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Bryant VE, Sorna MJ, Dana A, Leon KG, Guastello AD, Sambuco N, Huxhold A, Allen B, Cuffe SP, Mathews CA, Dale LP. Protective and risk factors associated with substance use coping among healthcare workers during the COVID-19 pandemic. Front Psychol 2023; 14:1228517. [PMID: 38173849 PMCID: PMC10761529 DOI: 10.3389/fpsyg.2023.1228517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 11/27/2023] [Indexed: 01/05/2024] Open
Abstract
Background Healthcare workers (HCWs) experienced high levels of stress and mental health consequences associated with the COVID-19 pandemic, which may have contributed to unhealthy coping behaviors, such as substance use coping (SUC). This study aimed to understand the extent of and predictors of SUC. Methods The sample consisted of 263 HCWs in North Central Florida. Univariable and multivariable logistic regression analyses investigated whether moral injury and other work risk factors, protective factors, and clinically relevant symptoms (i.e., work exhaustion, interpersonal disengagement, depression, anxiety, and/or PTSD) were associated with likelihood of SUC. Results Clinically relevant levels of interpersonal disengagement and anxiety increased the likelihood of SUC. Mediational analyses found that interpersonal disengagement and anxiety explained 54.3% of the relationship between Self Moral Injury and SUC and explained 80.4% of the relationship between professional fulfillment and SUC. Conclusion Healthcare supervisors should be aware that providers who are experiencing moral injury and less professional fulfillment may be experiencing significant interpersonal disengagement and anxiety, which could lead to SUC. Future studies should examine the effects of implementing targeted prevention and treatment interventions, along with longitudinal outcomes related to SUC behaviors.
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Affiliation(s)
- Vaughn E. Bryant
- Department of Psychiatry, College of Medicine – Jacksonville, University of Florida, Jacksonville, FL, United States
| | - Michael J. Sorna
- Department of Psychiatry, College of Medicine – Jacksonville, University of Florida, Jacksonville, FL, United States
| | - Audrey Dana
- Department of Psychology, University of North Florida, Jacksonville, FL, United States
| | - Kalie G. Leon
- Department of Psychology, University of North Florida, Jacksonville, FL, United States
| | - Andrea D. Guastello
- Department of Psychiatry, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Nicola Sambuco
- Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, Gainesville, FL, United States
| | - Ashley Huxhold
- Department of Psychiatry, College of Medicine – Jacksonville, University of Florida, Jacksonville, FL, United States
| | - Brandon Allen
- Department of Emergency Medicine, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Steven P. Cuffe
- Department of Psychiatry, College of Medicine – Jacksonville, University of Florida, Jacksonville, FL, United States
| | - Carol A. Mathews
- Department of Psychiatry, Center for OCD, Anxiety and Related Disorders, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Lourdes P. Dale
- Department of Psychiatry, College of Medicine – Jacksonville, University of Florida, Jacksonville, FL, United States
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Dewabhrata W, Ahsan A, Bella A, Amalia N, Kusuma D, Pertiwi YBA. Mental Health, Environmental, and Socioeconomic Geographic Factors of Severe Drug Addiction: Analysis of Rehabilitation Center Data in Indonesia. Subst Abuse 2023; 17:11782218231203687. [PMID: 37822734 PMCID: PMC10563495 DOI: 10.1177/11782218231203687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/06/2023] [Indexed: 10/13/2023]
Abstract
Background A growing number of recent literatures have attempted to document the factors related to drug use in different contexts, but limited studies analyzed the factors related to patient's severity level. Objective We aimed to examine the correlates of behavioral, environmental, socioeconomic, geographic factors, and severe drug addiction. Methods We used a sample of 6790 people who use drugs (PWUD) from rehabilitation centers during 2019 to 2020 in Indonesia. Data were obtained from Drugs Rehabilitation Information System (SIRENA) by the Indonesian National Narcotics Agency (BNN) during 2019 to 2020. SIRENA used the adapted version of WHO's Addiction Severity Index (ASI), which assesses patient's addiction severity level and relevant factors. A composite of the ASI factors is classified as "poor" or "serious" if its score is 4 or higher. The data was analyzed using logistic regression model to estimate correlations of severe drug addiction. Results We found a high prevalence (65.08%) of our sample reported having severe drug addiction, which needed intervention and support. Poor psychiatric condition (OR = 4.02, CI: 2.97-5.44), serious work-related issue (OR = 2.10, 1.75-2.51), poor medical condition (OR = 2.01, 1.32-3.06), and serious family and social problems (OR = 2.56, 2.15-3.05) were significantly associated with severe drug addiction. Male users had higher odds of severe drug addiction (OR = 1.81, 1.55-2.20), compared to female counterparts. Patients in urban areas had higher odds of severe drug addiction (OR = 1.19, 1.1-1.3) than those in rural. Those in less developed regions (eg, Sumatera, Kalimantan, and Sulawesi) had higher odds of severe drug addiction (OR = 2.33, 1.9-2.9), compared to those in the most developed region (eg, Java and Bali). Conclusion This evidence can help policymakers in refining the harm reduction policies in Indonesia and other countries with similar settings.
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Affiliation(s)
- Wijaya Dewabhrata
- Department of Economics, Faculty of Economics and Business, Universitas Indonesia, Depok, West Java, Indonesia
- Indonesian National Narcotics Agency (BNN), Ciamis Regency, West Java, Indonesia
| | - Abdilah Ahsan
- Department of Economics, Faculty of Economics and Business, Universitas Indonesia, Depok, West Java, Indonesia
- Lembaga Demografi, Faculty of Economics and Business, Universitas Indonesia, Depok, West Java, Indonesia
| | - Adrianna Bella
- Centre for Health Economics, Monash Business School, Monash University, Melbourne, VIC, Australia
| | - Nadira Amalia
- Lembaga Demografi, Faculty of Economics and Business, Universitas Indonesia, Depok, West Java, Indonesia
| | - Dian Kusuma
- Centre for Health Economics & Policy Innovation, Imperial College Business School, London, UK
| | - Yuyu Buono Ayuning Pertiwi
- Lembaga Demografi, Faculty of Economics and Business, Universitas Indonesia, Depok, West Java, Indonesia
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Ma R, Romano E, Ashworth M, Yadegarfar ME, Dregan A, Ronaldson A, de Oliveira C, Jacobs R, Stewart R, Stubbs B. Multimorbidity clusters among people with serious mental illness: a representative primary and secondary data linkage cohort study. Psychol Med 2023; 53:4333-4344. [PMID: 35485805 PMCID: PMC10388332 DOI: 10.1017/s003329172200109x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/24/2022] [Accepted: 03/30/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND People with serious mental illness (SMI) experience higher mortality partially attributable to higher long-term condition (LTC) prevalence. However, little is known about multiple LTCs (MLTCs) clustering in this population. METHODS People from South London with SMI and two or more existing LTCs aged 18+ at diagnosis were included using linked primary and mental healthcare records, 2012-2020. Latent class analysis (LCA) determined MLTC classes and multinominal logistic regression examined associations between demographic/clinical characteristics and latent class membership. RESULTS The sample included 1924 patients (mean (s.d.) age 48.2 (17.3) years). Five latent classes were identified: 'substance related' (24.9%), 'atopic' (24.2%), 'pure affective' (30.4%), 'cardiovascular' (14.1%), and 'complex multimorbidity' (6.4%). Patients had on average 7-9 LTCs in each cluster. Males were at increased odds of MLTCs in all four clusters, compared to the 'pure affective'. Compared to the largest cluster ('pure affective'), the 'substance related' and the 'atopic' clusters were younger [odds ratios (OR) per year increase 0.99 (95% CI 0.98-1.00) and 0.96 (0.95-0.97) respectively], and the 'cardiovascular' and 'complex multimorbidity' clusters were older (ORs 1.09 (1.07-1.10) and 1.16 (1.14-1.18) respectively). The 'substance related' cluster was more likely to be White, the 'cardiovascular' cluster more likely to be Black (compared to White; OR 1.75, 95% CI 1.10-2.79), and both more likely to have schizophrenia, compared to other clusters. CONCLUSION The current study identified five latent class MLTC clusters among patients with SMI. An integrated care model for treating MLTCs in this population is recommended to improve multimorbidity care.
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Affiliation(s)
- Ruimin Ma
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Eugenia Romano
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | - Mark Ashworth
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Mohammad E. Yadegarfar
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Alexandru Dregan
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK
| | - Amy Ronaldson
- Health Services and Population Research Department, Psychology and Neuroscience (IoPPN), King's College London, London, UK
| | | | - Rowena Jacobs
- Centre for Health Economics, University of York, York, UK
| | - Robert Stewart
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- South London and Maudsley NHS Foundation Trust, Denmark Hill, London, UK
| | - Brendon Stubbs
- Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neuroscience (IoPPN), King's College London, London, UK
- Physiotherapy Department, South London and Maudsley National Health Services Foundation Trust, London, SE5 8AB, UK
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Hayanga B, Stafford M, Bécares L. Ethnic inequalities in multiple long-term health conditions in the United Kingdom: a systematic review and narrative synthesis. BMC Public Health 2023; 23:178. [PMID: 36703163 PMCID: PMC9879746 DOI: 10.1186/s12889-022-14940-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 12/23/2022] [Indexed: 01/28/2023] Open
Abstract
Indicative evidence suggests that minoritised ethnic groups have higher risk of developing multiple long-term conditions (MLTCs), and do so earlier than the majority white population. While there is evidence on ethnic inequalities in single health conditions and comorbidities, no review has attempted to look across these from a MLTCs perspective. As such, we currently have an incomplete understanding of the extent of ethnic inequalities in the prevalence of MLTCs. Further, concerns have been raised about variations in the way ethnicity is operationalised and how this impedes our understanding of health inequalities. In this systematic review we aimed to 1) describe the literature that provides evidence of ethnicity and prevalence of MLTCs amongst people living in the UK, 2) summarise the prevalence estimates of MLTCs across ethnic groups and 3) to assess the ways in which ethnicity is conceptualised and operationalised. We focus on the state of the evidence prior to, and during the very early stages of the pandemic. We registered the protocol on PROSPERO (CRD42020218061). Between October and December 2020, we searched ASSIA, Cochrane Library, EMBASE, MEDLINE, PsycINFO, PubMed, ScienceDirect, Scopus, Web of Science, OpenGrey, and reference lists of key studies/reviews. The main outcome was prevalence estimates for MLTCs for at least one minoritised ethnic group, compared to the majority white population. We included studies conducted in the UK reporting on ethnicity and prevalence of MLTCs. To summarise the prevalence estimates of MLTCs across ethnic groups we included only studies of MLTCs that provided estimates adjusted at least for age. Two reviewers screened and extracted data from a random sample of studies (10%). Data were synthesised using narrative synthesis. Of the 7949 studies identified, 84 met criteria for inclusion. Of these, seven contributed to the evidence of ethnic inequalities in MLTCs. Five of the seven studies point to higher prevalence of MLTCs in at least one minoritised ethnic group compared to their white counterparts. Because the number/types of health conditions varied between studies and some ethnic populations were aggregated or omitted, the findings may not accurately reflect the true level of ethnic inequality. Future research should consider key explanatory factors, including those at the macrolevel (e.g. racism, discrimination), as they may play a role in the development and severity of MLTCs in different ethnic groups. Research is also needed to ascertain the extent to which the COVID19 pandemic has exacerbated these inequalities.
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Affiliation(s)
- Brenda Hayanga
- Department of Global Health and Social Medicine, King’s College London, Bush House, North East Wing, 40 Aldwych, London, WC2B 4BG UK
| | - Mai Stafford
- The Health Foundation, 8 Salisbury Square, London, EC4Y 8AP UK
| | - Laia Bécares
- Department of Global Health and Social Medicine, King’s College London, Bush House, North East Wing, 40 Aldwych, London, WC2B 4BG UK
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5
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Ethnic Inequalities in Healthcare Use and Care Quality among People with Multiple Long-Term Health Conditions Living in the United Kingdom: A Systematic Review and Narrative Synthesis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph182312599. [PMID: 34886325 PMCID: PMC8657263 DOI: 10.3390/ijerph182312599] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/15/2021] [Accepted: 11/24/2021] [Indexed: 11/28/2022]
Abstract
Indicative evidence suggests that the prevalence of multiple long-term conditions (i.e., conditions that cannot be cured but can be managed with medication and other treatments) may be higher in people from minoritised ethnic groups when compared to people from the White majority population. Some studies also suggest that there are ethnic inequalities in healthcare use and care quality among people with multiple long-term conditions (MLTCs). The aims of this review are to (1) identify and describe the literature that reports on ethnicity and healthcare use and care quality among people with MLTCs in the UK and (2) examine how healthcare use and/or care quality for people with MLTCs compares across ethnic groups. We registered the protocol on PROSPERO (CRD42020220702). We searched the following databases up to December 2020: ASSIA, Cochrane Library, EMBASE, MEDLINE, PsycINFO, PubMed, ScienceDirect, Scopus, and Web of Science core collection. Reference lists of key articles were also hand-searched for relevant studies. The outcomes of interest were patterns of healthcare use and care quality among people with MLTCs for at least one minoritised ethnic group, compared to the White majority population in the UK. Two reviewers, L.B. and B.H., screened and extracted data from a random sample of studies (10%). B.H. independently screened and extracted data from the remaining studies. Of the 718 studies identified, 14 were eligible for inclusion. There was evidence indicating ethnic inequalities in disease management and emergency admissions among people with MLTCs in the five studies that counted more than two long-term conditions. Compared to their White counterparts, Black and Asian children and young people had higher rates of emergency admissions. Black and South Asian people were found to have suboptimal disease management compared to other ethnic groups. The findings suggest that for some minoritised ethnic group people with MLTCs there may be inadequate initiatives for managing health conditions and/or a need for enhanced strategies to reduce ethnic inequalities in healthcare. However, the few studies identified focused on a variety of conditions across different domains of healthcare use, and many of these studies used broad ethnic group categories. As such, further research focusing on MLTCs and using expanded ethnic categories in data collection is needed.
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6
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Fortin MP, Lavoie M, Dufour I, Chouinard MC. La littératie en santé chez les personnes présentant des troubles mentaux graves. SANTE MENTALE AU QUEBEC 2020. [DOI: 10.7202/1070243ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Le Plan d’action 2015-2020 en santé mentale du Québec vise, chez les personnes présentant des troubles mentaux graves, le développement d’une autonomie optimale dans la société et l’utilisation adéquate des services de santé. Néanmoins, à ce jour, un manque de données est rapporté au Québec, sur la capacité des personnes présentant des troubles mentaux à accéder, à comprendre et à utiliser l’information relative à la santé, ce qui correspond au concept de littératie en santé (LS). Une étude descriptive quantitative a été menée pour décrire la LS chez les personnes présentant des troubles mentaux graves et demeurant dans la communauté de Dolbeau-Mistassini, au Saguenay–Lac-Saint-Jean (Québec). Les données ont été collectées à l’aide de trois questionnaires autorapportés, incluant le Questionnaire sur la littératie en santé (QLS). Ce questionnaire permet de décrire la LS à partir de 9 dimensions, afin de soulever les besoins individuels, organisationnels et sociaux en lien avec la LS des personnes ciblées. Les résultats obtenus auprès des participants (n = 30) ont montré que la LS était plus faible dans la dimension « Comprendre l’information relative à la santé ». Les résultats de cette étude mettent en évidence la nécessité d’adapter les interventions éducatives chez cette population. Cette adaptation pourrait permettre à cette population de mieux intégrer le contenu de l’enseignement reçu, tout en privilégiant l’accompagnement d’un proche lors de la rencontre avec un professionnel de la santé.
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Affiliation(s)
- Marie-Pier Fortin
- B. Sc., inf., étudiante à la maîtrise, Département des sciences de la santé, Université du Québec à Chicoutimi
| | - Mélissa Lavoie
- M. Sc. inf., candidate au doctorat, Département des sciences de la santé, Université du Québec à Chicoutimi
| | - Isabelle Dufour
- M. Sc. inf. candidate au doctorat, École des sciences infirmières, Faculté de médecine et des sciences de la santé, Université de Sherbrooke
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Gale-Grant O, Bailey J, Burke O, Kelleher MJ. Use of Prescribed Psychotropic Medications in an Opioid Substitution Therapy Cohort. J Dual Diagn 2019; 15:254-259. [PMID: 31519141 DOI: 10.1080/15504263.2019.1662150] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Objective: Comorbid mental illness is extremely common in individuals receiving opioid substitution therapy. The use of common psychiatric medications is complex in this cohort with increased risks of drug-drug interaction, overdose, and diversion or abuse of prescribed medication. We have therefore investigated rates of co-prescribing and psychiatric comorbidity in a cohort of individuals receiving therapeutic methadone or buprenorphine. Methods: Comprehensive electronic medical records were accessed for a cohort of individuals (n = 698) receiving opioid substitution therapy at a single center in London, United Kingdom. The following was collected for each individual: demographic data, current prescribed medications (including opioid substitution therapy agents), duration of prescription, indication for each prescription, and psychiatric diagnoses. Results: A total of 610 individuals were included in the final analysis. High rates of psychotropic co-prescribing were observed, with 36.7% of individuals receiving a psychotropic medication in addition to their opioid substitution drug, including 35.4% receiving an antidepressant, 9.2% an antipsychotic, 8.6% a benzodiazepine, and 4.5% a gabapentinoid, rates that are far in excess of the local population prescription frequency; 75.5% of antipsychotic prescriptions and 47.7% of benzodiazepine prescriptions were for an unlicensed indication. Conclusions: This highlights the need for evidence-based treatment of comorbid mental illness for individuals receiving opioid substitution therapy.
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Affiliation(s)
- Oliver Gale-Grant
- MRC Centre for Neurodevelopmental Disorders, King's College London, London, UK
| | - James Bailey
- Addictions Psychiatry Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
| | - Olivia Burke
- Addictions Psychiatry Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
| | - Michael J Kelleher
- Addictions Psychiatry Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK
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8
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Rane A, Nadkarni A, Kanekar J, Fernandes W, Borker HA, Pereira Y. Alcohol use in schizophrenia: prevalence, patterns, correlates and clinical outcomes in Goa, India. ACTA ACUST UNITED AC 2018. [DOI: 10.1192/pb.bp.111.036459] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and methodTo explore the patterns of alcohol consumption and its impact on clinical outcomes in schizophrenia in low- and middle-income countries. We performed a cross-sectional survey of 315 patients with schizophrenia and calculated the prevalence of alcohol consumption and alcohol use disorder. The patients' sociodemographic profiles and clinical outcomes, including Brief Psychiatric Rating Scale (BPRS) scores, were compared between abstainers and drinkers using the χ2- andt-tests.ResultsThe 1-year prevalence of drinking, hazardous drinking and alcohol dependence was 16.8% (95% CI 12.9–21.4), 5.7% (95% CI 3.4–8.9) and 2.5% (95% CI 1.1–4.9), respectively. Male gender, single or post-marital status, higher education and being economically active were significantly associated with alcohol consumption. Alcohol drinkers were significantly more likely to be on combination psychotropics compared with abstainers. The mean total BPRS score was significantly lower in alcohol drinkers compared with abstainers. Drinking alcohol was associated with fewer deficit symptoms.Clinical implicationsCultural settings have a significant impact on the prevalence of alcohol use disorder in schizophrenia.
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Graham HL, Copello A, Birchwood M, Orford J, McGovern D, Georgiou G, Godfrey E. Service innovations. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/s0955603600002099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
One of the challenges for services in the UK has been how best to meet the needs of those people who experience severe mental health problems and use drugs and alcohol problematically. It is now well-documented in the international literature that the coexistence of severe mental health and substance misuse problems are common (e.g. Regier et al, 1990; Krausz et al, 1996; Menezes et al, 1996; Fowler et al, 1998; Mueser et al, 2000; Graham et al, 2001) and often correlated with a number of adverse outcomes (Smith & Hucker, 1994; Johnson, 1997; Mueser et al, 2000). Integrated treatment approaches developed in the USA for this client group (e.g. Drake & Wallach, 2000; Drake et al, 2001), and although they offer much food for thought and some direction, they could not be wholly imported and implemented in the UK because of significant differences in the contextual factors that guide service provision in the two countries. The challenge in the UK has been to develop effective services that fit with the unique community-based treatment approaches for substance misuse problems and mental health that have developed and historically offered separately and in parallel.
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Graham HL, Copello A, Birchwood M, Orford J, McGovern D, Georgiou G, Godfrey E. Service innovations. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.27.5.183] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
One of the challenges for services in the UK has been how best to meet the needs of those people who experience severe mental health problems and use drugs and alcohol problematically. It is now well-documented in the international literature that the coexistence of severe mental health and substance misuse problems are common (e.g. Regier et al, 1990; Krausz et al, 1996; Menezes et al, 1996; Fowler et al, 1998; Mueser et al, 2000; Graham et al, 2001) and often correlated with a number of adverse outcomes (Smith & Hucker, 1994; Johnson, 1997; Mueser et al, 2000). Integrated treatment approaches developed in the USA for this client group (e.g. Drake & Wallach, 2000; Drake et al, 2001), and although they offer much food for thought and some direction, they could not be wholly imported and implemented in the UK because of significant differences in the contextual factors that guide service provision in the two countries. The challenge in the UK has been to develop effective services that fit with the unique community-based treatment approaches for substance misuse problems and mental health that have developed and historically offered separately and in parallel.
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11
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Graham HL, Copello A, Griffith E, Freemantle N, McCrone P, Clarke L, Walsh K, Stefanidou CA, Rana A, Birchwood M. Pilot randomised trial of a brief intervention for comorbid substance misuse in psychiatric in-patient settings. Acta Psychiatr Scand 2016; 133:298-309. [PMID: 26590876 PMCID: PMC5091625 DOI: 10.1111/acps.12530] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2015] [Indexed: 12/30/2022]
Abstract
OBJECTIVE This proof of principle study evaluated the effectiveness and feasibility of a brief motivational intervention, delivered in mental health in-patient settings, to improve engagement in treatment for drug and alcohol misuse. METHOD A randomised controlled trial using concealed randomisation, blind, independent assessment of outcome at 3 months. Participants were 59 new adult admissions, to six acute mental health hospital units in one UK mental health service, with schizophrenia related or bipolar disorder diagnoses, users of community mental health services and also misusing alcohol and/or drugs. Participants were randomised to Brief Integrated Motivational Intervention (BIMI) with Treatment As Usual (TAU), or TAU alone. The BIMI took place over a 2-week period and encouraged participants to explore substance use and its impact on mental health. RESULTS Fifty-nine in-patients (BIMI n = 30; TAU n = 29) were randomised, the BIMI was associated with a 63% relative odds increase in the primary outcome engagement in treatment [OR 1.63 (95% CI 1.01-2.65; P = 0.047)], at 3 months. Qualitative interviews with staff and participants indicated that the BIMI was both feasible and acceptable. CONCLUSION Mental health hospital admissions present an opportunity for brief motivational interventions focussed on substance misuse and can lead to improvements in engagement.
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Affiliation(s)
- H L Graham
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
| | - A Copello
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
| | - E Griffith
- School of Psychology, University of Bath, Claverton Down, Bath, UK
| | - N Freemantle
- Department of Primary Care and Population Health, Upper Third Floor, UCL Medical School (Royal Free Campus), London, UK
| | - P McCrone
- Health Service and Population Research Department, Institute of Psychiatry, Kings College London, London, UK
| | - L Clarke
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
| | - K Walsh
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
| | - C A Stefanidou
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
| | - A Rana
- School of Psychology, University of Birmingham, Edgbaston, Birmingham, UK
| | - M Birchwood
- Division of Mental Health and Wellbeing, University of Warwick, Coventry, UK
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Lai HMX, Cleary M, Sitharthan T, Hunt GE. Prevalence of comorbid substance use, anxiety and mood disorders in epidemiological surveys, 1990-2014: A systematic review and meta-analysis. Drug Alcohol Depend 2015; 154:1-13. [PMID: 26072219 DOI: 10.1016/j.drugalcdep.2015.05.031] [Citation(s) in RCA: 495] [Impact Index Per Article: 55.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2015] [Revised: 05/25/2015] [Accepted: 05/27/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND Comorbidity is highly prevalent between substance use disorders (SUDs), mood and anxiety disorders. We conducted a systematic review and meta-analysis to determine the strength of association between SUDs, mood and anxiety disorders in population-based epidemiological surveys. METHODS A comprehensive literature search of Medline, EMBASE, CINAHL, PsychINFO, Web of Science, and Scopus was conducted from 1990 to 2014. Sources were chosen on the basis that they contained original research in non-clinical populations conducted in randomly selected adults living within defined boundaries. Prevalence of comorbid SUDs, mood and anxiety disorders and odds ratios (ORs) were extracted. RESULTS There were 115 articles identified by electronic searches that were reviewed in full text which yielded 22 unique epidemiological surveys to extract lifetime and 12-month prevalence data for psychiatric illness in respondents with an SUD. Meta-analysis indicated the strongest associations were between illicit drug use disorder and major depression (pooled OR 3.80, 95% CI 3.02-4.78), followed by illicit drug use and any anxiety disorder (OR 2.91, 95% CI 2.58-3.28), alcohol use disorders and major depression (OR 2.42, 95% CI 2.22-2.64) and alcohol use disorders and any anxiety disorder (OR 2.11, 95% CI 2.03-2.19). ORs for dependence were higher than those for abuse irrespective to diagnoses based on lifetime or 12-month prevalence. CONCLUSIONS This review confirms the strong association between SUDs, mood and anxiety disorders. The issue has now been recognised worldwide as a factor that affects the profile, course, patterns, severity and outcomes of these disorders.
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Affiliation(s)
| | - Michelle Cleary
- School of Nursing and Midwifery, University of Western Sydney, NSW, Australia.
| | | | - Glenn E Hunt
- Discipline of Psychiatry, University of Sydney, NSW, Australia.
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Correlates of dependence and treatment for substance use among people with comorbid severe mental and substance use disorders: findings from the "Psychiatric and Addictive Dual Disorder in Italy (PADDI)" Study. Compr Psychiatry 2015; 58:152-9. [PMID: 25591906 DOI: 10.1016/j.comppsych.2014.11.021] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Accepted: 11/26/2014] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE People with severe mental illness (SMI) have often comorbid alcohol and other substance disorders but substantial barriers to addiction care remain. The study is aimed at describing correlates associated with dependence and with treatment for substance use among people with SMI and comorbid substance disorders cared in community mental health teams (CMHTs). METHODS This study capitalized on data from a national survey on comorbid severe mental and substance use disorders, among 2235 subjects in 42 CMHTs nationwide. RESULTS 26% of people with SMI and comorbid misuse suffered from dependence on alcohol and 21% on any other substance. Use of opioids, liver diseases, involvement with criminal justice system, but also area of residence, all were associated with dependence in people with SMI. As regards treatment for substance use, only 50% of comorbid people with SMI were treated by specialist services in the past 12 months. This was associated with opioids and cocaine use, as well as with liver diseases, and involvement with criminal justice. People with schizophrenia and those living in Central and Southern Italy, had the lowest chances to be treated for their comorbid substance use disorder. CONCLUSIONS There are extensive unmet treatment needs among comorbid individuals with SMI. Better integration of substance abuse and mental health care systems, and more effective reciprocal referral procedures, are needed.
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Walsh K, Copello A. Severe and enduring mental health problems within an established substance misuse treatment partnership. PSYCHIATRIC BULLETIN 2014; 38:216-9. [PMID: 25285219 PMCID: PMC4180985 DOI: 10.1192/pb.bp.113.045138] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Revised: 10/25/2013] [Accepted: 11/04/2013] [Indexed: 11/23/2022]
Abstract
Aims and method The study reports findings of an investigation into the presence of severe and enduring mental health problems within the four statutory and non-statutory teams of an established substance misuse treatment partnership. Results Of a total of 772 clients in the four teams surveyed, 69 (8.9%) were identified as having severe and enduring mental health problems and problem substance use in the past 12 months. Alcohol was the most prevalent substance used by this predominantly male group. Different rates were found across the four teams, with higher numbers in the non-statutory teams. The clients displayed significant levels of self-harm and suicide risk and were responsible for 131 acute service contacts over the past 12 months. Clinical implications Clients with severe and enduring mental health problems engaged with substance misuse services display high levels of complex need. It is important to identify the best and most effective service response to this group.
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Affiliation(s)
| | - Alex Copello
- University of Birmingham ; Birmingham and Solihull Mental Health Foundation Trust
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15
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Graham HL, Birchwood M, Griffith E, Freemantle N, McCrone P, Stefanidou CA, Walsh K, Clarke L, Rana A, Copello A. A pilot study to assess the feasibility and impact of a brief motivational intervention on problem drug and alcohol use in adult mental health inpatient units: study protocol for a randomized controlled trial. Trials 2014; 15:308. [PMID: 25085539 PMCID: PMC4124140 DOI: 10.1186/1745-6215-15-308] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2014] [Accepted: 07/14/2014] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Substance misuse in those with severe mental health problems is common and associated with poor engagement in treatment and treatment outcomes. Up to 44% of those admitted into psychiatric inpatient facilities have coexisting substance-misuse problems. However, this is not routinely addressed as part of their treatment plan. A mental health admission may present a window of opportunity for inpatients to reevaluate the impact of their substance use. This study will aim to evaluate the effectiveness of a targeted brief motivational intervention in improving engagement in treatment and to assess how feasible and acceptable this intervention is to inpatients and staff as a routine intervention. METHODS/DESIGN This randomized controlled trial will use concealed randomization; blind, independent assessment of outcome at 3 months; characterization of refusers and dropouts; and be analyzed according to the intention-to-treat principle. After baseline assessments, eligible participants will be randomized either to the Brief Integrated Motivational Intervention plus Treatment As Usual, or Treatment as Usual alone. Eligible participants will be those who are new admissions; >18 years; ICD-10 diagnosis of -schizophrenia or related disorder, bipolar affective disorder, recurrent depressive disorder, and DSM-IV diagnosis of substance abuse or dependence over the last 3 months. The primary outcome is engagement in treatment for substance misuse, and secondary outcomes include readiness to change substance misuse together with a cost-effectiveness analysis. Qualitative interviews with staff and participants will assess the acceptability of the intervention. DISCUSSION This pilot randomized trial will provide the first robust evidence base for inpatient care of people with severe mental health problems and co-morbid substance misuse and provide the groundwork for confirmatory trials to evaluate a potentially feasible, cost-effective, and easy-to-implement treatment option that may be readily integrated into standard inpatient and community-based care. TRIAL REGISTRATION ISRCTN43548483 Date of ISRCTN assignation: 4/17/2014.
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Affiliation(s)
| | - Max Birchwood
- />Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, CV4 7AL Coventry, UK
| | - Emma Griffith
- />University of Bath, Claverton Down Bath, BA2 7AY UK
| | - Nick Freemantle
- />Department of Primary Care and Population Health, Upper Third Floor, UCL Medical School (Royal Free Campus), Rowland Hill Street, London, NW3 2PF UK
| | - Paul McCrone
- />Health Service and Population Research Department, Institute of Psychiatry, Kings College London, London, UK
| | | | - Kathryn Walsh
- />University of Birmingham, Edgbaston, Birmingham B15 2TT UK
| | - Latoya Clarke
- />University of Birmingham, Edgbaston, B15 2TT Birmingham UK
| | - Arsal Rana
- />University of Birmingham, Edgbaston, Birmingham B15 2TT UK
| | - Alex Copello
- />University of Birmingham, Edgbaston, Birmingham B15 2TT UK
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Abstract
AbstractObjective: Over recent years in England there has been widespread development of assertive outreach teams supporting patients with severe mental illness living in the community. Assertive outreach staff members are exposed to a variety of new stressors and risks. This study investigated the emotional impact on keyworkers of working with assertive outreach patients. This was considered in terms of the attitudes keyworkers hold towards patients with particular types of difficulty. The study also measured individual keyworker stress.Methods: Keyworkers from three teams in Birmingham were surveyed regarding their attitudes towards individual patients. Questionnaires measuring attitudes and patient difficulties were derived for the purpose of the study. Strengths of attitudes were correlated against different patient difficulties. Keyworker stress was measured using the General Health Questionnaire, GHQ12.Results: Certain patient difficulties, in particular poor engagement, psychotic symptoms and aggression were associated with feelings of failure in keyworkers whilst drug use, particularly crack cocaine use, was associated with fear of visiting patients at home. Some 41% of keyworkers met ‘caseness’ criteria on the GHQ12. Negative attitudes appeared to be independent of GHQ scores.Conclusions: Keyworkers expressed a number of positive and negative attitudes in relation to patient difficulties. Negative attitudes did not appear to be simply a feature of keyworker stress, however it is acknowledged that the sample size was small. Keyworkers' responses suggested a sense of personal failure when their patients were unwell or poorly engaged, despite patients being selected for assertive outreach on the basis of such difficulties. Recognition of negative attitudes may help in the improvement of training and supervision of staff members.
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Manuel JI, Gandy ME, Rieker D. Trends in hospital discharges and dispositions for episodes of co-occurring severe mental illness and substance use disorders. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2014; 42:168-75. [PMID: 24509709 DOI: 10.1007/s10488-014-0540-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
This study examined trends in general hospital discharges and dispositions involving episodes of severe mental illness (SMI) with and without co-occurring substance use disorders. We analyzed data from the National Hospital Discharge Survey from 1979 through 2008. Discharges involving SMI and co-occurring substance use disorders (COD) were associated with shorter lengths of stay and had a greater likelihood of being discharged routinely or home and reduced likelihood of being transferred to a short- or long-term facility. Although COD discharges had a greater odds of leaving against medical advice than SMI discharges, this effect was not significant over time. A greater understanding of hospital discharge planning practices is needed to ensure that patients are linked to appropriate aftercare services.
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Affiliation(s)
- Jennifer I Manuel
- School of Social Work, Academic Learning Commons, Virginia Commonwealth University, 1000 Floyd Avenue, Richmond, VA, 23284, USA,
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18
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Luciano A, Carpenter-Song EA. A qualitative study of career exploration among young adult men with psychosis and co-occurring substance use disorder. J Dual Diagn 2014; 10:220-5. [PMID: 25391280 PMCID: PMC4474040 DOI: 10.1080/15504263.2014.962337] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE This article explores the meaning and importance of career exploration and career development in the context of integrated treatment for young adults with early psychosis and substance use disorders (i.e., co-occurring disorders). METHODS Twelve young adult men (aged 18 to 35 years) with co-occurring disorders recruited from an integrated treatment center completed a series of three semi-structured in-depth qualitative interviews. Data were transcribed verbatim and analyzed using thematic analysis. Purposive sampling ensured participants represented a range of substance abuse treatment stages. RESULTS Participants had a mean age of 26 (SD = 3) and identified as White. Two-thirds of participants (n = 8, 67%) had diagnosed schizophrenia-spectrum disorders, three (25%) had bipolar disorder, and one (8%) had major depression; four (33%) also had a co-occurring anxiety disorder. The most common substance use disorders involved cannabis (n = 8, 67%), cocaine (n = 5, 42%), and alcohol (n = 5, 42%). These young adult men with co-occurring disorders described past jobs that did not align with future goals as frustrating and disempowering, rather than confidence-building. Most young adult participants began actively developing their careers in treatment through future-oriented work or school placements. They pursued ambitious career goals despite sporadic employment and education histories. Treatment engagement and satisfaction appeared to be linked with career advancement prospects. CONCLUSIONS Integrating career planning into psychosocial treatment is a critical task for providers who serve young adults with co-occurring disorders. Whether integrating career planning within early intervention treatment planning will improve clinical, functional, or economic outcomes is a promising area of inquiry for rehabilitation researchers and clinicians.
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Affiliation(s)
- Alison Luciano
- a Dartmouth Psychiatric Research Center , Geisel School of Medicine at Dartmouth , Lebanon , New Hampshire , USA
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Wobrock T, Falkai P, Schneider-Axmann T, Hasan A, Galderisi S, Davidson M, Kahn RS, Derks EM, Boter H, Rybakowski JK, Libiger J, Dollfus S, López-Ibor JJ, Peuskens J, Hranov LG, Gaebel W, Fleischhacker WW. Comorbid substance abuse in first-episode schizophrenia: effects on cognition and psychopathology in the EUFEST study. Schizophr Res 2013; 147:132-139. [PMID: 23537477 DOI: 10.1016/j.schres.2013.03.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2012] [Revised: 02/28/2013] [Accepted: 03/01/2013] [Indexed: 11/17/2022]
Abstract
UNLABELLED Studies and meta-analyses investigating the influence of substance use disorder (SUD) (substance abuse or dependence) on psychopathology and neurocognitive function in schizophrenia patients have revealed controversial results. Most studies did only have small samples and did not focus exclusively on first-episode schizophrenia patients. METHOD In a post-hoc analysis of the European First Episode Schizophrenia Trial (EUFEST) psychopathology and cognitive performances of patients with (FE-SUD, N=119, consisting of N=88 patients with persisting SUD at baseline and N=31 patients with previous SUD) and without SUD (FE-non-SUD, N=204) were compared at baseline and 6 months follow-up. Neurocognitive assessment included the Rey Auditory Verbal Learning Test (RAVLT); Trail Making Tests A and B (TMT), Purdue Pegboard and Digit-Symbol Coding. RESULTS In total 31.1% of patients reported SUD, and 22.2% of patients used cannabis. There were no significant differences between patients with and without SUD concerning PANSS scores, extrapyramidal motor symptoms or neurocognitive measures except better performance in psychomotor speed (TMT-A, p=0.033, Cohen's d=0.26) in patients with SUD at 6 months follow-up. Interestingly, SUD patients with ongoing substance use at follow-up showed elevated positive symptoms (PANSS positive score, p=0.008, Cohen's d=0.84) compared to those who abstained. PANSS scores at baseline were increased in patients with an onset of SUD before the age of 16 years. In addition we found a correlation between longer duration of cannabis use and higher cognitive performance as well as reduced symptom improvement and more extrapyramidal motor symptoms in patients with higher frequency of cannabis consumption. CONCLUSIONS FE-SUD and FE-non-SUD show similar psychopathology and neuropsychological performances at baseline and during the first 6 months of antipsychotic treatment.
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Affiliation(s)
- T Wobrock
- Department of Psychiatry and Psychotherapy, University Medical Centre, Georg-August-University, Göttingen, Germany; Centre of Mental Health, Darmstadt-Dieburg Clinics, Groß-Umstadt, Germany.
| | - P Falkai
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - T Schneider-Axmann
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - A Hasan
- Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
| | - S Galderisi
- Department of Psychiatry, University of Naples SUN, Naples, Italy
| | - M Davidson
- Department of Psychiatry, Sheba Medical Center, Tel-Hashomer, Israel
| | - R S Kahn
- Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, The Netherlands
| | - E M Derks
- Rudolf Magnus Institute of Neuroscience, Department of Psychiatry, University Medical Center Utrecht, The Netherlands
| | - H Boter
- Department of Epidemiology (unit HTA), University of Groningen, University Medical Centre Groningen, Groningen, The Netherlands
| | | | - J Libiger
- Department of Psychiatry, University Hospital Hradec Kralove, Czech Republic
| | - S Dollfus
- Department of Adult Psychiatry, Centre Hospitalier Universitaire, Centre Esquirol, Caen, France
| | - J J López-Ibor
- Institute of Psychiatry and Mental Health, San Carlos Clinical University Hospital of Madrid, Spain
| | - J Peuskens
- University Psychiatric Centre, Katholieke Universiteit Leuven, Campus St. Jozef Kortenberg, Leuven, Belgium
| | - L G Hranov
- Department of Psychiatry, University Hospital of Neurology and Psychiatry, St. Naum, Sofia, Bulgaria
| | - W Gaebel
- Department of Psychiatry and Psychotherapy, Heinrich-Heine-University, Düsseldorf, Germany
| | - W W Fleischhacker
- Department of Psychiatry, Department of Biological Psychiatry, Medical University of Innsbruck, Austria
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Shahriyarmolki K, Meynen T. Needs assessment of dual diagnosis: A cross-sectional survey using routine clinical data. DRUGS-EDUCATION PREVENTION AND POLICY 2013. [DOI: 10.3109/09687637.2013.796910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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The journey through cannabis use: a qualitative study of the experiences of young adults with psychosis. J Nerv Ment Dis 2011; 199:703-8. [PMID: 21878786 DOI: 10.1097/nmd.0b013e318229d6bd] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The present study explored the personal experiences of cannabis and psychosis among young adults, including the reasons and meanings of cannabis use and the perceived relationship between cannabis and mental health. Interviews with seven young adults with psychosis who described regular current or past cannabis use were conducted and analyzed using Interpretative Phenomenological Analysis. Four master themes emerged: The Journey Through Cannabis Use, The Social and Cultural World, The Struggle to Make Sense, and The Depths and Beyond. Respondent validation supported these themes, particularly the idea of cannabis use as a journey that changed in time. Social and cultural factors clearly influenced the initiation of and decision whether to continue using cannabis. Individuals could simultaneously hold positive and negative views on using cannabis. Implications for clinical interventions are explored, and the relevance of motivational interviewing and the stages of change models of behavior change are noted.
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Schulte SJ, Meier PS, Stirling J, Berry M. Unrecognised dual diagnosis – a risk factor for dropout of addiction treatment. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/17523281003705199] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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23
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Dual diagnosis in a Dublin tertiary addiction centre - A cross-sectional study. Ir J Psychol Med 2009; 26:191-193. [PMID: 30282241 DOI: 10.1017/s0790966700000690] [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: 11/06/2022]
Abstract
OBJECTIVES To address the relative dearth of information relating to the prevalence of psychiatric co-morbidity among attenders of community addiction facilities. METHODS We carried out a cross-sectional study of clients attending a Dublin-based tertiary addiction centre to assess the rates of psychiatric co-morbidity, determine the demographic and clinical variables and evaluate the level of contact with allied medical care especially primary care and community psychiatric services. Information was sourced from available patient records. RESULTS Forty-three per cent of the clients (n = 59), attending the service were found to have a chart diagnosis of psychiatric disorder. Only 15% of these were in contact with community psychiatric services. CONCLUSIONS This high rate of psychiatric co-morbidity has implications in terms of funding, training and service delivery.
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Clutterbuck R, Tobin D, Orford J, Copello A, Preece M, Birchwood M, Day E, Graham H, Griffith E, McGovern D. Exploring the attitudes of staff working within mental health settings toward clients who use cannabis. DRUGS-EDUCATION PREVENTION AND POLICY 2009. [DOI: 10.1080/09687630801945861] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Day E, Best D, Copello A, Young H, Khoosal N, Modern N. Characteristics of drug‐using patients and treatment provided in primary and secondary settings. JOURNAL OF SUBSTANCE USE 2009. [DOI: 10.1080/14659890701639816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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26
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Todd J, Green G, Pevalin DJ, Ikuesan BA, Harrison M, Self C, Baldacchino A. Service uptake in a sample of substance misuse and community mental health service clients: A case control study. J Ment Health 2009. [DOI: 10.1080/09638230500060011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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27
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Ley A, Jeffery D, Shaw S, Weaver T. Development of a brief screen for substance misuse amongst people with severe mental health problems living in the community. J Ment Health 2009. [DOI: 10.1080/09638230701494852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Graham HL, Copello A, Birchwood M, Orford J, McGovern D, Mueser KT, Clutterbuck R, Godfrey E, Maslin J, Day E, Tobin D. A preliminary evaluation of integrated treatment for co-existing substance use and severe mental health problems: Impact on teams and service users. J Ment Health 2009. [DOI: 10.1080/09638230600902633] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Carrà G, Johnson S. Variations in rates of comorbid substance use in psychosis between mental health settings and geographical areas in the UK. A systematic review. Soc Psychiatry Psychiatr Epidemiol 2009; 44:429-47. [PMID: 19011722 DOI: 10.1007/s00127-008-0458-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 10/16/2008] [Indexed: 01/14/2023]
Abstract
BACKGROUND Comorbid substance misuse in psychosis is associated with significant clinical, social and legal problems. An epidemiologically informed approach to planning service delivery requires an understanding of which clinical populations are at particularly high risk for such 'dual diagnosis'. Evidence has now been accumulating in the UK since the early 1990s, and allows a relatively comprehensive comparison of rates between service settings, geographical areas and social contexts in terms of ethnic background. METHODS A literature search was carried out with the aim of investigating: (a) comorbid alcohol and drug misuse rates in people with established psychosis in different mental health and addiction settings in the UK, (b) variations in such rates between different population groups. RESULTS There are wide variations in reported drug and alcohol misuse rates in psychosis. Most recent UK studies report rates between 20 and 37% in mental health settings, while figures in addiction settings are less clear (6-15%). Rates are generally not as high as in US studies, but appear to be especially high in inpatient and crisis team settings (38-50%) and forensic settings. In terms of geography, rates appear highest in inner city areas. Some ethnic groups are over-represented among clinical populations of people with dual diagnosis. CONCLUSIONS Rates of substance misuse in psychosis are likely to be influenced by service setting, population composition and geography. Acute and forensic settings are especially appropriate for the development of targeted interventions.
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Affiliation(s)
- Giuseppe Carrà
- Dept. of Mental Health Sciences, Royal Free and University College Medical School, Charles Bell House, 67-73 Riding House Street, London, W1W 7EY, UK.
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Wobrock T, Sittinger H, Behrendt B, D'Amelio R, Falkai P. Comorbid substance abuse and brain morphology in recent-onset psychosis. Eur Arch Psychiatry Clin Neurosci 2009; 259:28-36. [PMID: 19194646 PMCID: PMC3085762 DOI: 10.1007/s00406-008-0831-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2008] [Accepted: 05/26/2008] [Indexed: 11/27/2022]
Abstract
The aim of the presented study was to compare schizophrenia and schizoaffective patients early in the course of the disease with and without comorbid substance abuse disorder (SUD vs. NSUD) with regard to brain morphology. In a prospective design 41 patients (20 SUD vs. 21 NSUD) diagnosed as recent-onset schizophrenia or schizoaffective disorder consecutively admitted to hospital received standardized psychopathological evaluation (BPRS, SANS, MADRS, CGI, GAF) and MRI scanning with volumetric measurement of superior temporal gyrus (STG), amygdala-hippocampal complex, and cingulum. Patients with SUD (primarily cannabis) were significantly younger, predominantly male and had a lower socioeconomic status. Despite less attentional impairment (SANS subscore) and elevated anxiety/depression (BPRS subscore) in patients with SUD compared to NSUD, no other psychopathological differences could be detected. There were no differences in the assessed temporolimbic brain morphology between the two subgroups. In conclusion, in this study substance abuse in recent-onset psychosis had no effect on brain morphology and the earlier onset of psychosis in patients with comorbid SUD could not be explained by supposed accentuated brain abnormalities in temporolimbic regions.
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Affiliation(s)
- Thomas Wobrock
- Department of Psychiatry and Psychotherapy, Georg-August-University Göttingen, von-Siebold-Strasse 5, 37075 Göttingen, Germany.
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Drukker M, Maarschalkerweerd M, Bak M, Driessen G, à Campo J, de Bie A, Poddighe G, van Os J, Delespaul P. A real-life observational study of the effectiveness of FACT in a Dutch mental health region. BMC Psychiatry 2008; 8:93. [PMID: 19055813 PMCID: PMC2629765 DOI: 10.1186/1471-244x-8-93] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2008] [Accepted: 12/04/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND ACT is an effective community treatment but causes discontinuity of care between acutely ill and currently stable patient groups. The Dutch variant of ACT, FACT, combines both intensive ACT treatment and care for patients requiring less intensive care at one time point yet likely to need ACT in the future. It may be hypothesised that this case mix is not beneficial for patients requiring intensive care, as other patient groups may "dilute" care provision. The effectiveness of FACT was compared with standard care, with a particular focus on possible moderating effects of patient characteristics within the case mix in FACT. METHODS In 2002, three FACT teams were implemented in a Dutch region in which a cumulative routine outcome measurement system was in place. Patients receiving FACT were compared with patients receiving standard treatment, matched on "baseline" symptom severity and age, using propensity score matching. Outcome was the probability of being in symptomatic remission of psychotic symptoms. RESULTS The probability of symptomatic remission was higher for SMI patients receiving FACT than for controls receiving standard treatment, but only when there was an unmet need for care with respect to psychotic symptoms (OR = 6.70, p = 0.002; 95% CI = 1.97-22.7). CONCLUSION Compared to standard care, FACT was more rather than less effective, but only when a need for care with respect to psychotic symptoms is present. This suggests that there is no adverse effect of using broader patient mixes in providing continuity of care for all patients with severe mental illness in a defined geographical area.
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Affiliation(s)
- Marjan Drukker
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, PO Box 616, (location Vijverdal) 6200 MD Maastricht, The Netherlands.
| | - Myrte Maarschalkerweerd
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, PO Box 616, (location Vijverdal) 6200 MD Maastricht, the Netherlands
| | - Maarten Bak
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, PO Box 616, (location Vijverdal) 6200 MD Maastricht, the Netherlands,Integrated Care and f-ACT (Psycope), Mondriaan, South Limburg, the Netherlands
| | - Ger Driessen
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, PO Box 616, (location Vijverdal) 6200 MD Maastricht, the Netherlands
| | - Joost à Campo
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, PO Box 616, (location Vijverdal) 6200 MD Maastricht, the Netherlands,Integrated Care and f-ACT (Psycope), Mondriaan, South Limburg, the Netherlands
| | - Arthur de Bie
- Prins Claus Centrum (Mental Health Centre), p.o. box 5500, 6130 MB Sittard, the Netherlands
| | - Giovanni Poddighe
- Prins Claus Centrum (Mental Health Centre), p.o. box 5500, 6130 MB Sittard, the Netherlands
| | - Jim van Os
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, PO Box 616, (location Vijverdal) 6200 MD Maastricht, the Netherlands,Division of Psychological Medicine, Institute of Psychiatry, De Crespigny Park, Denmark Hill, London, UK
| | - Philippe Delespaul
- Department of Psychiatry and Neuropsychology, South Limburg Mental Health Research and Teaching Network, EURON, Maastricht University, PO Box 616, (location Vijverdal) 6200 MD Maastricht, the Netherlands,Integrated Care and f-ACT (Psycope), Mondriaan, South Limburg, the Netherlands
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Jones A. What are the nursing implications when using paliperidone prolonged release for people with schizophrenia. J Psychiatr Ment Health Nurs 2008; 15:792-9. [PMID: 19012670 DOI: 10.1111/j.1365-2850.2008.01299.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Paliperidone prolonged release (PR) is a new product licensed for the treatment of schizophrenia. It is the active metabolite of risperidone, a drug that has been successfully used in the treatment of schizophrenia and mood disorder. Paliperidone PR has a unique pharmacological delivery mechanism that may incur benefits for particular patients diagnosed with schizophrenia. Studies investigating paliperidone PR are reviewed along with implications for its use by nurse prescribers and those nurses who monitor the use of medication for people with psychosis.
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Affiliation(s)
- A Jones
- North Wales NHS Trust, Llwyn-y-Groes Psychiatric Unit, Wrexham, UK.
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Hughes L, Tobin D, McGlynn P, Heffernan K. A pilot of team‐based dual diagnosis training for assertive Outreach teams. ADVANCES IN DUAL DIAGNOSIS 2008. [DOI: 10.1108/17570972200800011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Assertive outreach teams are working with a significant proportion of people with complex needs, including dual diagnosis. Government policy has highlighted the role of assertive outreach in engaging and intervening with this group. This paper reports on the development and evaluation of a specific team‐focused training package and its trial in the Eastern and West Midlands regions.
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Rush B, Koegl CJ. Prevalence and profile of people with co-occurring mental and substance use disorders within a comprehensive mental health system. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2008; 53:810-21. [PMID: 19087479 DOI: 10.1177/070674370805301207] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To examine the prevalence and profile of people with co-occurring mental and substance use disorders in relation to numerous demographic, diagnostic, and needs-related variables across a comprehensive system of mental health services using a standard methodology. METHOD Data were collected on cases (n = 9839) sampled from specialty tertiary inpatient, specialty outpatient, and community-based mental health programs. Status with respect to co-occurring disorders was based on recorded diagnosis of substance use disorder and the substance abuse measure within the Colorado Client Assessment Record. The demographic and needs profile was compared across groups with or without co-occurring disorders within each level of care. RESULTS Overall, the prevalence of co-occurring disorders was 18.5%, and highest among clients receiving specialty tertiary inpatient care (28%), and within selected subpopulations such as younger adults (55%) and those with personality disorders (34%). There were few differences between groups based on co-occurring disorders in the specialty inpatient programs. For outpatient and community settings, the clients with co-occurring disorders were distinguished by a more impaired and complex needs profile and more likely to be young, single, male, and of low education. Across all levels of care, having a co-occurring disorder was strongly associated with antisocial and challenging behaviour, legal involvement, and risk of suicide or self-harm. CONCLUSION The prevalence estimate of co-occurring disorders is likely representative of a multilevel system of care that serves a large, mixed urban and rural population. Results highlight the need to focus on specific subpopulations and sectors in pursuit of more integrated treatment and support for their mental health and addictions problems.
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Affiliation(s)
- Brian Rush
- Health Systems Research and Consulting Unit, Centre for Addiction and Mental Health, Toronto, Ontario.
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Schulte SJ, Meier PS, Stirling J, Berry M. Treatment approaches for dual diagnosis clients in England. Drug Alcohol Rev 2008; 27:650-8. [PMID: 18830860 DOI: 10.1080/09595230802392816] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Dual diagnosis (DD, co-occurrence of substance use and mental health problems) prevalence data in England are limited to specific regions and reported rates vary widely. Reliable information on actual service provision for dual diagnosis clients has not been collated. Thus a national survey was carried out to estimate dual diagnosis prevalence in treatment populations and describe the service provision available for this client population in drug/alcohol (DAS) and mental health services (MHS). DESIGN A questionnaire was sent to managers of 706 DAS and 2374 MHS. Overall, 249 (39%) DAS and 493 (23%) MHS participated in the survey. RESULTS In both DAS and MHS, around 32% of clients were estimated to have dual diagnosis problems. However, fewer than 50% of services reported assessing clients for both problem areas. Regarding specific treatment approaches, most services (DAS: 88%, MHS: 87%) indicated working jointly with other agencies. Significantly fewer services used joint protocols (DAS: 55%, MHS: 48%) or shared care arrangements, including access to external drug/alcohol or mental health teams (DAS: 47%, MHS: 54%). Only 25% of DAS and 17% of MHS employed dual diagnosis specialists. CONCLUSIONS Dual diagnosis clients constitute a substantial proportion of clients in both DAS and MHS in England. Despite recent policy initiatives, joint working approaches tend to remain unstructured.
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Affiliation(s)
- Sabrina J Schulte
- Department of Psychology, Elizabeth Gaskell Campus, Manchester Metropolitan University, UK.
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36
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Schulte S, Holland M. Dual diagnosis in Manchester, UK: practitioners' estimates of prevalence rates in mental health and substance misuse services. ACTA ACUST UNITED AC 2008. [DOI: 10.1080/17523280802019901] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Crebbin K, Mitford E, Paxton R, Turkington D. Drug and alcohol misuse in first episode psychosis: An observational study. Neuropsychiatr Dis Treat 2008; 4:417-23. [PMID: 18728795 PMCID: PMC2518377 DOI: 10.2147/ndt.s2178] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND There have been very few observational studies of drug and alcohol misuse in first-episode psychosis in the UK. METHOD Using an observational database of first episode psychosis in Northumberland, a county in Northern England, information on patients aged 16 to 36 years were collected at presentation and annual follow-up between October 1998 and October 2005. Patterns of drug and alcohol misuse were compared using hospitalization as an outcome measure, and violence rates were examined retrospectively. RESULTS Drug misuse without alcohol misuse was associated with a highly significant increase in hospital days. An alcohol problem, either with or without coexisting drug misuse, was not predictive of increased hospital days. Drug and alcohol misuse together was associated with violence. CONCLUSIONS This paper lends some support to those Early Intervention in Psychosis (EIP) teams currently advising patients that drug misuse may have a greater impact than alcohol use on the outcome of first-episode psychosis.
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Knott JC, Pleban A, Taylor D, Castle D. Management of mental health patients attending Victorian emergency departments. Aust N Z J Psychiatry 2007; 41:759-67. [PMID: 17687662 DOI: 10.1080/00048670701517934] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To evaluate the management of mental health presentations to Victorian emergency departments. METHOD An observational study in five Victorian emergency departments (four metropolitan and one regional). All patients with an ICD-10 discharge diagnosis for a predetermined mental health disorder were included. Data were collected on patient demographics, presentation, clinical management (emergency and mental health) and disposition. RESULTS There were 3702 patients enrolled (96.0% of all mental health presentations). At presentation 39.1% were intoxicated and 39.9% arrived by ambulance, 17.6% with the police. There was a significant variation (p <0.001) between sites for: the median time to be seen by a clinician (14 vs 43 min), the time between referral to and review by mental health services (15 vs 50 min), the median time in the emergency department (208 min vs 380 min), the proportion who spent >24 h in the emergency department (0.0% vs 11.6%) and disposition (proportion discharged home from ED 49.8% vs 63.5%). CONCLUSION Important variations were identified in the management of patients with mental health presentations to Victorian emergency departments. This variation is most likely due to differing access to resources. All levels of administration must work with carers and patients to ensure that optimal patient care is provided at every site.
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Affiliation(s)
- Jonathan C Knott
- Emergency Medicine Research Unit, Royal Melbourne Hospital, Parkville, Australia.
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40
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Rosenblatt AB, Mekhail NA. Management of pain in addicted/illicit and legal substance abusing patients. Pain Pract 2007; 5:2-10. [PMID: 17156112 DOI: 10.1111/j.1533-2500.2005.05102.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Approximately one-third of the American population experiences chronic pain. This varies in origin and severity. It also has been documented that billions of dollars are lost yearly because of health care expenses and missed workdays for chronic pain. Addiction is a primary, chronic, neurobiological disease with genetic, psychological and environmental factors influencing its development and manifestations. Addictive disorders occur in 3% to 26% of the general population, 19% to 255 of hospitalized patients and 40% to 60% in patients who sustained major trauma. More specifically 13.9 million of people living in USA over the age of 12 years are currently using illicit drugs. Although patients with chronic pain may be at an increased risk for addiction, the general population has demonstrated similar addiction rates. Unfortunately, patients who have chronic pain and addition will only have one of these aspects addressed. The purpose of this article is to clarify specific definition of substance use, abuse and addiction. As well as examining the role of pain physicians in evaluating and treating the chronic pain patients who have a history of substance abuse, and lastly outline strategy for assessing patients at risks and evaluating the most practical way of dealing with their chronic pain issues.
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Affiliation(s)
- Aaron B Rosenblatt
- The Cleveland Clinic Foundation, Department of Pain Management, Cleveland, Ohio, USA
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41
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Wobrock T, Sittinger H, Behrendt B, D'Amelio R, Falkai P, Caspari D. Comorbid substance abuse and neurocognitive function in recent-onset schizophrenia. Eur Arch Psychiatry Clin Neurosci 2007; 257:203-10. [PMID: 17131214 DOI: 10.1007/s00406-006-0707-x] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2006] [Accepted: 05/26/2006] [Indexed: 11/28/2022]
Abstract
Despite the high prevalence of comorbid substance use disorder (SUD) up to 65% in schizophrenia there is still few knowledge about the influence of substance abuse on neurocognitive function. In a prospective design we recruited 68 patients (aged 18-40 years) diagnosed as recent-onset schizophrenia or schizoaffective disorder consecutively admitted to hospital. The patients received standardized psychopathological evaluation of schizophrenic symptoms [Brief Psychiatric Rating Scale (BPRS), Scale for the Assessment of Negative Symptoms (SANS)], depressive symptoms [Montgomery Asberg Depression Rating Scale, (MADRS)] and global ratings [Clinical Global Impressions Scale (CGI), Global Assessment of Functioning Scale (GAF)]. Out of this sample 44 subjects underwent after stabilization (4-6 weeks after admission) neuropsychological investigation focusing on early information processing (Trail-Making-Test A, Digit Span), visuo-spatial ability (Corsi Block Tapping), verbal fluency (Verbal Fluency Test, semantic and letter category), and executive functioning and cognitive flexibility [Trail-Making-Test B, Wisconsin Card Sorting Test (WCST)]. About 36% of patients reported drug abuse [European Addiction Severity Index (EuropASI)] with a high prevalence for cannabis. Compared with nonabusers the sample of substance abusers was younger, predominantly male and had lower socioeconomic status. Attentional impairment according to the SANS subscale was less in abusers than in nonabusers on admission, no other psychopathological differences could be detected. Schizophrenic patients without substance abuse demonstrated significantly better performance only in a few neurocognitive tasks (Verbal Fluency, letter category and at trend level Digit Span, backwards), while there tended to be an advantage for substance abusers in executive functioning (WCST, not significant). These results are consistent with other studies of first-episode patients. The lack of higher cognitive disturbance in young schizophrenic patients with comorbid substance abuse may encourage clinicians to develop integrated treatment programmes using cognitive strategies of drug therapy.
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Affiliation(s)
- Thomas Wobrock
- Dept. of Psychiatry and Psychotherapy, University Hospital of Saarland, 66421 Homburg/Saar, Germany.
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Cruce G, Nordström LG, Ojehagen A. Risky use and misuse of alcohol, drugs and cigarettes detected by screening questionnaires in a clinical psychosis unit. Nord J Psychiatry 2007; 61:92-9. [PMID: 17454723 DOI: 10.1080/08039480701226062] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The use of screening instruments has been proposed to facilitate identification of risky substance use and misuse. This study aims to investigate the use of a screening procedure to identify hazardous or harmful use of alcohol, drug-related problems and riskful use of cigarettes in a clinical psychosis setting. The use of alcohol, drugs and cigarettes was examined by three self-reporting instruments: Alcohol Use Disorders Identification Test (AUDIT), Drug Use Disorders Identification Test (DUDIT) and Fagerström Test for Nicotine Dependence (FTND). Two hundred and forty-one out of 374 patients (64%) took part in the investigation. Eighteen per cent had a hazardous or harmful alcohol use, 9% drug-related problems and 49% were smokers. Multivariate analyses showed that women, as well as smokers had an increasing risk of having drug-related problems. The use of screening questionnaires increases the awareness that risky use of alcohol, drugs and cigarettes is common among persons with psychosis. Many persons with psychosis used alcohol, drugs and cigarettes in a risky way. It is important to identify these problems to make proper interventions due to the negative medical and social consequences of this use. Such identification may be facilitated by use of screening instruments.
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Affiliation(s)
- Gunilla Cruce
- Department of Clinical Sciences, Lund Psychiatry and the Vardal Institute, Lund University Hospital, Kioskgatan 19, Lund, SE-221 85, Sweden.
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Fakhoury WKH, Priebe S. An unholy alliance: substance abuse and social exclusion among assertive outreach patients. Acta Psychiatr Scand 2006; 114:124-31. [PMID: 16836600 DOI: 10.1111/j.1600-0447.2005.00740.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate the relationship between social exclusion and outcomes of mentally ill patients with substance abuse problems receiving assertive outreach treatment in London. METHOD Analysis was conducted on data on 580 patients from the 'Pan-London Assertive Outreach Study (PLAO)'. Data were collected using clinician-rated scales of alcohol and drug abuse in the last 6 months before baseline. Outcomes - hospitalization and compulsory hospitalization- were assessed over a 9-month follow-up period. RESULTS The analysis identified a group of patients with substance abuse who suffer from social exclusion and forensic problems (n = 77, 15.8%), and had poorer outcomes than the rest of the patients in terms of hospitalization (52% vs. 36% respectively) and compulsory (39% vs. 22% respectively) hospitalization. CONCLUSION There is a distinct group of patients whose treatment requires social inclusion and forensic expertise. Future research into which model of service is suitable for these patients and in what setting is recommended.
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Affiliation(s)
- W K H Fakhoury
- Unit for Social and Community Psychiatry, Barts and The London School of Medicine, Queen Mary, University of London, London, UK.
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O'Hare T, Sherrer MV, Shen C. Subjective distress from stressful events and high-risk behaviors as predictors of PTSD symptom severity in clients with severe mental illness. J Trauma Stress 2006; 19:375-86. [PMID: 16788997 DOI: 10.1002/jts.20131] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Survey data collected from 257 community mental health center clients tested direct and indirect relationships among subjective distress associated with stressful/traumatic events and high-risk behaviors, substance abuse, and posttraumatic stress disorder (PTSD) symptoms. Structural equation modeling (SEM) revealed substantial direct effects of subjective distress associated with lifetime physical and sexual abuse on PTSD symptom severity. Subjective distress related to high-risk behaviors (e.g., suicide attempts) mediated subjective distress and PTSD symptom severity. Subjective distress from physical and sexual abuse was also strongly related to problem drinking. Adding gender to the model revealed greater subjective distress from physical and sexual abuse for women and greater drinking problems for men. Otherwise, gender had little effect on the model overall.
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Pozzi G, Frustaci A, Janiri L, Di Giannantonio M. The challenge of psychiatric comorbidity to the public services for drug dependence in Italy: A national survey. Drug Alcohol Depend 2006; 82:224-30. [PMID: 16233962 DOI: 10.1016/j.drugalcdep.2005.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2005] [Revised: 09/20/2005] [Accepted: 09/27/2005] [Indexed: 11/18/2022]
Abstract
UNLABELLED We evaluated the availability of resources and specific expertise for treating comorbidity at the Italian public Services for Drug Dependence (SerTs). A stratified sample of 100 SerTs was constructed and a specific questionnaire mailed to the clinical managers. The interview aimed at: characteristics of the respondent; theoretical knowledge of comorbidity; influence of dual diagnosis on clinical practice; general, human, and organisational resources; quality evaluation. MAIN RESULTS (a) 90% of managers are medical doctors but <50% have a specialisation in psychiatry or qualification in psychotherapy; (b) about half of the managers have a fair knowledge of comorbidity; (c) the managers' estimate of prevalence is 25% for Axis I and 25-50% for Axis II comorbidity, and they consider the bad course of illness as the main cause of increased costs; (d) the SerTs' resources appear incomplete: psychiatric consultation and collaboration with therapeutic communities are available in about 90%, but routine assessment of psychopathology and day hospital or day care programs are lacking in over 50%; (e) about half of the managers declare themselves fairly satisfied about the treatments offered, but 80% complain about inadequate cooperation of the mental health services and >95% claim about inadequate education of their staff. The results were also analysed by factors of stratification: regional distribution, urban/rural location, and number of clients in care. In conclusion, the problem of comorbidity should be faced more effectively, particularly by means of improved organisational resources and continuing education of staff members.
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Affiliation(s)
- Gino Pozzi
- Institute of Psychiatry and Psychology, Università Cattolica del Sacro Cuore, Rome, Italy.
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Abstract
BACKGROUND Increasing attention has been given by researchers to cannabis use in individuals with psychosis. As psychoses are relatively low-prevalence disorders, research has been mostly been restricted to small-scale studies of treatment samples. The reported prevalence estimates obtained from these studies vary widely. AIMS To provide prevalence estimates based on larger samples and to examine sources of variability in prevalence estimates across studies. METHOD Data from 53 studies of treatment samples and 5 epidemiological studies were analysed. RESULTS Based on treatment sample data, prevalence estimates were calculated for current use (23.0%), current misuse (11.3%), 12-month use (29.2%), 12-month misuse (18.8%), lifetime use (42.1%) and lifetime misuse (22.5%). Epidemiological studies consistently reported higher cannabis use and misuse prevalence in people with psychosis. CONCLUSIONS The factor most consistently associated with increased odds of cannabis prevalence was specificity of diagnosis. Factors such as consumption patterns and study design merit further consideration.
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Affiliation(s)
- Bob Green
- Community Forensic Mental Health Service, 42 Albert Street, Brisbane 4001, Australia.
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Jones DR, Macias C, Barreira PJ, Fisher WH, Hargreaves WA, Harding CM. Prevalence, severity, and co-occurrence of chronic physical health problems of persons with serious mental illness. Psychiatr Serv 2004; 55:1250-7. [PMID: 15534013 PMCID: PMC2759895 DOI: 10.1176/appi.ps.55.11.1250] [Citation(s) in RCA: 191] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study examined Medicaid claims forms to determine the prevalence, severity, and co-occurrence of physical illness within a representative sample of persons with serious mental illness (N=147). METHODS Representativeness of health problems in the study sample was established through comparison with a larger sample of persons with serious mental illness enrolled in Medicaid within the same state. Standardized annual costs were then assigned to Medicaid claims diagnoses, and individual health problem severity was measured as the sum of estimated treatment costs for diagnosed conditions. RESULTS Seventy-four percent of the study sample (N=109) had been given a diagnosis of at least one chronic health problem, and 50 percent (N=73) had been given a diagnosis of two or more chronic health problems. Of the 14 chronic health conditions surveyed, chronic pulmonary illness was the most prevalent (31 percent incidence) and the most comorbid. Persons with chronic pulmonary illness were second only to those with infectious diseases in average annual cost of treatment ($8,277). Also, 50 percent or more of participants in eight other diagnostic categories had chronic pulmonary illness. A regression analysis identified age, obesity, and substance use disorders as significant predictors of individual health problem severity. CONCLUSIONS Risk adjustment for physical health is essential when setting performance standards or cost expectations for mental health treatment. Excluding persons with chronic health problems from mental health service evaluations restricts generalizability of research findings and may promote interventions that are inappropriate for many persons with serious mental illness.
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Affiliation(s)
- Danson R. Jones
- Department of community intervention research at McLean Hospital, 115 Mill Street, Belmont, Massachusetts 02478-9106 (e-mail, )
| | - Cathaleene Macias
- Department of community intervention research at McLean Hospital, 115 Mill Street, Belmont, Massachusetts 02478-9106 (e-mail, )
| | - Paul J. Barreira
- Department of community intervention research at McLean Hospital, 115 Mill Street, Belmont, Massachusetts 02478-9106 (e-mail, )
| | - William H. Fisher
- Center for Mental Health Services Research at the University of Massachusetts Medical School in Worcester
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Abstract
The common co-occurrence of substance misuse and other psychiatric disorders and their intricate relationships have led to major community-based epidemiological studies in the US which showed high rates of current and lifetime comorbidity. Moreover, studies of clinical populations conducted in North America, Europe and Australia, showed even higher rates of comorbidity. The aetology of this comorbidity has also been investigated and important models have emerged with findings that inform its assessment and treatment. Future epidemiological studies should focus on the study of concurrent conditions rather than lifetime ones using research diagnostic instruments with high reliability providing information on a number of key outcomes.
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Affiliation(s)
- Mohammed T Abou-Saleh
- 1Reader & Honorary Consultant in Addiction Psychiatry, St George's Hospital Medical School, University of London, UK
| | - Aleksandar Janca
- 2University of Western Australia, School of Psychiatry and Clinical Neurosciences, Australia
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50
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Weaver T, Madden P, Charles V, Stimson G, Renton A, Tyrer P, Barnes T, Bench C, Middleton H, Wright N, Paterson S, Shanahan W, Seivewright N, Ford C. Comorbidity of substance misuse and mental illness in community mental health and substance misuse services. Br J Psychiatry 2003; 183:304-13. [PMID: 14519608 DOI: 10.1192/bjp.183.4.304] [Citation(s) in RCA: 264] [Impact Index Per Article: 12.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Improved management of mental illness and substance misuse comorbidity is a National Health Service priority, but little is known about its prevalence and current management. AIMS To measure the prevalence of comorbidity among patients of community mental health teams (CMHTs) and substance misuse services, and to assess the potential for joint management. METHOD Cross-sectional prevalence survey in four urban UK centres. RESULTS Of CMHT patients, 44% (95% CI 38.1-49.9) reported past-year problem drug use and/or harmful alcohol use; 75% (95% CI 68.2-80.2) of drug service and 85% of alcohol service patients (95% CI 74.2-93.1) had a past-year psychiatric disorder. Most comorbidity patients appear ineligible for cross-referral between services. Large proportions are not identified by services and receive no specialist intervention. CONCLUSIONS Comorbidity is highly prevalent in CMHT, drug and alcohol treatment populations, but may be difficult to manage by cross-referral psychiatric and substance misuse services as currently configured and resourced.
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Affiliation(s)
- T Weaver
- Centre for Research on Drugs and Health Behaviour/Department of Social Science and Medicine, Imperial College London, UK.
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