European Psychiatry - Volume 41 - April 2017

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25th European Congress of Psychiatry / European Psychiatry 41S (2017) S847–S910 S877
EV1437
Alcohol-related cue-reactivity predicts
abstinence duration in individuals
with severe alcohol-use disorders
S. Karthik ∗, B. Holla , R.D. Bharath , G. Venkatasubramaniyan ,
V. Benegal
1 National Institute of Mental Health and Neurosciences, Psychiatry,
Bangalore, Karnataka, India
2 National Institute of Mental Health and Neurosciences, Neuro
Imaging and Interventional Radiology, Bangalore, Karnataka, India
∗ Corresponding author.
Introduction Alcohol use disorder (AUD) is an important global
public health problemwith complex aetiology and relapsing remit-
ting course. Clinical measures of alcohol dependence severity and
alcohol-craving, are largely unreliable in identifying individuals
at high-risk for relapse. Functional human neuroimaging meth-
ods that employ symptom provocation paradigms have shown
promise in identifying critical brain regions with cue-elicited
alcohol-craving response.
Objective The present study aimed at examining the utility of
fMRI cue-reactivity (CR) in predicting relapse risk.
Methods The study was conducted on inpatients of a tertiary care
neuropsychiatric hospital. Thirty-two treatment-seeking right-
handed men were recruited for the study after informed consent.
Following detoxification and 3-day drug-washout period, they
underwent a task-based fMRI while viewing images of alcohol-
related and control cues presented to them using a previously
validated fMRI paradigm. All patients received anti-craving med-
ications (baclofen: 60–80mg/d, n = 16; naltrexone: 50–100mg/d,
n = 16) and were prospectively followed-up till their first alcohol
lapse.
Results Random-effect analysis using one-sample test revealed
significant CR to alcohol-related cues (relative to implicit base-
line) with activation in salience-reward related regions [insula,
cingulate, dorsal striatum (DS)], visual-attention regions [occipito-
temporal] and deactivation of default-mode regions [posterior
cingulate (PCC)] (all significant at PFWE < 0.05, whole-brain cor-
rected). Cox-proportional hazard regressions revealed that greater
CR in Insula (Chi2 = 10.33; P = 0.001; HR = 3.1; 95% CI = 1.5–6.3) and
DS (Chi2 = 10.87; P = 0.001; HR = 2.8; 95%CI = 1.5–5.2) predicts faster
subsequent time to first drink after accounting for the role of clinical
measures.
Conclusion These findings indicate that CR can serve as poten-
tial marker to identify individuals at high-risk for relapse. Further
examination of intervention-related CR change may aid in person-
alizing treatment of AUD.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV1438
Modafinil: A smart drug with
psychiatric implications
H. Saiz Garcia ∗, L. Montes Reula , A. Portilla Fernádez ,
V. Pereira Sanchez , N. Olmo Lopez , E. Mancha Heredero ,
A.S. Rosero Enriquez , M.E. Martinez Parre˜no
1 Complejo Hospitalario Navarra, Psychiatry, Pamplona, Spain
2 Clínica Universidad de Navarra, Psychiatry, Pamplona, Spain
3 CSM Salburua, Psychiatry, Vitoria, Spain
∗ Corresponding author.
Introduction Modafinil is approved to treat excessive somno-
lence but it is also off-spec used as a treatment for ADHD and
as a cognitive enhancer. Research on the effects of modafinil on
cognitive function have yielded mixed results. Modafinil interact
with dopamine, noradrenaline, serotonin, glutamate, orexin, his-
tamine and GABA levels. The regulation of these neurotransmitters
is widely known to be implicated in most of the neuropsychiatric
disorders.
Methodology A review was conducted aiming to clarify the bio-
logical mechanisms of action of modafinil; its effects on attention,
learning, executive functions and creative thinking; as well as
possible neuropsychiatric disorders associated to its intake. The lit-
erature search was conducted in PubMed data reviewing articles
dating between 2015 and 2016.
Results (1) Empirical evidence for cognitive enhancing effects of
one of the most frequently used substances, modafinil, is sparse.
Studies suggest that with more protracted and complex testing,
more benefits are associated to modafinil use.
(2) Modafinil may be implicated in alterations of reward-related
behaviour. Compared to placebo, modafinil leads to an enhanced
tendency to make previously rewarded choices compared to
the avoidance of previously punished choices. This pattern of
altered choice behaviour is probably induced by an increase of
the dopamine level and a potential contribution of elevated nora-
drenaline.
Conclusions Some people share information about this drug in
social network. Off-label use of this drug may be implicated in
alterations of reward-related behaviour and patients with previ-
ous psychiatric disorders should be aware of its possible adverse
effects.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
EV1439
Nootropics: Emergents drugs
associated with new clinical
challenges
H. Saiz Garcia ∗, L. Montes Reula , A. Portilla Fernandez ,
V. Pereira Sanchez Olmo Lopez ancha Heredero
A.S. Rosero Enrique E. Martinez Parre˜no
1 Complejo Hospitalario Navarra, Psychiatry, Pamplona, Spain
2 Clinica Universidad de Navarra, Psychiatry, Pamplona, Spain
3 CSM Salburua, Psychiatry, Vitoria, Spain
∗ Corresponding author.
Introduction The “nootropic” or simplified as a “smart drug”, is a
common term that will tag along with the compound responsible
for the enhancement of mental performance. Certain individuals
with a history of mental or substance use disorders might be par-
ticularly vulnerable to its adverse effects.
Methodology A reviewwas conducted aiming to clarify themech-
anisms associated of how these drugs increase mental functions
including memory, motivation, concentration, and attention; and
which kind of individuals are at risk of developing adverse effects
when taking these drugs. The literature search was conducted in
PubMed data reviewing articles dating between 2015 and 2016.
Results – Glutaminergic Signalling, Cholinergic System, Amyloid
Precursor Protein and Secondary Messenger may be related to the
cognitive enhancement achieved by Nootropics. Others, like insulin
and angiotensin receptor may involved too.
– Some of them, like Ginkgo biloba, seem to have neuroprotective
effects observed in human and animal models, acting as antioxidant
and antiapoptotic, also inducing inhibition effects against caspase-
3 activation and amyloid-aggregation toward Alzheimer’s disease.
– Synthetic nootropics, a lab created compound such as piracetam,
especially in people with history of drug abuse, may be associated
with psychiatric exacerbations of some patients.
Conclusions Young adults all over Europe, especially university
students, are starting to use nootropic drugs to improve their
academic results. Some of them seem to have beneficial effects
over mental health but others are sometimes related with sudden
and unexplained exacerbations in stable psychiatric patients. It is
important to early identify symptoms and to treat them properly.