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Knocking on the Doors of Perception: the role of psilocybin in substance use disorder treatment
- R. Sousa, L. Costa, J. Brás, R. Vaz, J. Martins, J. Abreu, E. Almeida, N. Castro, R. Andrade, N. Cunha
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, p. S270
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Introduction
Substance use disorders(SUDs) are a major health concern and current treatment interventions have proven only limited success. Despite increasing effectiveness, still about 50–60% relapse within 6–12 months after treatment [Cornelius et al., Addict Behav. 2003;28 381-386]. SUDs are defined as chronic disorders of brain reward system, motivation, and memory processes that have gone awry. Medication reducing craving and substance use is mainly available for alcohol dependence and to a lesser extent for other substances.
Hallucinogens may represent a group of agents with potential anti-craving properties subsequently reducing substance use in SUD patients. For instance, lysergic acid diethylamide(LSD) and psilocybin have previously been shown to effectively alleviate symptoms of alcohol and nicotine dependence.
ObjectivesNew treatments preferably focusing on reducing craving and subsequent substance use are therefore urgently needed. The hallucinogen psilocybin may provide a new treatment option for SUD patients, given the beneficial results observed in recent studies
MethodsSystematic revision of literature.
ResultsIn the 1950s, a group of drugs with potential to alter consciousness were discovered (hallucinogens). Several studies suggested their anti-SUD potential, improving self-acceptance and interpersonal relationships, reducing craving and alcohol use. As a result of its recreational popularity during the 1960s, they were banned in 1967, greatly hampering scientific research in this field. Recently, psilocybin, an hallucinogenic substance in psilocybin-containing mushrooms has gained popularity in neuropsychological research, showing to increase trait openness, cognitive and behavioral flexibility, and ratings of positive attitude, mood, social effects, and behavior and even reported persistent positive changes in attitude and behavior. These findings might suggest a valuable compound for the treatment of psychiatric conditions with several additional studies providing supportive evidence for the therapeutic potential of psilocybin for SUD treatment and relapse prevention.
ConclusionsWith the reported limited amount of side effects and potential beneficial effects of psilocybin in SUD, there are valid reasons to further investigate the therapeutic efficacy and safety of psilocybin as a potential SUD treatment. On the one hand, psilocybin may exert its anti-addictive properties by beneficial effects on negative emotional states and stress. On the other hand, psilocybin may improve cognitive inflexibility and compulsivity. Research on the efficacy of psilocybin on SUD is still limited to a handful of published studies to date. As a result, many important questions related to the use of psilocybin as a complement to current treatment of SUD and its working mechanisms remain unanswered. Before psilocybin can be implemented as a treatment option for SUD, more extensive research is needed.
Disclosure of InterestNone Declared
Suicidality among inpatients - Right under our noses
- A. S. Morais, F. Martins, V. Henriques, P. Casimiro, N. Descalço, R. Diniz Gomes, N. Cunha e Costa, S. Cruz
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- Journal:
- European Psychiatry / Volume 66 / Issue S1 / March 2023
- Published online by Cambridge University Press:
- 19 July 2023, pp. S1106-S1107
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Introduction
An inpatient suicide is a tragic event that, despite not very prevalent, should not be overlooked. It occurs in 250 in 100 000 psychiatric hospital admissions (which represents a suicide risk fifteen times greater than general population) and in 1.7-1.9 in 100 000 in general hospitals (4-5 times greater risk). Together they constitute 5-6% of all suicides.
ObjectivesThe purpose of the authors is to explore the epidemiology, the risk factors and the prevention of suicide in inpatient setting.
MethodsA brief non-systematized review is presented, using the literature available on PubMed and Google Scholar.
ResultsThe risk was higher at admission (first week) and immediately after discharge (first 24 hours, up to two weeks).
It was found to be correlated to pour staffing, an increased number of patients with severe mental illnesses and accessibility to lethal means. Many risk factors were identified, some of them specific to context. Risk Factors at admission in a psychiatric hospital – personal or familiar suicide history, schizophrenia or mood disorder, alcohol use, involuntary admission, living alone, absence from the service without permission. Later till discharge - personal suicide history (or attempts after admission), relational conflicts, unemployment, living alone, lack of discharge planning and lack of contact in the immediate post-discharge period. In General Hospitals – chronicity and severity of somatic disease, poor coping strategies, psychiatric comorbidities and lack of liaison psychiatry.
Strategies to prevent inpatient suicide should take in environmental modification (specific to environment and specific to patient – as planned levels of supervision), optimisation of the care of the patients at suicidal risk, staff education and involvement of families in care. There are few studies on the efficacy of pharmacotherapy on reducing suicidal ideation in inpatients (just for clozapine and ketamine); some psychotherapies show promising results. The post-suicide approach cannot be neglected, whether in supporting the family, the team involved and even other patients.
ConclusionsThe assumption of the predictive and preventive value of the risk assessment has been under scrutiny. Depressed mood and a prior history of self-harm are well-established independent risk factors for inpatient suicide; however they lose their predictive value due to their high prevalence. Up to 70% of inpatients who committed suicide didn’t express suicidal ideation on the previous interviews. Most effective measures to prevent suicide are environmental modifications and staff education approaches, giving appropriate responses to each patient’s circumstances.
There is a paucity of literature on suicide in this setting. It should become a priority in national programs of Suicide Prevention.
Disclosure of InterestNone Declared
Overlap between substance and behavioural addictions: substance abuse in patients with pathological gambling
- N. Cunha E Costa, S. Cruz, G. Sobreira
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S832
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Introduction
Pathological gambling consists of a persistent and maladaptive pattern of gambling behavior, that often leads to significant adverse psychosocial and financial outcomes. It is currently classified as an “Impulse Disorder” on ICD-10 but the DSM-5 moved this diagnosis from “Impulse-Control Disorders” to “Substance-Related and Addictive Disorders” section[1]. Behavioral addictions, especially pathological gambling, share many features with substance dependences, namely clinical findings and behavioural patterns, comorbidity with psychiatric disorders, genetic factors and family history, neurobiology, natural history and response to treatment[2].
ObjectivesTo study the impact of substance abuse in patients with pathological gambling.
MethodsLiterary review, using PubMed database search, regarding substance abuse and pathological gambling.
Results57,5% of individuals with pathological gambling also present with some form of substance use[3].There was also a large percentage of patients presenting with nicotine dependence (60,1%) and a fourfold increase in the risk of developing an alcohol use disorder[3]. Individuals with substance use disorders also show a threefold risk of developing pathological gambling and substance use appears to negatively influence gambling behaviours in this population. Gambling habits in adolescents have been linked to an increased risk of current and lifetime drug use of multiple substances[4]. Other psychiatric comorbidities were also frequent in this population: 37.9% of patients presented with mood disorders and 37.4% with anxiety disorders[3].
ConclusionsThere is a significant clinical and neurobiological overlap between substance use disorders and pathological gambling. Individuals with pathological gambling have a high prevalence of substance use disorders and an increased lifetime risk of substance use, which negatively influences gambling behavior.
DisclosureNo significant relationships.
Dissociation and emotional dysregulation in pathological personalities related to the fear of SARS-COV-2: a case report
- R. Sousa, J. Brás, A. Costa, R. Vaz, J. Martins, D. Teixeira, A. Marques, J. Abreu, E. Almeida, N. Cunha
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S528
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Introduction
The COVID-19 pandemic represented a serious strain on the mental health resilience worldwide. Implementation of restrictive rules implied the disruption of social networks, eliciting emotional exhaustion and intense response to fear. This was amplified by media spread of panic and fake news, representing risk factors for post traumatic stress disorder (PTSD). Fear can be dangerous, especially accounting premorbid psychopathological vulnerability, such as pathological personality traits. Emotional dysregulation increases fear levels, mediated by the relationship between emotional dysregulation and lack of tolerance.
ObjectivesClinical case presentation of patient who developed dissociative and behavioral symptoms following COVID-19 infection. Bibliographic research.
MethodsBibliographic research using Pubmed®. Clinical file consultation and patient interviews.
ResultsHeightened psychophysiological reactivity can result from the persistent fear experienced during a traumatic event and repeated memories related to it, leading to a sensitization of the response to fear. We present 57 year-old female patient, admitted to the COVID ward after trying to escape from home isolation due to positivity to COVID-19. In the hospital setting she developed dissociative symptoms, trying to escape from the ward and infect other people.
ConclusionsIntense fear responses to COVID-19 are likely explained by poor emotion regulation capacities as well as dissociative mechanisms. Studies have shown that this pandemic was experienced as a real traumatic event and some studies have found that it may lead to the development of PTSD. Pathological personality is positively related to PTSD symptoms, attributable to higher levels of mood instability, cognitive/perceptual disorders, interpersonal dysfunctions and negative affection.
DisclosureNo significant relationships.
Paliperidone palmitate-induced enuresis: a case report
- S. Cruz, N. Cunha E Costa, A. Morais, M. Mendonça, R. Trindade, S. Xavier
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- Journal:
- European Psychiatry / Volume 65 / Issue S1 / June 2022
- Published online by Cambridge University Press:
- 01 September 2022, p. S798
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Introduction
Schizophrenia is a severe mental illness that requires long-term treatment with antipsychotics and the intramuscular (IM) long-acting injectable (LAI) formulations may enhance treatment adherence. Some antipsychotics have been associated with enuresis, including atypical antipsychotics such as risperidone(6.2%), quetiapine(6.7%), olanzapine (9.6% ) and clozapine (20.7%) [1]. Although oral paliperidone has been related to urinary incontinence, there is only 1 report of urinary incontinence linked to monthly paliperidone palmitate [2]. [1] Harrison-Woolrych, M., Skegg, K., Ashton, J., Herbison, P., Skegg, D.C., 2011. Nocturnal enuresis in patients taking clozapine, risperidone, olanzapine and quetiapine: comparative cohort study. British Journal of Psychiatry 199, 140–144. doi:10.1192/bjp.bp.110.087478 [2] Karslıoǧlu, E.H., Özalp, E., Çayköylü, A., 2016. Paliperidone Palmitate-induced Urinary Incontinence: A Case Report. Clinical Psychopharmacology and Neuroscience 14, 96–100. doi:10.9758/cpn.2016.14.1.96
ObjectivesTo establish an association between paliperidone palmitate and enuresis.
MethodsCase report and a narrative review of the literature.
ResultsThe patient was a 25-year-old healthy man when he was diagnosed with schizophrenia. Doctors prescribed paliperidone palmitate (LAI) 200mg monthly and he started to complain of enuresis. He was clearly suffering with this unpleasant and embarrassing adverse effect so the LAI was reduced to 150mg. Enuresis remained, so it was prescribed oxybutynin 20 mg/day and the patient improved.
ConclusionsWe reported a case in which enuresis is likely to be associated with high-dose paliperidone LAI (with no clinical evidence of an organic cause). To treat it, the most effective strategy was oxybutynin 20 mg/day. This case is also important to show the impact of this symptom, which is not actively investigated.
DisclosureNo significant relationships.
DESAlert: Enabling Real-Time Transient Follow-Up with Dark Energy Survey Data
- A. Poci, K. Kuehn, T. Abbott, F. B. Abdalla, S. Allam, A.H. Bauer, A. Benoit-Lévy, E. Bertin, D. Brooks, P. J. Brown, E. Buckley-Geer, D. L. Burke, A. Carnero Rosell, M. Carrasco Kind, R. Covarrubias, L. N. da Costa, C. B. D’Andrea, D. L. DePoy, S. Desai, J. P. Dietrich, C. E Cunha, T. F. Eifler, J. Estrada, A. E. Evrard, A. Fausti Neto, D. A. Finley, B. Flaugher, P. Fosalba, J. Frieman, D. Gerdes, D. Gruen, R. A. Gruendl, K. Honscheid, D. James, N. Kuropatkin, O. Lahav, T. S. Li, M. March, J. Marshall, K. W. Merritt, C.J. Miller, R. C. Nichol, B. Nord, R. Ogando, A. A. Plazas, A. K. Romer, A. Roodman, E. S. Rykoff, M. Sako, E. Sanchez, V. Scarpine, M. Schubnell, I. Sevilla, C. Smith, M. Soares-Santos, F. Sobreira, E. Suchyta, M. E. C. Swanson, G. Tarle, J. Thaler, R. C. Thomas, D. Tucker, A. R. Walker, W. Wester, (The DES Collaboration)
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- Publications of the Astronomical Society of Australia / Volume 33 / 2016
- Published online by Cambridge University Press:
- 30 September 2016, e049
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The Dark Energy Survey is undertaking an observational programme imaging 1/4 of the southern hemisphere sky with unprecedented photometric accuracy. In the process of observing millions of faint stars and galaxies to constrain the parameters of the dark energy equation of state, the Dark Energy Survey will obtain pre-discovery images of the regions surrounding an estimated 100 gamma-ray bursts over 5 yr. Once gamma-ray bursts are detected by, e.g., the Swift satellite, the DES data will be extremely useful for follow-up observations by the transient astronomy community. We describe a recently-commissioned suite of software that listens continuously for automated notices of gamma-ray burst activity, collates information from archival DES data, and disseminates relevant data products back to the community in near-real-time. Of particular importance are the opportunities that non-public DES data provide for relative photometry of the optical counterparts of gamma-ray bursts, as well as for identifying key characteristics (e.g., photometric redshifts) of potential gamma-ray burst host galaxies. We provide the functional details of the DESAlert software, and its data products, and we show sample results from the application of DESAlert to numerous previously detected gamma-ray bursts, including the possible identification of several heretofore unknown gamma-ray burst hosts.