European Psychiatry - Volume 41 - April 2017

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25th European Congress of Psychiatry / European Psychiatry 41S (2017) S53–S68 S55
seeking SUD treatment. Neurobiological and neurocognitive differ-
ences are present between ADHD patients with and without SUD,
which together may partially explain the reduced effectiveness of
methylphenidate in adult ADHD patients with SUD.
Disclosure of interest The author has not supplied his declaration
of competing interest.
W008
Treatment of ADHD with cannabinoids
P. Asherson ∗ ooper
1 London, United Kingdom
2 King’s College London, Social Genetic and Developmental
Psychiatry, London, United Kingdom
∗ Corresponding author.
Introduction Adults with ADHD describe self-medicating with
cannabis, with some reporting a preference for cannabis over ADHD
medications.
Objectives The experimental medicine in ADHD-cannabinoids
study was a pilot randomised placebo-controlled experimental
study of a cannabinoid medication, Sativex oromucosal spray, in
30 adults with ADHD.
Methods The primary outcome was cognitive performance and
activity level using QbTest. Secondary outcomes included ADHD
and emotional lability (EL) symptoms.
Results Thirty participants were randomly assigned to the active
(n = 15) or placebo (n = 15) group. For the primary outcome, no
significant difference was found in the ITT analysis although the
overall pattern of scores was such that the active group usually had
scores that were better than the placebo group (Est = -0.17, 95%CI-
0.40 to 0.07, P = 0.16, n = 15/11 active/placebo). For secondary
outcomes, Sativex was associated with non-significant improve-
ments in hyperactivity/impulsivity (P = 0.03), a cognitive measure
of inhibition (P = 0.05), inattention (P = 0.10) and emotional lability.
Per-protocol effects were higher.
Conclusion Results did not meet significance following adjust-
ment for multiple testing. One serious (muscular seizures/spasms)
and three mild adverse events occurred in the active group and
one serious (cardiovascular problems) adverse event in the placebo
group. Adults with ADHD may represent a subgroup of individuals
who experience a reduction of symptoms and no cognitive impair-
ments following cannabinoid use. This provides some preliminary
evidence in support of the self-medication theory of cannabis use
in ADHD. A larger trial is warranted.
Disclosure of interest Kings College London research support
account for Asherson received honoraria for consultancy to Shire,
Eli-Lilly and Novartis educational/research awards fromShire, Lilly,
Novartis, Vifor Pharma, GW Pharma and QbTech speaker at spon-
sored events for Shire, Lilly and Novartis.
W009
Guidelines for managing ADHD and
substance use disorders
F. Matthys
Department of Psychiatry, University Hospital Brussels (UZ Jette) &
Vrije Universiteit Brussels (VUB), Belgium
Guideline for managing ADHD and substance use disorders (SUD)
Frieda Matthys, MD, PhD.
Background Despite the high prevalence of ADHD in adults with
SUD and the availability of an approved guideline, under diagnosis
and inadequate treatment still persist. This comorbidity associates
with reduced treatment effectiveness, making successful treatment
in adults with ADHD and SUD a challenge.
Methods The guideline of 2010 for recognizing and treating adult
ADHD in patients with SUD is updated in 2016, in cooperation
with caregivers, of the addiction centers in Belgium and based on
research literature and clinical experience. The english translation
is discussed by an international group of clinicians and experts to
result in a consensus statement via ICASA (International Collabo-
ration on ADHD and Substance Abuse).
Results This consensus presents a useful guide for the diagnosis
and treatment of ADHD and SUD. Due to the lack of scientific evi-
dence on some of the topics, the guide is a combination of evidence
based and practice based recommendations.
Conclusion The management of ADHD in patients with SUD
remains a challenge. Diagnosis is complicated by SUD symptoms
and by the skepticism associated with the recognition of ADHD
in adults. The treatment is hampered by high relapse rates and
reduced effectiveness of the currently available pharmacothera-
pies. Combining psycho-and pharmacotherapy in an integrated
treatment that covers both ADHD and SUD, may help to keep these
patients in treatment.
A Dutch manual for the integrated treatment of ADHD and SUD is
being developed.
Disclosure of interest Honorarium Lilly.
Advisory board Johnson&Johnson.
Workshop: big data in psychiatry. unprecedented
opportunities, new strategies
W010
Permutations and computational
power: A molecular cascade analysis
to approach big data in psychiatry
A. Drago
Aarhus university- Denmark, department of clinical medicine-
Psykiatrisk Forskningsenhed Vest, Herning, Denmark
In the last few years, we conducted a number of molecular pathway
analyses on the genetic samples provided by the NIMH. The molec-
ular pathway approach accounts for the polygenic nature of the
most part of psychiatric disorders. Nevertheless, the limits of this
approach including the limited knowledge about the function of the
genes, the fact that longer genes have higher probability to harbour
variations significantly associatedwith the phenotype under analy-
sis and the false positive associations for single variations, demand
statistical control and bio-statistical knowledge. Permutations are
a methodology to control for false positive associations, but their
implementation requires that a number of criteria are taken into
account: 1) the same number of genes and the same number of
variations of the index pathway must be simulated in order to limit
the bias of selecting significantly longer or shorter genes; 2) a suffi-
cient number of permutated pathways is created (10E5 to 10E6
depending on computational resources) which demands higher
computational power; 3) the correct statistical thresholds are iden-
tified and discussed; 4) some pathways might be over-represented
and the source of information must be constantly updated. The
tools for running a molecular pathway analysis (R Foundation for
Statistical Computing, 2013) when interacting with a supercluster
PC and the international bioinformatic datasets (Embase, NIMH and
others), together with the critical steps of bioinformatics scripting
(bash language) are described and discussed.
Disclosure of interest The author has not supplied his declaration
of competing interest.