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P.6.e.003 Internet addiction and its social consequences
P.6.e Addiction – Other (clinical) P.6.e.002 Impact of attention deficit hyperactivity disorder comorbidity in substance use disorders D. Danki Erken ° , N. Dilbaz, O. Kilico Kafali, S. Telci, T. Okay. Ankara Numune Training and Research Hospital, Psychiatry Department, Ankara, Turkey Attention deficit hyperactivity disorder (ADHD) is a common childhood disorder that persists into adulthood. Studies have found that substance use disorders (SUD) are seen more often in those with ADHD than the general population. ADHD appears to be a significant risk factor for adult SUD. Individuals with ADHD have an earlier age of onset of SUD and substance dependence is less likely to remit than in those without ADHD. Adults with SUD reported a lifetime prevalence ranging from 15% to 30% for ADHD (Timothy et al. 2004). At the end of this presentation the participant will be able to recognize the prevalence of ADHD and risk factors – such as socio-economic level, onset of age – among SUD in Turkish population. They will also have the opportunity to understand the relationship of ADHD and depressive symptoms, anger expressions among SUD patients. This study will also explore the effect of comorbidity on the treatment of SUD patients with or without ADHD. There are two aims of this study: First aim is to determine the prevalance of ADHD among SUD patients. The second aim is to investigate the risk factors for comorbidity and also the effect of ADHD on depression, suicidality, behavioral problems and agression and also outcome of the treatment among SUD patients. One hundred and thirty seven adult male patients who were diagnosed as having SUD according to DSM-IV were included in the study. Participants were evaluated with detailed childhood and family history, Wender-Utah Rating Scale, ADHD Screening Test, and also DSM-IV criteria for ADHD. Patients completed semistructured sociodemographic form, Spielberger State-Trait Anger Expression Inventory (SSTAEI), Beck Depression Inventory (BDI), Suicide Thoughts Scale (STS) and Informed Consent Form that were given by an another specialist. Thirty-six (26.2%) of the participants were found to meet DSM-IV criteria for ADHD. Individuals with ADHD were more likely to have lower socioeconomical levels (p < 0.01), lower educational levels (p < 0.01), more vehicle accidents (p < 0.05), more imprisonments (p < 0.01), earlier onsets ( p < 0.01), higher number of treatments (p < 0.05) compared with those without ADHD. While in comparison of mean SSTAEI and BDI scores – state anger (p < 0.01), anger expression in (p < 0.01), anger expression out (p < 0.01) and depression scores (p < 0.01) have been found to be higher in ADHD patients. There have been no significant difference between STS scores of the participants (p = 0.849). The rate of ADHD in clinical samples of treatment seeking substance users in Turkish population is (26.2%) also high as in other studies with rates ranging from 15% to 30%. ADHD appears to make a substantial contribution to SUD, poor academic achievement, delinquency, high rate of depressive symptoms and aggression. The comorbidity of ADHD is associated with higher levels of substance related problems and poorer outcomes (Wilens et al. 2006). We can conclude that the medication treatment of ADHD in childhood might have a protective effect with regard to the development of SUD during adolescence and adulthood.
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References [1] Timothy E, et al, 2004, attention-deficit/hyperactivity disorder in adults. JAMA 292, 619–623. [2] Wilens TE, Biederman J, 2006, Alcohol, drugs, and attention-deficit/ hyperactivity disorder: a model for the study of addictions in youth. J Psychopharmacol 20, 580.
P.6.e.003 Internet addiction and its social consequences A. Kwiatkowska1 ° , E. Ziolko1 , K. Krysta2 , M. Muc-Wierzgon1 , A. Brodziak1 , I. Krupka-Matuszczyk2 , J. Przybylo2 . 1 Medical University of Silesia, Department of Internal Diseases, Bytom, Poland; 2 Medical University of Silesia, Department of Psychiatry and Psychotherapy, Katowice, Poland Purpose: In the context of social life each addiction is a destructive attachment leading to functional disturbance in relationships with other people causing suffering and loneliness. The objective of this study was to show the influence of the Internet overuse on human relationships and displaying network addiction features in the young generation. Methods: Out of the group of 100 students 68 daily Internet users aged 19 to 24 were examined. An anonymous inquiry containing 28 questions was used. The inquiry was constructed basing on available tests checking Internet addiction and authors’ observation. Age, gender and place of residency were taken into account as the characteristics of the examined group. Results: Family conflicts related to a long lasting use of computer appear in 54% responders’ families. At the same time 48.5% reports their families’ complaints about their too long staying on the net. 42.6% responders admit neglecting their school, work and family responsibilities. 70.6% react with hostility if somebody tries to disturb their Internet use. 40% of the examined men and 20% women admit that Internet relationships outnumber their real friendships. 38.2% of the responders neglect their sleep, 38.4% relax, when using Internet. For 61.7% responders life without Internet would be sad and empty. According to our inquiry studies 19.1% of the responders spend less then 5 hours a week with their real friends, 8.8% responders do it less then 2 hours a week. Persons using Internet for more than 5 hours a week e.g. frequently fulfill criteria of Internet dependence. In the context of social life every dependences, including dependence to the Internet is a destructive attitude leading to disorders of functioning of a man in relations to other people, it increases the state of suffering an loneliness. The users of Internet, through increasing hours spend on-line go through subsequent phases of dependence: from a fascination and relax, through a feeling of reducing discomfort, a need to keep a relationship with other users of the net for keeping the life balance, escape from everyday problems, to a deepening of depression because of neglecting everyday problems. The examined population included 10 males and 58 females, 57 of them lived in the cities, 11 of them in the villages. The result showed that internet overuse is a reason for family conflicts in 50% examinees, due to long term stay on-line young people have problems in learning, work and family duties, on-line stay above 5 hours a day may be followed by increased risk of addiction. Prolonged internet use influences reduction of contacts with real friends. Conclusions: (1) Abuse of Internet is a source of conflict in families in about 50% examined responders. (2) Because of a long time spent in the Internet, young people neglect their responsibilities concerning school, work and family life. (3) Staying on
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the net for more than 5 hours a day is associated with a risk of dependence. (4) A long time use of Internet results in decrease in contacts with real friends. References [1] Ko CH, Yen JY, Chen CC, Chen SH, Wu K, Yen CF, 2006. Tridimensional personality of adolescents with internet addiction and substance use experience. Can J Psychiatry 51(14), 887−94. [2] Wan CS, Chiou WB, 2006. Why are adolescents addicted to online gaming? An interview study in Taiwan. Cyberpsychol Behav 9(6), 762−6. [3] Ng BD, Wiemer-Hastings P, 2005. Addiction to the internet and online gaming. Cyberpsychol Behav 8(2), 110−3.
indicate a similar mechanism as both of these amino acids are excitatory neurotransmitters in the CNS. The lower CSF level of glycine in pathological gamblers is in accord with a reduced inhibiting function. Conclusion: Pathological gambling is associated with changes in amino acid patterns and distribution, indicating a role of amino acids in the neurobiology of the disorder. References
P.6.e.004 CSF amino acids in pathological gamblers and healthy controls
[1] Nordin C, Eklundh T, 1996, Lower CSF taurine levels in male pathological gamblers than in healthy controls. Hum Psychopharmacol Clin Exp 11, 401–403. [2] Nordin C, Sj¨odin I, 2006, Altered CSF taurine function in pathological gambling. J Psychiatr Res 40, 473–474. [3] Nordin C, Sj¨odin I, 2007, CSF cholecystokinin, gamma-aminobutyric acid and neuropeptide Y in pathological gamblers and healthy controls. J Neural Transm 114, 499–503.
C. Nordin1 ° , R.C. Gupta2 , I. Sj¨odin1 . 1 Psychiatry, Dept. of Neuroscience and Locomotion, Faculty of Health Sciences, Link¨oping, Sweden; 2 SASRD, Nagaland University, Medziphema, India
P.6.e.005 Relationship between personality dimensions, substance misuse and repetition of deliberate self harm
Background: Little has been reported on the role of amino acids in pathiological gambling. In a recent study, the CSF levels of the monoamine precursers tryptophan and tyrosine as well as of gamma-aminobutyric acid (GABA) were found to be higher in pathological male gamblers than in healthy male controls. Contradictory results have been obtained for the inhibitory amino acid taurine. Pathological male gamblers displayed higher CSF taurine levels than healthy male controls, while lower levels were found in a previous study. Within a larger project aimed at exploring biochemical and genetic factors and personality profiles in pathological gambling, we report data on amino acids in cerebrospinal fluid (CSF). Material and Methods: Eleven pathological male gamblers and 11 healthy male controls were lumbar-punctured at the L 4−5 level in the left decubitus position after a minimum of 8 hours in the fasting state. Three consecutive 6-ml CSF fractions were drawn. Amino acids were determined by HPLC. Results: Compared with healthy controls, pathological male gamblers displayed higher CSF concentrations of glutamic acid, aspartic acid, phenylalanine and ornithine, while glycine was found to have a lower concentration. A decreasing CSF gradient from the first (0−6 ml) to the third (13−18 ml) CSF fraction was found for glutamic acid, ornithine, glycine, leucine, isoleucine, lysine and glutamine in both pathological gamblers and healthy controls. A decreasing gradient was also found for aspartic acid and phenylalanine but only in pathological gamblers. A similar decreasing gradient was found for methionine in healthy controls. Disrupted gradients were found for valine in both pathological male gamblers and healthy male controls. In pathological male gamblers (but not in healthy male controls), a disrupted gradient was also found for arginine. No differences were found between pathological gamblers with or without, affective disorders, anxiety disorders and alcohol abuse/dependence, respectively. Confounding factors such as age, body mass index, intraspinal pressure, atmospheric pressure, neuraxis distance and CSF collection time seem to exert an influence on some of the amino acids investigated. There was an effect of smoking on isoleucine. Discussion: In conjunction with previous findings on tyrosine, a higher CSF level of phenylalanine is not unexpected given that phenylalanine is metabolised to tyrosine. The higher level of aspartic and glutamic acid in pathological male gamblers may
J. Sinclair ° , M.J. Garner, D.S. Baldwin. Royal South Hants Hospital, Mental Health Group, Southampton, United Kingdom The management of deliberate self-harm (DSH) patients poses a significant challenge for health services. Whilst the majority of patients reach diagnostic criteria for a depressive episode, there is substantial co-morbidity with substance misuse and personality disorder. Current accepted categorical classifications of personality disorders have been criticised as being purely descriptive, rather than based on presumed neuropsychobiology (Svrakic et al., 2002) and this has hampered understanding of the complex interaction between underlying cognitive and emotional structures and manifest behaviours. The Temperament and Character Inventory (TCI) is a well validated measure of personality which integrates 4 dimensions of temperament: novelty seeking (NS); harm avoidance (HA); reward dependence (RW) and persistence (PS), with 3 dimensions of character: self-directedness (SD); co-cooperativeness (CO) and self-transcendence (ST) (Cloninger, 1993). We wished to explore relationships between personality dimensions, substance misuse and self-harm in a cohort of 150 patients, originally recruited in 1997 after an episode of DSH and followed up over 7 years. Assessments included details of current substance use and repetition of DSH during the follow up period and completion of the AUDIT (Alcohol use disorders identification test), TCI-140 R and Beck depression inventory (BDI). Data were available in 73 patients (51 women, 22 men). There were no significant differences in terms of age, gender, suicidal intent or number of episodes at index episode between the 73 patients and the original cohort of 150. In those patients interviewed for this study, the median number of episodes of DSH during the follow-up period was 1 (IQR: 0−2) and 13 patients (18.6%) had at least 1 episode in the year prior to follow-up. 25 patients (40%) screened positive for harmful use of alcohol (AUDIT >8) and 22 (31.9%) admitted to recent use of illicit substances. Recent repetition (within the last year) was associated with lower NS scores (p = 0.043), and lower CO scores (p = 0.038), but these did not remain statistically significant when adjusted for BDI scores. In the total group, there was a significant correlation between high scores on the BDI and lower levels of self-directedness (p < 0.0001), perseverance (p < 0.0001), reward dependence (p = 0.048), and
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References [1] Timothy E, et al, 2004, attention-deficit/hyperactivity disorder in adults. JAMA 292, 619–623. [2] Wilens TE, Biederman J, 2006, Alcohol, drugs, and attention-deficit/ hyperactivity disorder: a model for the study of addictions in youth. J Psychopharmacol 20, 580.
P.6.e.003 Internet addiction and its social consequences A. Kwiatkowska1 ° , E. Ziolko1 , K. Krysta2 , M. Muc-Wierzgon1 , A. Brodziak1 , I. Krupka-Matuszczyk2 , J. Przybylo2 . 1 Medical University of Silesia, Department of Internal Diseases, Bytom, Poland; 2 Medical University of Silesia, Department of Psychiatry and Psychotherapy, Katowice, Poland Purpose: In the context of social life each addiction is a destructive attachment leading to functional disturbance in relationships with other people causing suffering and loneliness. The objective of this study was to show the influence of the Internet overuse on human relationships and displaying network addiction features in the young generation. Methods: Out of the group of 100 students 68 daily Internet users aged 19 to 24 were examined. An anonymous inquiry containing 28 questions was used. The inquiry was constructed basing on available tests checking Internet addiction and authors’ observation. Age, gender and place of residency were taken into account as the characteristics of the examined group. Results: Family conflicts related to a long lasting use of computer appear in 54% responders’ families. At the same time 48.5% reports their families’ complaints about their too long staying on the net. 42.6% responders admit neglecting their school, work and family responsibilities. 70.6% react with hostility if somebody tries to disturb their Internet use. 40% of the examined men and 20% women admit that Internet relationships outnumber their real friendships. 38.2% of the responders neglect their sleep, 38.4% relax, when using Internet. For 61.7% responders life without Internet would be sad and empty. According to our inquiry studies 19.1% of the responders spend less then 5 hours a week with their real friends, 8.8% responders do it less then 2 hours a week. Persons using Internet for more than 5 hours a week e.g. frequently fulfill criteria of Internet dependence. In the context of social life every dependences, including dependence to the Internet is a destructive attitude leading to disorders of functioning of a man in relations to other people, it increases the state of suffering an loneliness. The users of Internet, through increasing hours spend on-line go through subsequent phases of dependence: from a fascination and relax, through a feeling of reducing discomfort, a need to keep a relationship with other users of the net for keeping the life balance, escape from everyday problems, to a deepening of depression because of neglecting everyday problems. The examined population included 10 males and 58 females, 57 of them lived in the cities, 11 of them in the villages. The result showed that internet overuse is a reason for family conflicts in 50% examinees, due to long term stay on-line young people have problems in learning, work and family duties, on-line stay above 5 hours a day may be followed by increased risk of addiction. Prolonged internet use influences reduction of contacts with real friends. Conclusions: (1) Abuse of Internet is a source of conflict in families in about 50% examined responders. (2) Because of a long time spent in the Internet, young people neglect their responsibilities concerning school, work and family life. (3) Staying on
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P.6.e Addiction – Other (clinical)
the net for more than 5 hours a day is associated with a risk of dependence. (4) A long time use of Internet results in decrease in contacts with real friends. References [1] Ko CH, Yen JY, Chen CC, Chen SH, Wu K, Yen CF, 2006. Tridimensional personality of adolescents with internet addiction and substance use experience. Can J Psychiatry 51(14), 887−94. [2] Wan CS, Chiou WB, 2006. Why are adolescents addicted to online gaming? An interview study in Taiwan. Cyberpsychol Behav 9(6), 762−6. [3] Ng BD, Wiemer-Hastings P, 2005. Addiction to the internet and online gaming. Cyberpsychol Behav 8(2), 110−3.
indicate a similar mechanism as both of these amino acids are excitatory neurotransmitters in the CNS. The lower CSF level of glycine in pathological gamblers is in accord with a reduced inhibiting function. Conclusion: Pathological gambling is associated with changes in amino acid patterns and distribution, indicating a role of amino acids in the neurobiology of the disorder. References
P.6.e.004 CSF amino acids in pathological gamblers and healthy controls
[1] Nordin C, Eklundh T, 1996, Lower CSF taurine levels in male pathological gamblers than in healthy controls. Hum Psychopharmacol Clin Exp 11, 401–403. [2] Nordin C, Sj¨odin I, 2006, Altered CSF taurine function in pathological gambling. J Psychiatr Res 40, 473–474. [3] Nordin C, Sj¨odin I, 2007, CSF cholecystokinin, gamma-aminobutyric acid and neuropeptide Y in pathological gamblers and healthy controls. J Neural Transm 114, 499–503.
C. Nordin1 ° , R.C. Gupta2 , I. Sj¨odin1 . 1 Psychiatry, Dept. of Neuroscience and Locomotion, Faculty of Health Sciences, Link¨oping, Sweden; 2 SASRD, Nagaland University, Medziphema, India
P.6.e.005 Relationship between personality dimensions, substance misuse and repetition of deliberate self harm
Background: Little has been reported on the role of amino acids in pathiological gambling. In a recent study, the CSF levels of the monoamine precursers tryptophan and tyrosine as well as of gamma-aminobutyric acid (GABA) were found to be higher in pathological male gamblers than in healthy male controls. Contradictory results have been obtained for the inhibitory amino acid taurine. Pathological male gamblers displayed higher CSF taurine levels than healthy male controls, while lower levels were found in a previous study. Within a larger project aimed at exploring biochemical and genetic factors and personality profiles in pathological gambling, we report data on amino acids in cerebrospinal fluid (CSF). Material and Methods: Eleven pathological male gamblers and 11 healthy male controls were lumbar-punctured at the L 4−5 level in the left decubitus position after a minimum of 8 hours in the fasting state. Three consecutive 6-ml CSF fractions were drawn. Amino acids were determined by HPLC. Results: Compared with healthy controls, pathological male gamblers displayed higher CSF concentrations of glutamic acid, aspartic acid, phenylalanine and ornithine, while glycine was found to have a lower concentration. A decreasing CSF gradient from the first (0−6 ml) to the third (13−18 ml) CSF fraction was found for glutamic acid, ornithine, glycine, leucine, isoleucine, lysine and glutamine in both pathological gamblers and healthy controls. A decreasing gradient was also found for aspartic acid and phenylalanine but only in pathological gamblers. A similar decreasing gradient was found for methionine in healthy controls. Disrupted gradients were found for valine in both pathological male gamblers and healthy male controls. In pathological male gamblers (but not in healthy male controls), a disrupted gradient was also found for arginine. No differences were found between pathological gamblers with or without, affective disorders, anxiety disorders and alcohol abuse/dependence, respectively. Confounding factors such as age, body mass index, intraspinal pressure, atmospheric pressure, neuraxis distance and CSF collection time seem to exert an influence on some of the amino acids investigated. There was an effect of smoking on isoleucine. Discussion: In conjunction with previous findings on tyrosine, a higher CSF level of phenylalanine is not unexpected given that phenylalanine is metabolised to tyrosine. The higher level of aspartic and glutamic acid in pathological male gamblers may
J. Sinclair ° , M.J. Garner, D.S. Baldwin. Royal South Hants Hospital, Mental Health Group, Southampton, United Kingdom The management of deliberate self-harm (DSH) patients poses a significant challenge for health services. Whilst the majority of patients reach diagnostic criteria for a depressive episode, there is substantial co-morbidity with substance misuse and personality disorder. Current accepted categorical classifications of personality disorders have been criticised as being purely descriptive, rather than based on presumed neuropsychobiology (Svrakic et al., 2002) and this has hampered understanding of the complex interaction between underlying cognitive and emotional structures and manifest behaviours. The Temperament and Character Inventory (TCI) is a well validated measure of personality which integrates 4 dimensions of temperament: novelty seeking (NS); harm avoidance (HA); reward dependence (RW) and persistence (PS), with 3 dimensions of character: self-directedness (SD); co-cooperativeness (CO) and self-transcendence (ST) (Cloninger, 1993). We wished to explore relationships between personality dimensions, substance misuse and self-harm in a cohort of 150 patients, originally recruited in 1997 after an episode of DSH and followed up over 7 years. Assessments included details of current substance use and repetition of DSH during the follow up period and completion of the AUDIT (Alcohol use disorders identification test), TCI-140 R and Beck depression inventory (BDI). Data were available in 73 patients (51 women, 22 men). There were no significant differences in terms of age, gender, suicidal intent or number of episodes at index episode between the 73 patients and the original cohort of 150. In those patients interviewed for this study, the median number of episodes of DSH during the follow-up period was 1 (IQR: 0−2) and 13 patients (18.6%) had at least 1 episode in the year prior to follow-up. 25 patients (40%) screened positive for harmful use of alcohol (AUDIT >8) and 22 (31.9%) admitted to recent use of illicit substances. Recent repetition (within the last year) was associated with lower NS scores (p = 0.043), and lower CO scores (p = 0.038), but these did not remain statistically significant when adjusted for BDI scores. In the total group, there was a significant correlation between high scores on the BDI and lower levels of self-directedness (p < 0.0001), perseverance (p < 0.0001), reward dependence (p = 0.048), and