European Psychiatry - Volume 33 - March 2016

48 / 812

S44 24th European Congress of Psychiatry / European Psychiatry 33S (2016) S18–S55
Relapse prevention in addiction – from bench to
bedside
S82
From genes to treatment: The effect of
polymorphisms in neurotransmitter
systems on addictive behaviour,
neural response and relapse
P. Bach ∗, S. Vollstädt-Klein , M. Kirsch , S. Hoffmann ,
A. Jorde , J. Frank , K. Charlet , A. Beck , A. Heinz , H. Walter ,
M. Rietschel , F. Kiefer
1 Central Institute of Mental Health, University of Heidelberg, Medical
Faculty Mannheim, Department of Addictive Behavior and Addiction
Medicine, Mannheim, Germany
2 Central Institute of Mental Health, University of Heidelberg, Medical
Faculty Mannheim, Department of Genetic Epidemiology in
Psychiatry, Mannheim, Germany
3 Charité, Universitätsmedizin Berlin, Department of Psychiatry and
Psychotherapy, Berlin, Germany
∗ Corresponding author.
Introduction The development and maintenance of an alcohol
addiction is a complex interaction between genetic and environ-
mental factors. Genetic effects seem to contribute substantially
to the risk of developing an addiction, but also to its course and
patients’ responses to different treatments. Recent studies identi-
fied associations betweenpolymorphisms in the genes of glutamate
and -opioid receptors and addiction risk. Those receptors are of
special interest, because they are targets of therapeutic agents, such
as acamprosate and topiramate.
Objectives and aims Several studies were conducted, in order to
further determine the effects of genetic polymorphisms in glu-
tamate and opioid receptor genes on addictive behavior, neural
response to alcohol cues and relapse risk.
Methods Genetic effects were investigated in samples of alcohol-
dependent patients using functional imaging techniques, neu-
ropsychological tests and follow-up investigation after standard
clinical treatment. Data on clinical parameters, neuronal response
to alcohol cues, functional neuronal connectivity and relapse risk
were collected and analyzed.
Results Results demonstrate effects of genetic polymorphisms in
glutamate and opioid receptors on neuronal response to alcohol
cues in frontal and mesolimbic brain areas, subjective craving and
time to first relapse. Current findingswill be discussed in the light of
existing evidence on the contribution of genetic effects to treatment
outcome and patient stratification.
Conclusions The investigation of genetic risk factors and mech-
anisms by which they affect addiction related phenotypes seems
to be a promising tool to identify molecular treatment targets and
predictors for successful treatment strategies.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
S83
Role of inhibitory processes in relapse
prevention treatment
G. Rudio
Laboratorio de Psicofisiología Clínica, Hospital Universitario 12 de
Octubre, Madrid, Spain
Alcohol dependence is a chronic disorder with frequent relapses
during recovery. Most studies have pointed out that craving is the
main process involved in relapse, but recently other factors have
been implicated in it, such as attentional bias and impulsivity.
Some authors consider that different stages could be involved in
the relapse process, and each may be governed by different mech-
anisms: Attentional bias; motivational response to alcohol cues and
inhibitory control.
Motivationally salient cues attract and hold selective attention,
and this “attentional bias, (AB)” is related to individual differ-
ences in appetitive and aversive motivation. In a recent review,
attentional bias has been shown to be significantly present in
alcohol-dependent and is associated with craving and risk to a
relapse in alcohol consumption.
In alcohol-dependent subjects, alcohol-related cues reach a very
high motivational valence (Motivational response, MR), which,
in effect, increases craving for alcohol and activates behavioral
strategies towards alcohol intake. One method used to assess
motivational valence of alcohol is the craving self-assessment. In
addition, in recent years, the affective modulation of the startle
reflex has been used as an objective measure of craving. It has been
shown that subjects with a low baseline startle response when
viewing alcohol-associated pictures are at major risk of relapse
compared to those with increased reactions.
Once alcohol craving has appeared, the subject will either drink or
not, depending on his ability to resist his behavior towards alco-
hol consumption (impulsivity or inhibitory control, IC). Moreover,
subjects that exhibit greater impulsivity are those more likely to
relapse.
Our group has recently conducted a study on a sample of 172
alcohol-dependent patients seen in outpatient therapeutic pro-
gramduring 12weeks. All of themwere assessedwith the following
measures: Attentional bias was assessed using the dot task, motiva-
tional responsewas evaluated using the affectivemodulation of the
startle reflex paradigm, inhibitory control was assessed by the stop-
signal reaction time task. Alcohol relapse variables were: relapse,
days to the first relapse and days of accumulated abstinence.
One of the most relevant results was that processes related to
inhibitory control (Stop-signal reaction time and attentional bias)
were the most relevant measures to explain variables related to
relapse in alcohol consumption during the treatment period.
Our results support the use of assessment strategies, therapeutic
and pharmacological inhibtoria aimed at improving the ability of
serious alcohol-dependent patients.
Disclosure of interest The author has not supplied his declaration
of competing interest.
Acknowledgements This project has been funded with the EA
1123 ERAB grant application.
Self-related processes and underlying brain
networks: Relevance for major psychiatric
disorders
S84
Self-related networks and negative
symptoms in psychotic disorders
A. Aleman
Groningen, The Netherlands
Objective Two factors of negative symptoms in schizophrenia
have been consistently described based on factor analysis, “expres-
sive deficits” and “social amotivation”. We aimed to investigate
the putatively differential involvement of self-related networks,
as measured with BOLD fMRI during a self-evaluation task, in
two dimensions of negative symptoms in schizophrenia (reduced
expression and social amotivation).
Method Forty-five patients with a diagnosis of schizophre-
nia participated in an fMRI study in which they performed a