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25th European Congress of Psychiatry / European Psychiatry 41S (2017) S53–S68


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.


Treatment of ADHD with cannabinoids

P. Asherson

1 ,

, R . C




London, United Kingdom


King’s College London, Social Genetic and Developmental

Psychiatry, London, United Kingdom

Corresponding author.


Adults with ADHD describe self-medicating with

cannabis, with some reporting a preference for cannabis over ADHD



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.


The primary outcome was cognitive performance and

activity level using QbTest. Secondary outcomes included ADHD

and emotional lability (EL) symptoms.


Thirty participants were randomly assigned to the active



= 15) or placebo (


= 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,


= 0.16,


= 15/11 active/placebo). For secondary

outcomes, Sativex was associated with non-significant improve-

ments in hyperactivity/impulsivity (


= 0.03), a cognitive measure

of inhibition (


= 0.05), inattention (


= 0.10) and emotional lability.

Per-protocol effects were higher.


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.


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.


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.


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).


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.


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


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.