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Introduction: At present in the province of Salamanca, there is no outpatient program focused on dual pathology. There is a perceived need of attention to those patients who present a serious mental disorder and a substance use disorder. Objectives: In accordance with the recommendations of the scientific evidence of recent years, we propose the creation of a specific healthcare resource within the framework of the University of Salamanca Health Complex. Methods: The dual pathology outpatient program sits (image 1) on the second level of the assistance system and follows the indications of the IV Mental Health Plan of the Regional Ministry of Health. It is intended to be a bridge between the two usual lines of assistance (image 2): mental health network and drug dependence network. It will offer a multidisciplinary and integrated approach from a biopsychosocial perspective. It will focus on diagnosis, differential diagnosis, psychopharmacological and psychotherapeutic approach, nursing care and psychometry. In addition, the dual pathology outpatient program aims to be a training area for service professionals and the basis for promoting research activity focused on dual pathology. A previous training and coordination program has been carried out with the different resources of both networks. A pilot project is proposed, building a therapeutic team consisting of a psychiatrist, two clinical psychologists, two nurses, a social worker and two social educators. Results: The first clinical results are presented. Conclusions: This new program results from the effort to improve care for patients with dual pathology. More experience in this area is necessary. [ABSTRACT FROM AUTHOR]

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Patients diagnosed with schizophrenia are at least three times more likely to develop a substance use disorder than controls. These patients are frequently prescribed benzodiacepines as a coadjuvant drug, which have a high potential for addiction. We performed a literature review aiming to gather evidence on various topics concerning the use of benzodiacepines in schizophrenia, with a focus on possible abuse: 1) Prevalence of prescripted and non-prescripted benzodiacepine use among patients, 2) Prevalence of abusers, 3) Effects of long-term benzodiacepine abuse in schizophrenia prognosis, 4) Possible management strategies for benzodiacepine abuse in this population. Our search revealed there is a high variability (up to 20%) in benzodiacepine abuse among patients, with cannabis and stimulants being more frequent, and no clear demographic traits have been identified among these patients. Patients with affective symptoms are more likely to abuse benzodiazepines. Its long-term effects on prognosis have been debated, with some papers hinting at a higher mortality rate. Tapering benzodiacepines has been associated with an improvement in some cognitive functions. Management strategies for potential abuse do not differ greatly for this population, and no specific pharmacological aid can be indicated, but an integral approach is proposed., Competing Interests: Declaration of Competing Interest Dr. Carlos Roncero has received fees to give lectures from Janssen-Cilag, Ferrer-Brainfarma, Pfizer, Indivior, Lundbeck, Otsuka, Servier, GSK, Rovi, Astra, Gilead, MSD, Sanofi, and Exceltis. He has received financial compensation for his participation as a board member of the Janssen-Ci-lag, Lundbeck, Gilead, MSD, Mundipharm, INDIVIOR, Exceltis, and Martindale board. He has participated in the PROTEUS project, which was funded by a grant from Reckitt-Benckisert/Indivior. He received two medical education grants by Gilead. Dr. Nerea M. Casado-Espada has received an economic award from Janssen in an oral communication contest. The other authors do not have any conflict of interest for this research., (Copyright © 2019 Elsevier B.V. All rights reserved.)