European Psychiatry - Volume 33 - March 2016

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24th European Congress of Psychiatry / European Psychiatry 33S (2016) S56–S71 S59
Results First results are expected in 2016with furthermajor find-
ings following in 2019.
Conclusions The MILESTONE project will provide unprecedented
information on the nature and magnitude of problems at the
CAMHS-AMHS interface, andpotential solutions to overcome these.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
Future experts on the floor: Young researchers in
addiction
W09
Neurostimulation in alcohol
dependence: The effect of repetitive
transcranial magnetic stimulation on
brain function and craving
J. Jansen ∗, O. van den Heuvel , Y. van der Werf , S. De Wit ,
D. Veltman , W. van den Brink , A. Goudriaan
1 Academic Medical Centre, Psychiatry, Amsterdam, Netherlands
2 VU University Medical Center, Psychiatry, Amsterdam, Netherlands
3 Netherlands Institute for Neuroscience, Amsterdam, Netherlands
∗ Corresponding author.
Background Alcohol dependence has long been related to
impaired processing and handling of negative emotions. This is the
first study to compare emotion regulation (ER) at a behavioral and
neural level in alcohol dependent patients (ADPs) and healthy con-
trols (HCs). It also examines the effects of high-frequency repetitive
transcranialmagnetic stimulation (rTMS) onER abilities and related
craving levels in ADPs.
Method Thirty-six ADPs and 32 HCs matched on age, sex, and
education, were included in a within-subject fixed-order study
with one functional magnetic resonance imaging (fMRI) session
and one rTMS plus fMRI session, with high-frequency (10Hz) rTMS
over the right dorsolateral prefrontal cortex (dlPFC). An fMRI emo-
tion regulation task (ERT) was administered during both sessions
and craving was measured before and after each ERT.
Results ADPs were impaired in the regulation of negative emo-
tion and showed a higher activation of ER related brain areas
compared toHCs. Furthermore, active rTMS improvedER abilities in
both ADPs and HCs, but was accompanied by a decrease in anterior
cingulate and left dlPFC activity only in ADPs. In addition, the ERT-
induced increase in craving levels in ADPs was trend-significantly
reduced by active rTMS, with a large effect size.
Conclusions ADPs are impaired in the regulation of negative emo-
tion and show enhanced neural activity in the ER brain circuit.
High-frequency rTMS improves ER in ADPs and HCs and normalizes
neural activity and tends to reduce craving in ADPs. Future studies
are needed to test the long-term effects of (multiple session) rTMS
on ER, craving, and drinking.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
W10
The impact of appetite regulating
peptides on substance use disorders
A. Koopmann∗, F. Kiefer
Central Institute of Mental Health, Department of Addictive Behavior
and Addiction Medicine, Mannheim, Germany
∗ Corresponding author.
Background Preclinical and clinical data suggest modulating
effects of the appetite regulating peptide ghrelin on food intake.
Recent data suggest that in food intake the “endostatic” energy-
homeostatic systems of the lateral hypothalamus (LH) and the
motivational, mesolimbic reward systemoperate in dynamic inter-
play with each other. Ghrelin receptors have been detected in
the ventral tegmentum of the midbrain (VTA), where they mod-
ulate the activity of dopaminergic neurons projecting to the NAc.
Assuming that Ghrelin modulate mesolimbic reactivity, the ques-
tion remains: is this only the case in response to food cues? Or
is this the case in response to reward-associated cues in general
(including those related to nicotine and alcohol)?
Methods Study 1: a consecutive sample of 61 alcohol-dependent
male inpatients was included. Blood was drawn at onset of with-
drawal 12-24 hours after admission, and following 14 days of
controlled abstinence in order to assess plasma concentrations of
both active and total ghrelin. In parallel, we assessed alcohol crav-
ing applying the Obsessive Compulsive Drinking Scale (OCDS) as
well as symptoms of depression (Beck Depression Inventory [BDI])
and anxiety (State Trait Anxiety Inventory [STAI]). The severity of
alcohol dependence was assessed with the Alcohol Dependence
Scale (ADS). Study 2: 54 non-treatment seeking smokers and 30
healthy controls with normal eating behavior, as measured by the
Three Factor Eating Questionnaire (TFEQ) participated in this study.
We measured plasma concentrations of both active and total ghre-
lin, using a blood sample taken two hours after a standardizedmeal
during early nicotine abstinence in the smoking group. Addition-
ally we quantified severity of addiction in the smoking group using
the number of cigarettes smoked per day, cotinine plasma concen-
tration and the Fagerström Test for Nicotine Dependence (FTND).
Results Study1: we found a significant positive correlation
between the plasma concentration of active ghrelin and alcohol
craving in both blood samples. Plasma concentrations of active
ghrelin increased significantly during early abstinence. In a linear
regressionmodel, the plasma concentration of active ghrelin on day
one, the scores of the ADS, and the BDI explained 36% of the vari-
ance in OCDS sum score ( P< 0001). By day 14, these same factors
accounted for 54% (P < 0.0001). We did not detect any association
between the plasma concentration of total ghrelin and patients’
alcohol cravings. Study 2: plasma concentration of acetylated ghre-
lin but not total ghrelin was significantly higher in smokers than
in non-smokers. Moreover, we found significant negative correla-
tions between acetylated ghrelin and all measures of the severity
of nicotine dependence.
Discussion In conclusion, both studies supports the general idea
that ghrelin’s central effects go beyond the endostatic regulation
of energy homeostasis, also involving pathways underlying reward
expectation and craving. Physiologic factors modulating the reac-
tivity of mesolimbic pathways represent an important research
topic for developing pharmacologic treatments for disorders char-
acterized by altered reward-related behaviors, such as substance
use disorders and behavioral addictions.
Disclosure of interest The authors have not supplied their decla-
ration of competing interest.
W11
Novel psychoactive substances
L. Orsolini ∗, D. Papanti , R. Vecchiotti ,
A. Valchera , J. Corkery , F. Schifano
1 Villa San Giuseppe Hospital, Hermanas Hospitalarias, Department
of Psychiatry, Ascoli Piceno, Italy
2 Maastricht University, Department of Psychiatry and
Neuropsychology, Maastricht, Netherlands
3 Polyedra, Polyedra Research, Teramo, Italy
4 University of Hertfordshire, School of Life and Medical Sciences,
Department of Pharmacy, Pharmacology and Medical Sciences,
Hatfield, United Kingdom
∗ Corresponding author.