therefore I act: alexithymia, urgency, and alcohol problems. Addict Behav. 2013;38(4):2014-7. doi: 10.1016/j.addbeh.2012.12.014.

Alexithymia is related to a higher severity of substance use disorders (SUD); however, few longitudinal studies have been performed on how alexithymia impacts treatment outcomes. This study aims to evaluate alexithymia as a factor that could influence retention and the time of the first relapse in a one-year follow-up in an outpatient treatment center for SUD. In total, 126 SUD outpatients (74.60% males; M age = 43.71, SD = 14.61 years) were evaluated at baseline with an AdHoc questionnaire for sociodemographic variables, the European Addiction Severity Index (EuropASI), the Semi-structured Clinical Interview for Axis I and Axis II Disorders of the DSM-IV, and the Toronto Alexithymia Scale (TAS-20). The prevalence of alexithymia was 41.3% and the mean score of TAS-20, was 57.27 (SD = 12.84). At baseline, alexithymia was related to a lower education level, cannabis use disorder, the psychological item of EuropASI, and mood spectrum disorders. In the Kaplan-Meier analysis, SUD patients with alexithymia were in treatment for less time and presented earlier relapses than non-alexithymic patients. In the Cox regression, alexithymia was only associated with less time in treatment. Therefore, alexithymia may have an important role in the outcomes of SUD treatment, and hence, therapeutic approaches for SUD that cover emotional impairments associated with alexithymia should be investigated and developed.

Psychiatric comorbidity can negatively impact the course of addictions. Psychiatric features of patients who continued treatment after the first stage of an addiction program have not been sufficiently analysed. Therefore, only these patients were included in order to compare psychiatric comorbidity and clinical factors between patients who were able or not to complete a long term substance-free program. Treatment-completion status of 245 patients was systematically recorded. Addiction severity, psychiatry comorbidity, and psychological symptoms were evaluated. No significant differences were found regarding comorbid psychiatric diagnoses and the completion of the treatment. Longer treatment duration (OR: 1.22; p 0.01), higher educational level (OR: 2.37; p = 0.02), and cocaine dependence as main substance (OR: 3.68; p 0.01) were found to be related to increased likelihood in completing the treatment. Patients with higher severity of alcohol consumption (OR: 0.06; p = 0.02) and more depressive symptoms (OR: 0.95; p = 0.01) completed the treatment less frequently. Moreover, differences regarding employment problems, treatment facilities, anxiety symptoms, dysfunctional impulsivity, and mental HRQoL were found. It is concluded that comorbid psychiatric diagnoses do not determine treatment outcomes. However, therapeutic and psychological factors have a major influence on the likelihood to complete a long-term treatment program.