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Szerman N, Vega P, Roncero C, Peris L, Grau-López L, Basurte-Villamor I. Cariprazine as a maintenance treatment in dual schizophrenia: a 6-month observational study in patients with schizophrenia and cannabis use disorder. Int Clin Psychopharmacol 2024:00004850-990000000-00150. [PMID: 39319529 DOI: 10.1097/yic.0000000000000568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/26/2024]
Abstract
Schizophrenia is often associated with substance use disorders, particularly cannabis use disorder (CUD). However, treatments frequently fail to address both conditions simultaneously. This study aimed to evaluate the antipsychotic effectiveness of cariprazine in patients with both schizophrenia and CUD in a real-world setting. A 6-month observational study was conducted on 58 patients diagnosed with schizophrenia and CUD, treated with cariprazine. Antipsychotic effectiveness was measured using the Positive and Negative Syndrome Scale and the Clinical Global Impression-Schizophrenia Scale, along with the Improvement and Severity scales. Cannabis consumption and addiction severity were assessed using the Cannabis Abuse Screening Test and the Severity of Dependence Scale, while functioning was evaluated with the Sheehan Disability Inventory. Cariprazine treatment resulted in significant improvements in schizophrenia symptoms (Positive and Negative Syndrome Scale change: -47.88 points, P < 0.0001; Clinical Global Impression-Schizophrenia Scale change: -8.26 points, P < 0.0001). Cannabis use and dependence also decreased (Cannabis Abuse Screening Test change: -7.0 points, P < 0.0001; Severity of Dependence Scale change: -7.88 points, P < 0.0001), alongside improvements in functioning (Sheehan Disability Inventory change: -9.48 points, P < 0.0001). These results suggest that cariprazine is effective for both schizophrenia and CUD, though further research is needed to confirm these findings.
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Affiliation(s)
- Nestor Szerman
- WADD, WPA Section Dual Disorders, Mental Health and Psychiatric Institute, Gregorio Marañón University Hospital
- Francisco de Vitoria University
| | - Pablo Vega
- Francisco de Vitoria University
- Institute for Addictions, Madrid Salud, Madrid City Council, Madrid, Spain
| | - Carlos Roncero
- Department of Psychiatry, University of Salamanca Healthcare Complex
- Institute of Biomedicine of Salamanca, University of Salamanca
- Psychiatric Unit, School of Medicine, University of Salamanca, Salamanca, Spain
| | - Lola Peris
- Centre Neuchâtelois De Psychiatrie, Marin-Epagnier, Neuenburg, Switzerland
- Laber Hospitals
| | - Lara Grau-López
- Department of Psychiatry, University Hospital Vall d'Hebron, Barcelona
| | - Ignacio Basurte-Villamor
- Francisco de Vitoria University
- Department of Psychiatry and Behavioral Health, Clínica López Ibor
- European University of Madrid, Madrid, Spain
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2
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Kádár BK, Gajdics J, Pribék IK, Andó B, Lázár BA. Characterization of alcohol-related seizures in withdrawal syndrome. Epilepsia Open 2024; 9:679-688. [PMID: 38279829 PMCID: PMC10984295 DOI: 10.1002/epi4.12906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 12/14/2023] [Accepted: 01/15/2024] [Indexed: 01/29/2024] Open
Abstract
OBJECTIVE Alcohol-related seizures (ARS) are one of the most important consequences of alcohol withdrawal syndrome (AWS). However, demographic and clinical characteristics, and furthermore, the relationship of ARS with delirium tremens (DT), have not yet been evaluated in detail. Therefore, the aim of the present study was to reveal the correlates of ARS and examine the interaction of ARS with the occurrence of DT and with the severity of AWS. METHODS In the retrospective study (Study 1) 2851 medical charts of inpatient admissions characterized by AWS and DT were listed. Demographic and clinical variables of ARS were assessed. In the follow-up study (Study 2), patients admitted with AWS without (N = 28) and with (N = 18) ARS were enrolled. Study 1 was performed between 2008 and 2023, and Study 2 was performed in 2019 in Hungary. To determine the severity of AWS, the Clinical Institute Withdrawal Assessment Scale for Alcohol, Revised (CIWA-Ar) was used. ARS is a provoked, occasional seizure; therefore, patients with epilepsy syndrome were excluded from the two studies. Statistical analyses were performed by the means of chi-square tests, multinomial logistic regressions, mixed ANOVA, and derivation. RESULTS The occurrence of DT, the history of ARS, and somatic co-morbidities were found to be risk factors for the appearance of ARS. ARS was proved to be a risk factor for the development of DT. In the follow-up study, there was no difference in the decrease of CIWA-Ar scores between the groups. SIGNIFICANCE Our present findings support the likelihood of kindling, which is one of the most important mechanisms underlying the development of ARS, but do not directly prove its presence. Additionally, our results revealed that the severity of AWS is not influenced by the presence of ARS. PLAIN LANGUAGE SUMMARY Provoked, occasional seizures during AWS are defined as ARS. In the present study, predictors and interactions of these seizures with DT-the most severe form of withdrawal-and with the severity of withdrawal were examined in retrospective and follow-up studies. The present study shows that a history of withdrawal seizures, the occurrence of DT, and somatic comorbidities are predictors of the development of seizures. Furthermore, our findings suggest that the presence of seizures does not influence the severity of withdrawal.
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Affiliation(s)
- Bettina Kata Kádár
- Addiction Research Group, Department of Psychiatry, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Janka Gajdics
- Addiction Research Group, Department of Psychiatry, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Ildikó Katalin Pribék
- Addiction Research Group, Department of Psychiatry, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Bálint Andó
- Addiction Research Group, Department of Psychiatry, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
| | - Bence András Lázár
- Addiction Research Group, Department of Psychiatry, Albert Szent-Györgyi Medical School, University of Szeged, Szeged, Hungary
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3
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Gajdics J, Bagi O, Farkas FF, Andó B, Pribék IK, Lázár BA. The Impact of the COVID-19 Pandemic on the Severity of Alcohol Use Disorder: Significance of Dual Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6939. [PMID: 37887677 PMCID: PMC10606859 DOI: 10.3390/ijerph20206939] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 09/28/2023] [Accepted: 10/16/2023] [Indexed: 10/28/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has been assumed to impact patients diagnosed with alcohol use disorder (AUD). The severity of the influence that the COVID-19 pandemic had on the symptoms of AUD has not yet been revealed in detail. The aim of this study was to examine the impact of the COVID-19 pandemic on patients diagnosed with AUD. This retrospective study was conducted between 11 March 2017 and 31 May 2022 in Hungary. Medical charts (N = 1082) of inpatients with the diagnosis of AUD were reviewed. Based on the dates of admissions, two groups were created: the 'before COVID-19' group (11 March 2017-10 March 2020) and the 'during COVID-19' group (11 March 2020-31 May 2022). Chi-square tests, independent-sample t-tests, and multinomial logistic regressions were performed. The occurrence of delirium tremens (DT) and psychiatric co-morbidities was significantly higher during the pandemic. Our results showed that the occurrence of DT and psychiatric co-morbidities significantly increased during the pandemic. Our results revealed that the pandemic enhanced the severe consequences of AUD, and the development of AUD might have increased in frequency among individuals previously diagnosed with mental illness during the pandemic. These findings indicate the significance of dual disorders in the post-pandemic period.
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Affiliation(s)
| | | | | | | | | | - Bence András Lázár
- Addiction Research Group, Department of Psychiatry, University of Szeged, 6720 Szeged, Hungary; (J.G.); (O.B.); (F.F.F.); (B.A.); (I.K.P.)
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4
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Ubhayarathna M, Langmead CJ, Diepenhorst NA, Stewart GD. Molecular and structural insights into the 5-HT 2C receptor as a therapeutic target for substance use disorders. Br J Pharmacol 2023. [PMID: 37679998 DOI: 10.1111/bph.16233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 09/09/2023] Open
Abstract
Substance use disorder (SUD) is a chronic condition, with maintained abuse of a substance leading to physiological and psychological alterations and often changes in cognitive and social behaviours. Current therapies include psychotherapy coupled with medication; however, high relapse rates reveal the shortcomings of these therapies. The signalling, expression profile, and neurological function of the serotonin 2C receptor (5-HT2C receptor) make it a candidate of interest for the treatment of SUD. Recently, psychedelics, which broadly act at 5-HT2 receptors, have indicated potential for the treatment of SUD, implicating the 5-HT2C receptor. The modern psychedelic movement has rekindled interest in the 5-HT2C receptor, resulting in many new studies, especially structural analyses. This review explores the structural, molecular and cellular mechanisms governing 5-HT2C receptor function in the context of SUD. This provides the basis of the preclinical and clinical evidence for their role in SUD and highlights the potential for future exploration.
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Affiliation(s)
- Maleesha Ubhayarathna
- Drug Discovery Biology and Neuroscience & Mental Health Therapeutic Program Area, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia
- ARC Centre for Cryo-electron Microscopy of Membrane Proteins, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Christopher J Langmead
- Drug Discovery Biology and Neuroscience & Mental Health Therapeutic Program Area, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia
- ARC Centre for Cryo-electron Microscopy of Membrane Proteins, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia
- Neuromedicines Discovery Centre, Monash University, Parkville, Australia
| | - Natalie A Diepenhorst
- Drug Discovery Biology and Neuroscience & Mental Health Therapeutic Program Area, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia
- ARC Centre for Cryo-electron Microscopy of Membrane Proteins, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia
| | - Gregory D Stewart
- Drug Discovery Biology and Neuroscience & Mental Health Therapeutic Program Area, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia
- ARC Centre for Cryo-electron Microscopy of Membrane Proteins, Monash Institute of Pharmaceutical Sciences, Monash University, Parkville, Australia
- Neuromedicines Discovery Centre, Monash University, Parkville, Australia
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5
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Morawetz C, Berboth S, Chirokoff V, Chanraud S, Misdrahi D, Serre F, Auriacombe M, Fatseas M, Swendsen J. Mood Variability, Craving, and Substance Use Disorders: From Intrinsic Brain Network Connectivity to Daily Life Experience. BIOLOGICAL PSYCHIATRY. COGNITIVE NEUROSCIENCE AND NEUROIMAGING 2023; 8:940-955. [PMID: 36775712 DOI: 10.1016/j.bpsc.2022.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2022] [Revised: 10/13/2022] [Accepted: 11/01/2022] [Indexed: 11/11/2022]
Abstract
BACKGROUND Substance use disorders (SUDs) are major contributors to morbidity and mortality rates worldwide, and this global burden is attributable in large part to the chronic nature of these conditions. Increased mood variability might represent a form of emotional dysregulation that may have particular significance for the risk of relapse in SUD, independent of mood severity or diagnostic status. However, the neural biomarkers that underlie mood variability remain poorly understood. METHODS Ecological momentary assessment was used to assess mood variability, craving, and substance use in real time in 54 patients treated for addiction to alcohol, cannabis, or nicotine and 30 healthy control subjects. Such data were jointly examined relative to spectral dynamic causal modeling of effective brain connectivity within 4 networks involved in emotion generation and regulation. RESULTS Differences in effective connectivity were related to daily life variability of emotional states experienced by persons with SUD, and mood variability was associated with craving intensity. Relative to the control participants, effective connectivity was decreased for patients in the prefrontal control networks and increased in the emotion generation networks. Findings revealed that effective connectivity within the patient group was modulated by mood variability. CONCLUSIONS The intrinsic causal dynamics in large-scale neural networks underlying emotion regulation play a predictive role in a patient's susceptibility to experiencing mood variability (and, subsequently, craving) in daily life. The findings represent an important step toward informing interventional research through biomarkers of factors that increase the risk of relapse in persons with SUD.
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Affiliation(s)
- Carmen Morawetz
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria.
| | - Stella Berboth
- Institute of Psychology, University of Innsbruck, Innsbruck, Austria
| | - Valentine Chirokoff
- National Centre for Scientific Research UMR 5287 - Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, University of Bordeaux, Bordeaux, France; École pratique des hautes études, Paris Sciences et Lettres Research University, Paris, France
| | - Sandra Chanraud
- National Centre for Scientific Research UMR 5287 - Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, University of Bordeaux, Bordeaux, France; École pratique des hautes études, Paris Sciences et Lettres Research University, Paris, France
| | - David Misdrahi
- National Centre for Scientific Research UMR 5287 - Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, University of Bordeaux, Bordeaux, France; Centre Hospitalier Charles Perrens, Bordeaux, France
| | - Fuschia Serre
- Centre National de la Recherche Scientifique UMR 6033 - Sleep, Addiction and Neuropsychiatry, University of Bordeaux, Bordeaux, France
| | - Marc Auriacombe
- Centre National de la Recherche Scientifique UMR 6033 - Sleep, Addiction and Neuropsychiatry, University of Bordeaux, Bordeaux, France; Centre Hospitalier Charles Perrens, Bordeaux, France; Centre Hospitalier Universitaire Bordeaux, Bordeaux, France
| | - Melina Fatseas
- National Centre for Scientific Research UMR 5287 - Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, University of Bordeaux, Bordeaux, France; Centre Hospitalier Universitaire Bordeaux, Bordeaux, France
| | - Joel Swendsen
- National Centre for Scientific Research UMR 5287 - Institut de Neurosciences Cognitives et Intégratives d'Aquitaine, University of Bordeaux, Bordeaux, France; École pratique des hautes études, Paris Sciences et Lettres Research University, Paris, France
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Harris J, Dalkin S, Jones L, Ainscough T, Maden M, Bate A, Copello A, Gilchrist G, Griffith E, Mitcheson L, Sumnall H, Hughes E. Achieving integrated treatment: a realist synthesis of service models and systems for co-existing serious mental health and substance use conditions. Lancet Psychiatry 2023; 10:632-643. [PMID: 37327804 DOI: 10.1016/s2215-0366(23)00104-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 06/18/2023]
Abstract
Approximately 30-50% of people with serious mental illness have co-existing drug or alcohol problems (COSMHAD), associated with adverse health and social care outcomes. UK guidelines advocate both co-occurring needs being met within mental health services, but uncertainty remains about how to operationalise this to improve outcomes. Various unevaluated service configurations exist in the UK. A realist synthesis was done to identify, test, and refine programme theories of how context shapes the mechanisms through which UK service models for COSMHAD work, for whom, and in what circumstances. Structured and iterative realist searches of seven databases identified 5099 records. A two-stage screening process identified 132 papers. Three broad contextual factors shaped COSMHAD services across 11 programme theories: committed leadership, clear expectations regarding COSMHAD from mental health and substance use workforces, and clear care-coordination processes. These contextual factors led to increased staff empathy, confidence, legitimisation, and multidisciplinary ethos, which improved care coordination and increased the motivation of people with COSMHAD to work towards their goals. Our synthesis highlights that integrating COSMHAD care is complex, and both individual and cultural behavioural shifts in leadership, workforce, and service delivery are essential to ensure people with COSMHAD receive compassionate, trauma-informed care that meets their needs.
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Affiliation(s)
- Jane Harris
- Public Health Institute, Faculty of Health, Liverpool John Moores University, Liverpool, UK.
| | - Sonia Dalkin
- Department of Social Work, Education and Community Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Newcastle, UK
| | - Lisa Jones
- Public Health Institute, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Tom Ainscough
- School of Healthcare, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - Michelle Maden
- Liverpool Reviews and Implementation Group, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Angela Bate
- Department of Social Work, Education and Community Wellbeing, Faculty of Health and Life Sciences, Northumbria University, Newcastle, UK
| | - Alexandre Copello
- School of Psychology, College of Life and Environmental Sciences, University of Birmingham, Birmingham, UK
| | - Gail Gilchrist
- National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Emma Griffith
- Specialised Services, Avon and Wiltshire NHS Partnership Trust, Bristol, UK
| | - Luke Mitcheson
- Department of Psychology and Psychiatry in Addictions, South London and Maudsley NHS Trust, London, UK
| | - Harry Sumnall
- Public Health Institute, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Elizabeth Hughes
- School of Heath and Social Care, Edinburgh Napier University, Edinburgh, UK
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7
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Luciano M, Di Vincenzo M, Mancuso E, Marafioti N, Di Cerbo A, Giallonardo V, Sampogna G, Fiorillo A. Does the Brain Matter? Cortical Alterations in Pediatric Bipolar Disorder: A Critical Review of Structural and Functional Magnetic Resonance Studies. Curr Neuropharmacol 2023; 21:1302-1318. [PMID: 36173069 PMCID: PMC10324338 DOI: 10.2174/1570159x20666220927114417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/14/2022] [Accepted: 07/28/2022] [Indexed: 11/22/2022] Open
Abstract
Pediatric bipolar disorder (PBD) is associated with significant psychosocial impairment, high use of mental health services and a high number of relapses and hospitalization. Neuroimaging techniques provide the opportunity to study the neurodevelopmental processes underlying PBD, helping to identify the endophenotypic markers of illness and early biological markers of PBD. The aim of the study is to review available studies assessing structural and functional brain correlates associated with PBD. PubMed, ISI Web of Knowledge and PsychINFO databases have been searched. Studies were included if they enrolled patients aged 0-18 years with a main diagnosis of PBD according to ICD or DSM made by a mental health professional, adopted structural and/or functional magnetic resonance as the main neuroimaging method, were written in English and included a comparison with healthy subjects. Of the 400 identified articles, 46 papers were included. Patients with PBD present functional and anatomic alterations in structures normally affecting regulations and cognition. Structural neuroimaging revealed a significant reduction in gray matter, with cortical thinning in bilateral frontal, parietal and occipital cortices. Functional neuroimaging studies reported a reduced engagement of the frontolimbic and hyperactivation of the frontostriatal circuitry. Available studies on brain connectivity in PBD patients potentially indicate less efficient connections between regions involved in cognitive and emotional functions. A greater functional definition of alteration in brain functioning of PBD patients will be useful to set up a developmentally sensitive targeted pharmacological and nonpharmacological intervention.
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Affiliation(s)
- Mario Luciano
- Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Matteo Di Vincenzo
- Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Emiliana Mancuso
- Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Niccolò Marafioti
- Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Arcangelo Di Cerbo
- Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, Italy
| | | | - Gaia Sampogna
- Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania “L. Vanvitelli”, Naples, Italy
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8
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Formánek T, Krupchanka D, Mladá K, Winkler P, Jones PB. Mortality and life-years lost following subsequent physical comorbidity in people with pre-existing substance use disorders: a national registry-based retrospective cohort study of hospitalised individuals in Czechia. Lancet Psychiatry 2022; 9:957-968. [PMID: 36335974 DOI: 10.1016/s2215-0366(22)00335-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/26/2022] [Accepted: 09/02/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND Substance use disorders constitute a major global public health problem, attributable largely to their subsequent comorbidity with other health conditions. This study aimed to investigate the risk of all-cause death and life-years lost following hospitalisation for 28 subsequent physical comorbid conditions in people with a previous hospitalisation for substance use disorder, compared with matched counterparts without substance use disorder. METHODS We did a retrospective cohort study on data from Czech nationwide registers of all-cause hospitalisations and deaths during the period from Jan 1, 1994, to Dec 31, 2017. The cohorts consisted of individuals who had initially been hospitalised between 15 and 70 years of age (index hospitalisation) and who were subsequently hospitalised with one or more of 28 comorbid physical health conditions. We included individuals with an index hospitalisation for substance use disorders and up to three counterparts without substance use disorders with a subsequent hospitalisation for the same physical health condition, with matching on sex, age (±3 years), work status, and discharge year at first hospitalisation for the subsequent condition. Data on ethnicity were not available. Risk of death due to any cause following the first hospitalisation for each physical health condition until Dec 31, 2017, and life-years lost after disease onset at ages 30, 45, and 60 years, and before 81 years of age, were examined. FINDINGS From a total 56 229 563 records of hospitalisations identified, we included 121 153 people with hospitalisation for substance use disorders and 6 742 134 people without hospitalisation for substance use disorders in the study. The 28 condition-specific cohorts comprised a median of 6444 individuals (IQR 2033-12 358), ranging from 444 for multiple sclerosis to 36 356 for diseases of the circulatory system. Across the cohorts, the proportion of males ranged from 31·4% for thyroid disorder to 100·0% for prostate disorders. The mean baseline age ranged from 30·0 years (SD 9·1) for chronic viral hepatitis in people with pre-existing substance use disorders to 62·2 years (9·7) for Parkinson's disease in people without pre-existing substance use disorders. After adjusting for potential confounders using stratified Cox proportional hazards models, individuals with a pre-existing substance use disorder had an increased risk of death due to any cause after the onset of 26 out of 28 physical health conditions, relative to their counterparts without substance use disorders, with adjusted hazard ratios ranging from 1·15 (1·09-1·21) for chronic liver disease to 3·86 (2·62-5·67) for thyroid disorder. For seven subsequent health conditions, the risk of death was more than doubled in the group with pre-existing substance use disorders. When compared with the general population via mortality tables, people with pre-existing substance use disorders had substantial losses in life-years after the onset of most of the subsequent physical health conditions regardless of age of onset, and, for the majority of comorbidities, lost considerably more life-years than their counterparts without substance use disorders. INTERPRETATION A history of hospitalisation for substance use disorders appears to have a significant negative effect on prognosis following the development of various subsequent physical health conditions. These findings strongly suggest that clinical vigilance and high-quality integrated treatment for people with substance use disorders could be life-saving and should be given higher priority on the public health agenda. FUNDING National Institute for Health and Care Research Applied Research Collaboration East of England at Cambridge and Peterborough National Health Service Foundation Trust.
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Affiliation(s)
- Tomáš Formánek
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia; Department of Psychiatry, University of Cambridge, Cambridge, UK.
| | - Dzmitry Krupchanka
- Department of Mental Health and Substance Use, World Health Organization, Geneva, Switzerland
| | - Karolína Mladá
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia; Department of Psychiatry, Faculty of Medicine, University Hospital in Pilsen, Charles University Prague, Pilsen, Czechia
| | - Petr Winkler
- Department of Public Mental Health, National Institute of Mental Health, Klecany, Czechia; Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Peter B Jones
- Department of Psychiatry, University of Cambridge, Cambridge, UK
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9
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Busch G, Seo JY. Establishing a System of Care for Severe and Refractory Dual Disorder in the State of Hawai'i. HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2022; 81:19-26. [PMID: 36660278 PMCID: PMC9783815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Dual disorder is the diagnosis of both substance use disorder and a psychiatric disorder in the same individual. This paper focuses on the cohort of persons with severe and refractory dual disorders (SRDD). This cohort exhibits disproportionately high use of emergency services, poor response to existing care resources, high risk of homelessness, and elevated risk of violent deaths. Clarifying the unique and problematic aspects of SRDD can provide direction for intervention and policy within the system of care in Hawai'i. Data regarding the prevalence of dual disorder in Hawai'i are reviewed along with Hawai'i data on emergency room utilization, and violent death rates relevant to a cohort of individuals with SRDD. The current system of care in Hawai'i is examined. Although not an official component of the public health system or system of care, the O'ahu Community Correctional Center is presented as a potential model for longer-term stabilization for those with SRDD. Interventions from the literature for dual disorders and their implications for SRDD are discussed. Based upon this review, the following recommendations are made: (1) strengthen specific dual disorder diagnosis data collection, including stratification of dual disorder severity, (2) enhance coordination and establish uniform state data governance across public safety, public health, and private sectors, (3) develop a care environment that makes long-term and integrated treatment available, (4) enhance case management services and patient engagement, and (5) encourage policy discussions of longer-term civil commitment for residential treatment for individuals with SRDD.
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Affiliation(s)
- Gerald Busch
- Department of Psychiatry, John A Burns School of Medicine, University of Hawai‘i at Mānoa
| | - Jin Young Seo
- Department of Psychiatry, John A Burns School of Medicine, University of Hawai‘i at Mānoa
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10
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Clinical care of patients with dual disorders in India: diverse models of care delivery. ADVANCES IN DUAL DIAGNOSIS 2022. [DOI: 10.1108/add-09-2022-0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose
This study aims to offer an overview of the models of clinical care of the patients with dual disorders in India.
Design/methodology/approach
All the members of the Dual Diagnosis India Network (DDIN) who shared the clinical care delivery at their center were invited to share the details of their model. In addition, an invite was also sent to those members who could not attend the online session but were interested in contributing the required information about their model. The information shared by the respondents was collated. The different models were then categorized based on their features.
Findings
Following the categorization of the clinical care services organization across different settings, five different models emerged. These were specialized dual diagnosis clinic; services for dual disorders offered as substance use disorder (SUD) treatment services within general psychiatry care; services for dual disorders in general psychiatry care; services for dual disorders offered as SUD treatment services separated from general psychiatry care; and services for dual disorders offered in general psychiatry services combined with exclusive SUD treatment services.
Originality/value
Currently, there is limited literature on models of dual disorders from the low- and middle-income countries. The authors believe that the documentation of these models from India shall be of help while setting up services for dual disorders in other health-care settings. This study can be a valuable resource for making informed choices while setting up new services.
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11
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Improving physical activity and diet in patients with severe mental disorders: Results from the LIFESTYLE multicentric, real-world randomized controlled trial. Psychiatry Res 2022; 317:114818. [PMID: 36088834 DOI: 10.1016/j.psychres.2022.114818] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 08/27/2022] [Accepted: 08/30/2022] [Indexed: 11/23/2022]
Abstract
Aims of the present study are to test the efficacy of a lifestyle group intervention, compared to a brief psychoeducational intervention, on levels of physical activity and dietary habits in a real-world sample of patients with severe mental disorders. The study, funded by the Italian Ministry of Education, has been carried out in six Italian University psychiatric outpatient units. All patients were randomly assigned to the experimental or control group and were assessed through standardized assessment instruments at baseline and six months after randomization. Of the 401 recruited patients, 43.3% had a diagnosis of bipolar disorder, 29.9% of psychosis and 26.9% of major depression. Patients were mainly female (57%), with a mean age of 45.6±11.8 years. Treated patients have almost 8 times the likelihood to show an increase of the total MET (OR: 8.02; p < .001) and of the walking MET (OR: 7.68; p < .001) and are more likely to increase the weekly consumption of vegetables (OR= 1.98, p < .05) and to reduce that of junk food (OR:0.23; p < .05). The present study support the notion that patients with severe mental disorders can improve their lifestyle behaviours and that, with appropriate support, they can achieve a healthy living.
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12
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Sampogna G, Borgi M, Collacchi B, Cirulli F, Cerino S, Rullo S, Di Vincenzo M, Luciano M, Di Tommaso V, Moliterni S, Bichi A, Garside J, Kivistö S, Iarion A, Fiorillo A. Using sport-based interventions for people with severe mental disorders: results from the European EASMH study. Int Rev Psychiatry 2022; 34:837-847. [PMID: 36786110 DOI: 10.1080/09540261.2022.2106122] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
People with severe mental disorders report significantly poorer physical health and a higher mortality rate compared with the general population. Several interventions have been proposed in order to challenge this mortality gap, the promotion of physical activities represents one of the most important strategies. In fact, in people with severe mental disorders, physical activity can improve body composition, quality of life, personal functioning, self-esteem, cognition, and cardiorespiratory fitness, as well as reducing affective, psychotic and anxiety symptoms, cardiometabolic burden and increase the global recovery. While sport-based programs are consistently being proposed as an integral part of effective personalized treatment approaches for people with severe mental disorders, their routine implementation is hampered by poor working task integration among different professionals and the lack of training programmes for sport professionals focused on people with severe mental disorders. In this paper, we will: (a) review the efficacy of exercise/sport-based interventions for people with severe mental disorders; (b) describe the main difficulties in engaging patients with severe mental disorders in these interventions; and (c) report the results of the first study on the best practices available in Europe in the field of sport and mental health carried out in the context of the European Alliance for Sport and Mental Health (EASMH) project. According to the EASMH survey, sport-based psychosocial interventions are not frequently available in mental health services, with significant differences at the European level. In the near future, it would be advisable to promote the integration and collaboration between mental health professionals and sport professionals, in order to improve the dissemination and availability of sport-based interventions in routine clinical practice. The EASMH project aims to fill this gap by creating a network of collaborators, researchers and stakeholders with different backgrounds in order to improve the dissemination of sport-based rehabilitation interventions and by developing an innovative training programme for sport coaches in order to improve their skills in interacting and building an effective relationship with people with severe mental disorders.
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Affiliation(s)
- Gaia Sampogna
- Department of Psychiatry, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Marta Borgi
- National Institute of Health, Rome, Italy.,European Culture and Sport Organization, ECOS, Rome; Italy
| | | | - Francesca Cirulli
- National Institute of Health, Rome, Italy.,European Culture and Sport Organization, ECOS, Rome; Italy
| | | | - Santo Rullo
- European Culture and Sport Organization, ECOS, Rome; Italy
| | - Matteo Di Vincenzo
- Department of Psychiatry, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania 'Luigi Vanvitelli', Naples, Italy
| | | | | | - Alberto Bichi
- The European Platform for Sport Innovation, EPSI, Brussels; Belgium
| | | | | | | | - Andrea Fiorillo
- Department of Psychiatry, University of Campania 'Luigi Vanvitelli', Naples, Italy
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13
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Addictive and other mental disorders: a call for a standardized definition of dual disorders. Transl Psychiatry 2022; 12:446. [PMID: 36229453 PMCID: PMC9562408 DOI: 10.1038/s41398-022-02212-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 09/22/2022] [Accepted: 09/29/2022] [Indexed: 11/17/2022] Open
Abstract
The persistent difficulty in conceptualizing the relationship between addictive and other mental disorders stands out among the many challenges faced by the field of Psychiatry. The different philosophies and schools of thought about, and the sheer complexity of these highly prevalent clinical conditions make progress inherently difficult, not to mention the profusion of competing and sometimes contradictory terms that unnecessarily exacerbate the challenge. The lack of a standardized term adds confusion, fuels stigma, and contributes to a "wrong door syndrome" that captures the difficulty of not only diagnosing but also treating addictive and other mental disorders in an integrated manner. The World Association on Dual Disorders (WADD) proposes the adoption of the term "Dual Disorder" which, while still arbitrary, would help harmonize various clinical and research efforts by rallying around a single, more accurate, and less stigmatizing designation.
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Martinotti G, Chiappini S, Mosca A, Miuli A, Santovito MC, Pettorruso M, Skryabin V, Sensi SL, Giannantonio MD. Atypical antipsychotic drugs in dual disorders: current evidence and clinical guidelines. Curr Pharm Des 2022; 28:2241-2259. [PMID: 35747956 DOI: 10.2174/1381612828666220623092853] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/15/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Concurrent disorder or dual diagnosis refers to a combination of substance use disorders and mental disorders that occur in the same patient simultaneously. These conditions pose significant clinical and healthcare impacts and are often underdiagnosed, undertreated, and complex to manage. OBJECTIVE We assessed the quality of current pharmacological recommendations for the management of dual diagnosis, particularly by evaluating the use of second-generation antipsychotics (SGA). METHOD A literature search was performed using the PubMed and Scopus databases for publications up to September 21, 2021, without any time restrictions. The following search strings were used: (aripiprazole OR brexpiprazole OR cariprazine OR paliperidone OR risperidone OR quetiapine OR clozapine OR olanzapine) AND (psychosis OR schizophrenia OR schizoaffective) AND ("substance use disorder" OR cocaine OR alcohol OR cannabis OR heroin OR "double diagnosis" OR "dual diagnosis")) NOT (animal OR rat OR mouse) NOT (review or meta-analysis). RESULTS The search produced a final set of 41 articles. Most patients were males and were affected by schizophrenia, with cannabis the most abused substance, followed by alcohol. Aripiprazole was the most used drug, either orally or by long-acting formulations, followed by risperidone with oral and long-acting formulations, clozapine, olanzapine, and quetiapine. CONCLUSION The findings highlight the use of SGA for the treatment of psychotic symptoms in comorbidity with substance use. Future studies on people with dual diagnosis and focused on long-term evaluations are warranted and need to investigate the efficacy of newly introduced molecules, such as partial D2 agonists and long-acting injectable antipsychotics.
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Affiliation(s)
- Giovanni Martinotti
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, 66100 Chieti-Pescara, Italy.,Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9AB, UK
| | - Stefania Chiappini
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, 66100 Chieti-Pescara, Italy.,Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9AB, UK
| | - Alessio Mosca
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, 66100 Chieti-Pescara, Italy
| | - Andrea Miuli
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, 66100 Chieti-Pescara, Italy
| | - Maria Chiara Santovito
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, 66100 Chieti-Pescara, Italy
| | - Mauro Pettorruso
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, 66100 Chieti-Pescara, Italy
| | - Valentin Skryabin
- Moscow Research and Practical Center on Addictions of the Moscow Department of Healthcare, 37/1 Lyublinskaya street, Moscow, Russia
| | - Stefano L Sensi
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, 66100 Chieti-Pescara, Italy
| | - Massimo Di Giannantonio
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, 66100 Chieti-Pescara, Italy
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15
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Correll CU, Solmi M, Croatto G, Schneider LK, Rohani-Montez SC, Fairley L, Smith N, Bitter I, Gorwood P, Taipale H, Tiihonen J. Mortality in people with schizophrenia: a systematic review and meta-analysis of relative risk and aggravating or attenuating factors. World Psychiatry 2022; 21:248-271. [PMID: 35524619 PMCID: PMC9077617 DOI: 10.1002/wps.20994] [Citation(s) in RCA: 215] [Impact Index Per Article: 107.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
People with schizophrenia die 15-20 years prematurely. Understanding mortality risk and aggravating/attenuating factors is essential to reduce this gap. We conducted a systematic review and random-effects meta-analysis of prospective and retrospective, nationwide and targeted cohort studies assessing mortality risk in people with schizophrenia versus the general population or groups matched for physical comorbidities or groups with different psychiatric disorders, also assessing moderators. Primary outcome was all-cause mortality risk ratio (RR); key secondary outcomes were mortality due to suicide and natural causes. Other secondary outcomes included any other specific-cause mortality. Publication bias, subgroup and meta-regression analyses, and quality assessment (Newcastle-Ottawa Scale) were conducted. Across 135 studies spanning from 1957 to 2021 (schizophrenia: N=4,536,447; general population controls: N=1,115,600,059; other psychiatric illness controls: N=3,827,955), all-cause mortality was increased in people with schizophrenia versus any non-schizophrenia control group (RR=2.52, 95% CI: 2.38-2.68, n=79), with the largest risk in first-episode (RR=7.43, 95% CI: 4.02-13.75, n=2) and incident (i.e., earlier-phase) schizophrenia (RR=3.52, 95% CI: 3.09-4.00, n=7) versus the general population. Specific-cause mortality was highest for suicide or injury-poisoning or undetermined non-natural cause (RR=9.76-8.42), followed by pneumonia among natural causes (RR=7.00, 95% CI: 6.79-7.23), decreasing through infectious or endocrine or respiratory or urogenital or diabetes causes (RR=3 to 4), to alcohol or gastrointestinal or renal or nervous system or cardio-cerebrovascular or all natural causes (RR=2 to 3), and liver or cerebrovascular, or breast or colon or pancreas or any cancer causes (RR=1.33 to 1.96). All-cause mortality increased slightly but significantly with median study year (beta=0.0009, 95% CI: 0.001-0.02, p=0.02). Individuals with schizophrenia <40 years of age had increased all-cause and suicide-related mortality compared to those ≥40 years old, and a higher percentage of females increased suicide-related mortality risk in incident schizophrenia samples. All-cause mortality was higher in incident than prevalent schizophrenia (RR=3.52 vs. 2.86, p=0.009). Comorbid substance use disorder increased all-cause mortality (RR=1.62, 95% CI: 1.47-1.80, n=3). Antipsychotics were protective against all-cause mortality versus no antipsychotic use (RR=0.71, 95% CI: 0.59-0.84, n=11), with largest effects for second-generation long-acting injectable anti-psychotics (SGA-LAIs) (RR=0.39, 95% CI: 0.27-0.56, n=3), clozapine (RR=0.43, 95% CI: 0.34-0.55, n=3), any LAI (RR=0.47, 95% CI: 0.39-0.58, n=2), and any SGA (RR=0.53, 95% CI: 0.44-0.63, n=4). Antipsychotics were also protective against natural cause-related mortality, yet first-generation antipsychotics (FGAs) were associated with increased mortality due to suicide and natural cause in incident schizophrenia. Higher study quality and number of variables used to adjust the analyses moderated larger natural-cause mortality risk, and more recent study year moderated larger protective effects of antipsychotics. These results indicate that the excess mortality in schizophrenia is associated with several modifiable factors. Targeting comorbid substance abuse, long-term maintenance antipsychotic treatment and appropriate/earlier use of SGA-LAIs and clozapine could reduce this mortality gap.
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Affiliation(s)
- Christoph U Correll
- Department of Child and Adolescent Psychiatry, Charité Universitätsmedizin Berlin, Berlin, Germany
- Department of Psychiatry, Zucker Hillside Hospital, Northwell Health, Glen Oaks, NY, USA
- Department of Psychiatry and Molecular Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Marco Solmi
- Department of Psychiatry, University of Ottawa, Ottawa, ON, Canada
- Department of Mental Health, Ottawa Hospital, Ottawa, ON, Canada
- Ottawa Hospital Research Institute (OHRI) Clinical Epidemiology Program, University of Ottawa, Ottawa, ON, Canada
- School of Epidemiology and Public Health, Faculty of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Giovanni Croatto
- Mental Health Department, AULSS 3 Serenissima, Mestre, Venice, Italy
| | | | | | | | | | - István Bitter
- Department of Psychiatry and Psychotherapy, Semmelweis University, Budapest, Hungary
| | - Philip Gorwood
- INSERM U1266, Institute of Psychiatry and Neurosciences of Paris (IPNP), Paris, France
- GHU Paris Psychiatrie et Neurosciences (CMME, Sainte-Anne Hospital), Université de Paris, Paris, France
| | - Heidi Taipale
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
- School of Pharmacy, University of Eastern Finland, Kuopio, Finland
| | - Jari Tiihonen
- Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
- Center for Psychiatry Research, Stockholm City Council, Stockholm, Sweden
- Department of Forensic Psychiatry, University of Eastern Finland, Niuvanniemi Hospital, Kuopio, Finland
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Adan A, Navarro JF. Protocol for Characterization of Addiction and Dual Disorders: Effectiveness of Coadjuvant Chronotherapy in Patients with Partial Response. J Clin Med 2022; 11:1846. [PMID: 35407454 PMCID: PMC8999756 DOI: 10.3390/jcm11071846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 03/21/2022] [Accepted: 03/23/2022] [Indexed: 12/04/2022] Open
Abstract
This protocol aims to characterize patients with dual disorders (DD; comorbid major depression and schizophrenia) compared with patients with only a diagnosis of substance use disorder (SUD) and those with only a diagnosis of severe mental illness (SMI; major depression and schizophrenia), evaluating clinical and personality characteristics, circadian rhythmic functioning, genetic polymorphism and neuropsychological performance in order to obtain a clinical endophenotype of differential vulnerability for these diagnostic entities. Patients will be divided into three groups: DD (45 men with comorbid schizophrenia, 45 men and 30 women with major depression), SUD (n = 90, with a minimum of 30 women) and SMI males (45 with schizophrenia, 45 with major depression). All patients will be under treatment, with at least three months of SUD abstinence and/or with SMI in remission or with stabilized symptoms. Outpatients of both sexes with insufficient restoration of circadian rhythmicity with SUD (n = 30) and dual depression (n = 30) will be asked to participate in a second two-month study, being alternately assigned to the condition of the chronobiological adjuvant approach to the treatment of regular hour habits and exposure to light or to the usual treatment (control). The effect of the intervention and patient compliance will be monitored with a Kronowise KW6® ambulatory device during the first two weeks of treatment and again at weeks 4 and 8 weeks. After completing the evaluation, follow-up of the clinical evolution will be carried out at 3, 6 and 12 months. This project will allow us to analyze the functional impact of DD comorbidity and to develop the first study of chronobiological therapy in the treatment of SUD and dual depression, with results transferable to the clinical setting with cost-effective recommendations for a personalized approach.
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Affiliation(s)
- Ana Adan
- Department of Clinical Psychology and Psychobiology, School of Psychology, University of Barcelona, Passeig de la Vall d’Hebrón 171, 08035 Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, 08035 Barcelona, Spain
| | - José Francisco Navarro
- Department of Psychobiology, School of Psychology, University of Málaga, Campus de Teatinos s/n, 29071 Málaga, Spain;
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Sampogna G, Luciano M, Di Vincenzo M, Andriola I, D'Ambrosio E, Amore M, Serafini G, Rossi A, Carmassi C, Dell'Osso L, Di Lorenzo G, Siracusano A, Rossi R, Fiorillo A. The Complex Interplay Between Physical Activity and Recovery Styles in Patients With Severe Mental Disorders in a Real-World Multicentric Study. Front Psychiatry 2022; 13:945650. [PMID: 35898630 PMCID: PMC9309609 DOI: 10.3389/fpsyt.2022.945650] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 05/31/2022] [Indexed: 11/13/2022] Open
Abstract
Compared with the general population, people with severe mental disorders have significantly worse physical health and a higher mortality rate, which is partially due to the adoption of unhealthy lifestyle behaviors, such as heavy smoking, use of alcohol or illicit drugs, unbalanced diet, and physical inactivity. These unhealthy behaviors may also play a significant role in the personal and functional recovery of patients with severe mental disorders, although this relationship has been rarely investigated in methodologically robust studies. In this paper, we aim to: a) describe the levels of physical activity and recovery style in a sample of patients with severe mental disorders; b) identify the clinical, social, and illness-related factors that predict the likelihood of patients performing physical activity. The global sample consists of 401 patients, with a main psychiatric diagnosis of bipolar disorder (43.4%, N = 174), psychosis spectrum disorder (29.7%; N = 119), or major depression (26.9%; N = 118). 29.4% (N = 119) of patients reported performing physical activity regularly, most frequently walking (52.1%, N = 62), going to the gym (21.8%, N = 26), and running (10.9%, N = 13). Only 15 patients (3.7%) performed at least 75 min of vigorous physical activity per week. 46.8% of patients adopted sealing over as a recovery style and 37.9% used a mixed style toward integration. Recovery style is influenced by gender (p < 0.05) and age (p < 0.05). The probability to practice regular physical activity is higher in patients with metabolic syndrome (Odds Ratio - OR: 2.1; Confidence Interval - CI 95%: 1.2-3.5; p < 0.050), and significantly lower in those with higher levels of anxiety/depressive symptoms (OR: 0.877; CI 95%: 0.771-0.998; p < 0.01). Globally, patients with severe mental disorders report low levels of physical activities, which are associated with poor recovery styles. Psychoeducational interventions aimed at increasing patients' motivation to adopt healthy lifestyle behaviors and modifying recovery styles may improve the physical health of people with severe mental disorders thus reducing the mortality rates.
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Affiliation(s)
- Gaia Sampogna
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Mario Luciano
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Matteo Di Vincenzo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Ileana Andriola
- Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Enrico D'Ambrosio
- Department of Basic Medical Science, Neuroscience, and Sense Organs, University of Bari Aldo Moro, Bari, Italy
| | - Mario Amore
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Gianluca Serafini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health (DINOGMI), Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Alessandro Rossi
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, L'Aquila, Italy
| | - Claudia Carmassi
- Psychiatric Unit, Department of Clinical and Experimental Medicine, AOUP, University of Pisa, Pisa, Italy
| | - Liliana Dell'Osso
- Psychiatric Unit, Department of Clinical and Experimental Medicine, AOUP, University of Pisa, Pisa, Italy
| | - Giorgio Di Lorenzo
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Alberto Siracusano
- Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Rodolfo Rossi
- Department of Biotechnological and Applied Clinical Sciences (DISCAB), University of L'Aquila, L'Aquila, Italy.,Department of Systems Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
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18
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Fiorillo A, Sartorius N. Mortality gap and physical comorbidity of people with severe mental disorders: the public health scandal. Ann Gen Psychiatry 2021; 20:52. [PMID: 34903254 PMCID: PMC8670051 DOI: 10.1186/s12991-021-00374-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 11/03/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Patients suffering from severe mental disorders, including schizophrenia, major depression and bipolar disorders, have a reduced life expectancy compared to the general population of up to 10-25 years. This mortality gap requires urgent actions from a public health perspective in order to be reduced. MAIN TEXT Factors associated with the high mortality rates in patients with severe mental disorders can be grouped into four groups: those related to the patients, to psychiatrists, to other non-psychiatrist medical doctors and to the healthcare system. Each of these factors should become the target of specific and dedicated interventions, in order to reduce the morbidity and mortality rate in patients with severe mental disorders. All these elements contribute to the neglect of physical comorbidity in patients with severe mental. In particular, the long-standing separation of psychiatry from other branches of medicine and the lack of specific training on this issue further contribute to the poor attention dedicated to management of physical comorbidities. Recently, several professional associations have invited national bodies regulating education of healthcare professionals to include the management of physical health of people with severe mental disorders in undergraduate and postgraduate educational programs. CONCLUSIONS The premature mortality in patients with severe mental disorders is a complex phenomenon resulting by the interaction of several protective and risk factors. Therefore, a multilevel approach is needed, in which the different stakeholders involved in health care provision establish workforces for the long-term management of physical and mental health conditions.
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Affiliation(s)
- Andrea Fiorillo
- Department of Psychiatry, University of Campania "L Vanvitelli", Naples, Italy.
| | - Norman Sartorius
- Association for the Improvement of Mental Health Programmes, Geneva, Switzerland
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Ferrer-Farré T, Dinamarca F, Mestre-Pintó JI, Fonseca F, Torrens M. Dual Disorders in the Consultation Liaison Addiction Service: Gender Perspective and Quality of Life. J Clin Med 2021; 10:jcm10235572. [PMID: 34884274 PMCID: PMC8658653 DOI: 10.3390/jcm10235572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 11/24/2021] [Accepted: 11/26/2021] [Indexed: 12/17/2022] Open
Abstract
Dual disorders (DD) and gender differences comprise an area of considerable concern in patients with substance use disorder (SUD). This study aims to describe the presence of DD among patients with SUD admitted to a general hospital and attended by a consultation liaison addiction service (CLAS), in addition to assessing its association with addiction severity and quality of life from a gender perspective, between 1 January and 30 September 2020. The dual diagnosis screening interview (DDSI), the severity of dependence scale (SDS), and the WHO well-being index were used to evaluate the patients. In the overall sample, DD prevalence was 36.8%, (women: 53.8% vs. men: 32.7%, NS). In both genders the most prevalent DD was depression (33.8%, women: 46.2% vs. men: 30.9%, p = 0.296). Women presented more panic disorders (46.2% vs. 12.7%, p = 0.019) and generalized anxiety (38.5% vs. 10.9%, p = 0.049) than men. When DD was present, women had worse quality of life than men (21.7 vs. 50 points, p = 0.02). During lockdown period 77 patients were attended to and 13 had COVID-19 infection, with no differences in relation to sociodemographic and consumption history variables. The study confirms a high prevalence of DD among patients with SUD admitted to a general hospital for any pathology, and its being associated with worse quality of life, particularly in women.
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Affiliation(s)
- Teresa Ferrer-Farré
- Department of Experimental and Health Sciences (CEXS), Universitat Pompeu Fabra, 08002 Barcelona, Spain; (T.F.-F.); (J.I.M.-P.)
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, 08290 Cerdanyola del Vallès, Spain;
| | - Fernando Dinamarca
- Institute of Neuropsychiatry and Addictions, Parc de Salut Mar, 08003 Barcelona, Spain;
- Addiction Research Group, IMIM-Institut Hospital del Mar d’Investigacions Mèdiques, 08003 Barcelona, Spain
| | - Joan Ignasi Mestre-Pintó
- Department of Experimental and Health Sciences (CEXS), Universitat Pompeu Fabra, 08002 Barcelona, Spain; (T.F.-F.); (J.I.M.-P.)
- Addiction Research Group, IMIM-Institut Hospital del Mar d’Investigacions Mèdiques, 08003 Barcelona, Spain
| | - Francina Fonseca
- Department of Experimental and Health Sciences (CEXS), Universitat Pompeu Fabra, 08002 Barcelona, Spain; (T.F.-F.); (J.I.M.-P.)
- Institute of Neuropsychiatry and Addictions, Parc de Salut Mar, 08003 Barcelona, Spain;
- Addiction Research Group, IMIM-Institut Hospital del Mar d’Investigacions Mèdiques, 08003 Barcelona, Spain
- Correspondence:
| | - Marta Torrens
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, 08290 Cerdanyola del Vallès, Spain;
- Institute of Neuropsychiatry and Addictions, Parc de Salut Mar, 08003 Barcelona, Spain;
- Addiction Research Group, IMIM-Institut Hospital del Mar d’Investigacions Mèdiques, 08003 Barcelona, Spain
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20
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Luciano M, Sampogna G, Amore M, Andriola I, Calcagno P, Carmassi C, Del Vecchio V, Dell'Osso L, Di Lorenzo G, Gelao B, Giallonardo V, Rossi A, Rossi R, Siracusano A, Fiorillo A. How to improve the physical health of people with severe mental illness? A multicentric randomized controlled trial on the efficacy of a lifestyle group intervention. Eur Psychiatry 2021; 64:e72. [PMID: 34812136 PMCID: PMC8715281 DOI: 10.1192/j.eurpsy.2021.2253] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Background
People with severe mental illnesses (SMI) have a mortality rate two times higher compared to the general population, with a decade of years of life lost. In this randomized controlled trial (RCT), we assessed in a sample of people with bipolar disorder, major depressive disorder, and schizophrenia spectrum disorder, the efficacy of an innovative psychosocial group intervention compared to a brief psychoeducational group intervention on patients’ body mass index (BMI), body weight, waist circumference, Framingham and HOMA-IR indexes.
Methods
This is a multicentric RCT with blinded outcome assessments carried out in six Italian university centers. After recruitment patients were randomized to receive a 6-month psychosocial intervention to improve patients’ physical health or a brief psychoeducational intervention. All recruited patients were assessed with standardized assessment instruments at baseline and after 6 months. Anthropometric parameters and blood samples have also been collected.
Results
Four-hundred and two patients with a diagnosis of bipolar disorder (43.3%), schizophrenia or other psychotic disorder (29.9%), or major depression (26.9%) were randomly allocated to the experimental (N = 206) or the control group (N = 195). After 6 months, patients from the experimental group reported a significant reduction in BMI (odds ratio [OR]: 1.93, 95% confidence intervals [CI]: 1.31–2.84; p < 0.001), body weight (OR = 4.78, 95% CI: 0.80–28.27, p < 0.05), and waist circumference (OR = 5.43, 95% CI: 1.45–20.30, p < 0.05). Participants with impaired cognitive and psychosocial functioning had a worse response to the intervention.
Conclusions
The experimental group intervention was effective in improving the physical health in SMI patients. Further studies are needed to evaluate the feasibility of this intervention in real-world settings.
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Affiliation(s)
- Mario Luciano
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Gaia Sampogna
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Mario Amore
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy
| | - Ileana Andriola
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | - Pietro Calcagno
- Section of Psychiatry, Department of Neuroscience, Ophthalmology, Genetics and Infant-Maternal Science, University of Genoa, Genoa, Italy
| | - Claudia Carmassi
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Valeria Del Vecchio
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
| | - Liliana Dell'Osso
- Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Giorgio Di Lorenzo
- Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Barbara Gelao
- Department of Basic Medical Science, Neuroscience and Sense Organs, University of Bari "Aldo Moro", Bari, Italy
| | | | - Alessandro Rossi
- Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Rodolfo Rossi
- Section of Psychiatry, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy
| | - Alberto Siracusano
- Department of System Medicine, University of Rome Tor Vergata, Rome, Italy
| | - Andrea Fiorillo
- Department of Psychiatry, University of Campania "L. Vanvitelli", Naples, Italy
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21
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Fabrazzo M, Russo A, Camerlengo A, Tucci C, Luciano M, De Santis V, Perris F, Catapano F, Coppola N. Delirium and Cognitive Impairment as Predisposing Factors of COVID-19 Infection in Neuropsychiatric Patients: A Narrative Review. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:1244. [PMID: 34833462 PMCID: PMC8622938 DOI: 10.3390/medicina57111244] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 11/07/2021] [Accepted: 11/10/2021] [Indexed: 02/07/2023]
Abstract
SARS-CoV-2 neuroinvasive and neurotropic abilities may underlie delirium onset and neuropsychiatric outcomes. Only a limited number of studies have addressed the potential effect of SARS-CoV-2 infection on mental health so far. Most studies mainly reported the acute onset of mixed neuropsychiatric conditions in patients infected with SARS-CoV-2, characterized by agitated behavior, altered level of consciousness, and disorganized thinking, regardless of psychological or socioeconomic triggering factors. The present narrative review aims to analyze and discuss the mechanisms underlying the neuroinvasive/neurotropic properties of SARS-CoV-2 and the subsequent mental complications. Delirium appeared as a clinical manifestation of SARS-CoV-2 brain infection in some patients, without systemic or multiple organ failure symptoms. A small number of studies demonstrated that neuropsychiatric symptoms associated with COVID-19, initially presenting as a confused state, may subsequently evolve in a way that is consistent with the patients' neuropsychiatric history. A literature analysis on this topic prevalently showed case reports and case series of patients presenting delirium or delirium-like symptoms as the main outburst of COVID-19, plus a cognitive impairment, from mild to severe, which pre-existed or was demonstrated during the acute phase or after infection. Dementia appeared as one of the most frequent predisposing factors to SARS-CoV-2 infection complicated with delirium. Instead, contrasting data emerged on the potential link between COVID-19 and delirium in patients with cognitive impairment and without a neuropsychiatric history. Therefore, clinicians should contemplate the possibility that COVID-19 appears as delirium followed by a psychiatric exacerbation, even without other systemic symptoms. In addition, cognitive impairment might act as a predisposing factor for COVID-19 in patients with delirium.
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Affiliation(s)
- Michele Fabrazzo
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (A.C.); (C.T.); (M.L.); (V.D.S.); (F.P.); (F.C.)
| | - Antonio Russo
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania “Luigi Vanvitelli”, Via S. Pansini 5, 80131 Naples, Italy; (A.R.); (N.C.)
| | - Alessio Camerlengo
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (A.C.); (C.T.); (M.L.); (V.D.S.); (F.P.); (F.C.)
| | - Claudia Tucci
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (A.C.); (C.T.); (M.L.); (V.D.S.); (F.P.); (F.C.)
| | - Mario Luciano
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (A.C.); (C.T.); (M.L.); (V.D.S.); (F.P.); (F.C.)
| | - Valeria De Santis
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (A.C.); (C.T.); (M.L.); (V.D.S.); (F.P.); (F.C.)
| | - Francesco Perris
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (A.C.); (C.T.); (M.L.); (V.D.S.); (F.P.); (F.C.)
| | - Francesco Catapano
- Department of Psychiatry, University of Campania “Luigi Vanvitelli”, Largo Madonna delle Grazie 1, 80138 Naples, Italy; (A.C.); (C.T.); (M.L.); (V.D.S.); (F.P.); (F.C.)
| | - Nicola Coppola
- Infectious Diseases Unit, Department of Mental Health and Public Medicine, University of Campania “Luigi Vanvitelli”, Via S. Pansini 5, 80131 Naples, Italy; (A.R.); (N.C.)
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22
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Adan A, Torrens M. Special Issue: Diagnosis and Management of Addiction and Other Mental Disorders (Dual Disorders). J Clin Med 2021; 10:jcm10061307. [PMID: 33810072 PMCID: PMC8004758 DOI: 10.3390/jcm10061307] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 03/20/2021] [Indexed: 12/17/2022] Open
Affiliation(s)
- Ana Adan
- Department of Clinical Psychology and Psychobiology, School of Psychology, University of Barcelona, Passeig de la Vall d’Hebrón 171, 08035 Barcelona, Spain
- Institute of Neurosciences, University of Barcelona, 08035 Barcelona, Spain
- Correspondence: ; Tel.: +34-933-125-060
| | - Marta Torrens
- Addiction Research Group (GRAd), Neuroscience Research Program, Hospital del Mar Medical Research Institute (IMIM), 08003 Barcelona, Spain;
- Institut de Neuropsiquiatria i Addiccions, Hospital del Mar, 08003 Barcelona, Spain
- Psychiatry Department, Universitat Autònoma de Barcelona (UAB), Cerdanyola del Vallès, 08093 Barcelona, Spain
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23
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Peris L, Szerman N. Partial Agonists and Dual Disorders: Focus on Dual Schizophrenia. Front Psychiatry 2021; 12:769623. [PMID: 34975572 PMCID: PMC8716462 DOI: 10.3389/fpsyt.2021.769623] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 11/18/2021] [Indexed: 12/31/2022] Open
Abstract
Dual disorder is a term applied to patients with an addictive disorder and other mental disorder. Epidemiological studies have established that dual disorders are an expectation rather than an exception. They are difficult to diagnose and treat and constitute a huge burden for both patients and their relatives and society. Current treatments are a combination of those needed to treat the addictive disorder with those focused on the co-occurring psychiatric disorder. Focusing specifically on schizophrenia, growing scientific evidence supports the existence of a shared vulnerability for substance use in these patients and those at risk. Various antipsychotics have been found to be useful in the treatment of psychotic symptoms and disorders; however, few effective treatments have been identified until now for substance use disorders in patients with dual schizophrenia. Partial agonism stands as a new pharmacological option available in recent years. Molecules with this kind of action may act as functional agonists or as antagonists, depending on the surrounding levels of the neurotransmitter. Studies have found their efficacy in schizophrenia, addiction, anxiety and depression. Certain partial agonist antipsychotics seem to have a role in the treatment of dual schizophrenia. That could be the case with cariprazine. Because of its higher affinity for dopaminergic D3 receptors compared to D2, a potential to prevent relapse to addiction, added to its antipsychotic efficacy, has been suggested. Here we briefly review current advances and future directions and introduce some personal insights into the role of partial agonists in co-occurring schizophrenia and substance use.
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Affiliation(s)
- Lola Peris
- Centre Neuchâtelois De Psychiatrie, Marin-Epagnier, Switzerland
| | - Nestor Szerman
- Hospital Universitario Gregorio Marañon, Madrid, Spain.,Fundación Patología Dual, WPA Section on Dual Disorders, WADD, Madrid, Spain
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24
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Szerman N, Ferre F, Basurte-Villamor I, Vega P, Mesias B, Marín-Navarrete R, Arango C. Gambling Dual Disorder: A Dual Disorder and Clinical Neuroscience Perspective. Front Psychiatry 2020; 11:589155. [PMID: 33329137 PMCID: PMC7732481 DOI: 10.3389/fpsyt.2020.589155] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 10/19/2020] [Indexed: 11/13/2022] Open
Abstract
Several behaviors, including compulsive gambling, have been considered non-substance-related addictive disorders. Categorical mental disorders (e.g., DSM-5) are usually accompanied by very different symptomatic expressions (affective, behavioral, cognitive, substance abuse, personality traits). When these mental disorders occur with addictive disorders, either concomitantly or sequentially over the life span, this clinical condition is called a dual disorder. Gambling disorder (GD) has been associated with other categorical psychiatric diagnoses: attention deficit hyperactivity disorder, depression, bipolar disorder, social anxiety, schizophrenia, substance use disorder, antisocial personality disorder; and dimensional symptoms including higher impulsivity, poorer emotional wellbeing, cognitive distortion, psychosis, deficient self-regulation, suicide, poorer family environment, and greater mental distress. We are calling this clinical condition Gambling Dual Disorder. From a clinical perspective, it is clear that Gambling Dual Disorder is not the exception but rather the expectation, and this holds true not just for GD, but also for other mental disorders including other addictions. Mental disorders are viewed as biological disorders that involve brain circuits that implicate specific domains of cognition, emotion, and behavior. This narrative review presents the state of the art with respect to GD in order to address current matters from a dual disorder, precision psychiatry, and clinical neuroscience perspective, rather than the more subjective approach of symptomatology and clinical presentation. This review also presents Gambling Dual Disorder as a brain and neurodevelopmental disorder, including from the perspectives of evolutionary psychiatry, genetics, impulsivity as an endophenotype, the self-medication hypothesis, and sexual biological differences. The wide vision of the disease advances a paradigm shift, highlighting how GD and dual disorders should be conceptualized, diagnosed, and treated. Rethinking GD as part of a dual disorder is crucial for its appropriate conceptualization from the perspective of clinical neuroscience and precision psychiatry.
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Affiliation(s)
- Nestor Szerman
- WADD WPA Section Dual Disorders, Institute of Psychiatry and Mental Health Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Francisco Ferre
- Institute of Psychiatry and Mental Health Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Ignacio Basurte-Villamor
- Institute of Psychiatry and Mental Health Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - Pablo Vega
- Institute of Addictions, Madrid Salud, Madrid, Spain
| | | | | | - Celso Arango
- Institute of Psychiatry and Mental Health Hospital General Universitario Gregorio Marañón, IiSGM, CIBERSAM, School of Medicine, Universidad Complutense, Madrid, Spain
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