1
|
Silbernagl M, Yanagida T, Slamanig R, Fischer G, Brandt L. Comorbidity Patterns Among Patients With Opioid Use Disorder and Problem Gambling: ADHD Status Predicts Class Membership. J Dual Diagn 2019; 15:147-158. [PMID: 30999811 DOI: 10.1080/15504263.2019.1590672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Objective: Psychiatric comorbidities are highly prevalent among individuals affected by substance use disorders and those with non-substance-related addictive disorders such as gambling disorder. More recently, the frequent co-occurrence of substance use disorders and attention-deficit hyperactivity disorder (ADHD) has received particular attention. The aim of our study was to identify patterns of psychiatric comorbidity and to examine associations between patient group and ADHD status with class membership. Methods: Participants were patients with opioid use disorder enrolled in opioid maintenance treatment (OMT), either recruited from the community (n = 142; M age = 35.8 years; 38.7% female) or prison (n = 133; M age = 35.7 years; 21.8% female), and patients undergoing treatment for problem gambling (PrG; n = 80; M age = 43.1 years; 20% female). To enable direct comparisons, the following instruments were applied: Mini International Neuropsychiatric Interview, Adult ADHD self-report scale, Wender Utah Rating Scale, and European Addiction Severity Index. We used a latent class analysis (LCA) to identify psychiatric comorbidity patterns and a multinomial logistic regression to examine associations between patient group, ADHD status, age, and gender with class membership. Results: The LCA resulted in a three-class solution: (1) a class of individuals with a relatively low probability of current psychiatric comorbidities, except for a high probability of substance use disorders; (2) a class with markedly increased probabilities of current and recurrent psychiatric comorbidities, especially for major depression; and (3) a class with very low probabilities of psychiatric comorbidities, except for moderate probabilities of substance use disorders and antisocial personality disorder. Both OMT patients recruited from the community and those in prison were less likely than PrG patients to be assigned to the most burdened class with respect to psychiatric comorbidity (class 2). Further, both individuals with ADHD in childhood and those with adult ADHD were more likely members of class 2. Conclusions: PrG patients seem to be at an even higher risk for psychiatric comorbidities compared to OMT patients. Raising awareness among practitioners for the high prevalence of psychiatric comorbidities among patients with gambling disorder and individuals with ADHD is crucial to initiate adequate treatment and to improve response.
Collapse
Affiliation(s)
- Marisa Silbernagl
- Center for Public Health, Medical University of Vienna , Vienna , Austria
| | - Takuya Yanagida
- Department for Applied Psychology: Work Education and Economy, University of Vienna , Vienna , Austria
| | - Rudolf Slamanig
- Department of Psychiatry and Psychotherapy, Medical University of Vienna , Vienna , Austria
| | - Gabriele Fischer
- Center for Public Health, Medical University of Vienna , Vienna , Austria
| | - Laura Brandt
- Department for Applied Psychology: Work Education and Economy, University of Vienna , Vienna , Austria
| |
Collapse
|
2
|
Ayoobi F, Bidaki R, Shamsizadeh A, Moghadam-Ahmadi A, Amiri H. Impact of opium dependency on clinical and neuropsychological indices of multiple sclerosis patients. Neurol Sci 2019; 40:2501-2507. [PMID: 31264108 DOI: 10.1007/s10072-019-03971-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 06/06/2019] [Indexed: 11/25/2022]
Abstract
The aim of this study was to determine the effect of opium on clinical and neuropsychological parameters in multiple sclerosis (MS) patients with substance dependency. A cross-sectional study was conducted on MS patients in Rafsanjan, Iran. Forty opium-addict MS patients (10 males and 30 females) aged between 18 and 50 years were compared with 40 MS patients with no addiction. Word-Pair Learning, Mini-Mental State Examination (MMSE), Wisconsin Card-Sorting Test (WCST), Depression, Anxiety, Expanded Disability Status Scale (EDSS), Fatigue, and the Multiple Sclerosis Functional Composite (MSFC) were measured and compared in the two groups. The comparison of two groups showed a significant increase trait anxiety (P < 0.001), fatigue (P = 0.009) and significant decrease in the executive function (P = 0.003), MMSE (P = 0.003), and working memory (P < 0.001) in addicted MS. It indicates the better efficiency of processing in the non-addicted MS patients. The MSFC z-score also was significantly higher in the non-addicted group (P < 0.001). The opium addiction has a negative impact on the clinical and neuropsychological outcome in MS patients.
Collapse
Affiliation(s)
- Fatemeh Ayoobi
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.,, Rafsanjan, Iran
| | - Reza Bidaki
- Diabetes Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.,Research Center of Addiction and Behavioral Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
| | - Ali Shamsizadeh
- Department of Physiology and Pharmacology, School of Medicine, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
| | - Amir Moghadam-Ahmadi
- Non-Communicable Diseases Research Center, Rafsanjan University of Medical Sciences, Rafsanjan, Iran.
| | - Houshang Amiri
- Neuroscience Research Center, Institute of Neuropharmacology, Kerman University of Medical Sciences, Kerman, Iran.,Department of Radiology and Nuclear Medicine, VU University Medical Center, Amsterdam, The Netherlands
| |
Collapse
|
3
|
Chang KC, Lin CY, Chang CC, Ting SY, Cheng CM, Wang JD. Psychological distress mediated the effects of self-stigma on quality of life in opioid-dependent individuals: A cross-sectional study. PLoS One 2019; 14:e0211033. [PMID: 30726249 PMCID: PMC6364895 DOI: 10.1371/journal.pone.0211033] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2018] [Accepted: 01/07/2019] [Indexed: 11/18/2022] Open
Abstract
Background Both stigma and psychological distress affect quality of life (QOL). This study is an attempt to determine the effects of these two factors on QOL and to explore possible mediation effects between psychological distress and self-stigma in opioid-dependent individuals. Methods This cross-sectional study comprised 268 consecutive, treatment-seeking opioid-dependent individuals who were interviewed using the brief version of the World Health Organization Quality of Life instrument (WHOQOL-BREF), the Self-Stigma Scale-Short (SSS-S), the Chinese Health Questionnaire-12 (CHQ-12), and the Opiate Treatment Index (OTI). A series of regression models were constructed to determine if the SSS-S and CHQ-12 predict the WHOQOL-BREF scores. Moreover, a comparison of the potential mediation effects of psychological distress (as assessed by the CHQ-12) was made between the SSS-S and the WHOQOL-BREF using the Baron and Kenny procedure (including three separate regressions), along with the Sobel test. Results The CHQ-12 score was predictive of the scores for the four domains and almost all facets of the WHOQOL-BREF except the item, “Dependence on medical aids.” Nonetheless, the SSS-S score predicted three of the four facets of the social QOL after adjustment of the CHQ-12 score. Psychological distress completely mediated the relation between self-stigma and the physical, psychological, and environmental domains, and partially mediated the relationship between self-stigma and social QOL (two-tailed Sobel test: p = 0.02 for each domain). Conclusions Psychological distress has a significant impact on the QOL of treated opioid users. It appears to be a core element in reducing the negative effects of self-stigma on aspects of QOL.
Collapse
Affiliation(s)
- Kun-Chia Chang
- Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan
- Department of Public Health College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chung-Ying Lin
- Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, The Hong Kong Polytechnic University, Hong Kong
| | - Chih-Cheng Chang
- Department of Psychiatry, Chi Mei Medical Center, Tainan, Taiwan
- Department of Senior Citizen Service Management, College of Recreation and Health Management, Chia Nan University of Pharmacy and Science, Tainan, Taiwan
| | - Shuo-Yen Ting
- Tsaotun Psychiatric Center, Ministry of Health and Welfare, Nantou, Taiwan
| | - Ching-Ming Cheng
- Jianan Psychiatric Center, Ministry of Health and Welfare, Tainan, Taiwan
| | - Jung-Der Wang
- Department of Public Health College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Departments of Internal Medicine and Occupational and Environmental Medicine, National Cheng Kung University Hospital, Tainan, Taiwan
- * E-mail:
| |
Collapse
|
4
|
Chang KC, Lu TH, Lee KY, Hwang JS, Cheng CM, Wang JD. Estimation of life expectancy and the expected years of life lost among heroin users in the era of opioid substitution treatment (OST) in Taiwan. Drug Alcohol Depend 2015; 153:152-8. [PMID: 26054944 DOI: 10.1016/j.drugalcdep.2015.05.033] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2015] [Revised: 04/16/2015] [Accepted: 05/20/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Opioid substitution treatment (OST) has been implemented in Taiwan since 2006. We estimated the life expectancy (LE) and expected years of life lost (EYLL) in a cohort of heroin users stratified by OST for comparison. METHODS A total of 1283 heroin users recruited from 2006 to 2008 were linked to the National Mortality Registry until the end of 2011. Among them, 983 received OST, while 300 did not. Kaplan-Meier estimation for survival was performed, and it was extrapolated to 50 years to obtain the LE using a semi-parametric method. We further estimated the EYLL for both cohorts by subtracting their life expectancies from the age- and sex-matched referents of the general population. Cause-specific standardized mortality ratios (SMRs) were calculated and compared with the national cohort to validate the representativeness of this sample. RESULTS After extrapolation to 50 years of survival, the estimated average LE and EYLL were 27.4 and 10.6 for OST subjects, respectively, while those of the non-OST were 20.2 and 18.4 years. The all-cause mortality rates (per 1000 person-years) in the observational period for the OST and non-OST group were 15.5 and 23.9, respectively, representing a 7.5- and 10.2-fold SMR compared to the general population, indicating a high representativeness for our sample. But SMR of suicide mortality elevated 16.2 and 3.1 folds in OST and non-OST group, respectively. CONCLUSIONS OST saves 7.8 EYLL more than non-OST after accounting for lead time bias. Effective suicide prevention programs could enhance its life-saving effect, especially among those co-morbid with depressive disorders.
Collapse
Affiliation(s)
- Kun-Chia Chang
- Jianan Psychiatric Center, Ministry of Health and Welfare, No. 80, Lane 870, Zhongshan Road, Rende District, Tainan 71742, Taiwan; Department of Public Health, College of Medicine, National Cheng Kung University, 1 University Road, Tainan 70101, Taiwan.
| | - Tsung-Hsueh Lu
- Department of Public Health, College of Medicine, National Cheng Kung University, 1 University Road, Tainan 70101, Taiwan.
| | - Kuan-Ying Lee
- Jianan Psychiatric Center, Ministry of Health and Welfare, No. 80, Lane 870, Zhongshan Road, Rende District, Tainan 71742, Taiwan.
| | - Jing-Shiang Hwang
- Institute of Statistical Science, Academia Sinica, 128 Academia Road, Section 2, Taipei 11529, Taiwan.
| | - Ching-Ming Cheng
- Jianan Psychiatric Center, Ministry of Health and Welfare, No. 80, Lane 870, Zhongshan Road, Rende District, Tainan 71742, Taiwan.
| | - Jung-Der Wang
- Department of Public Health, College of Medicine, National Cheng Kung University, 1 University Road, Tainan 70101, Taiwan; Department of Internal Medicine and Occupational and Environmental Medicine, National Cheng Kung University Hospital, 138 Sheng Li Road, Tainan 70401, Taiwan.
| |
Collapse
|
5
|
Zhong B, Xiang Y, Cao X, Li Y, Zhu J, Chiu HFK. Prevalence of antisocial personality disorder among Chinese individuals receiving treatment for heroin dependence: a meta-analysis. SHANGHAI ARCHIVES OF PSYCHIATRY 2014; 26:259-71. [PMID: 25477719 PMCID: PMC4248258 DOI: 10.11919/j.issn.1002-0829.214091] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Accepted: 09/10/2014] [Indexed: 11/05/2022]
Abstract
Background Studies from Western countries consistently report very high rates of comorbid Antisocial
Personality Disorder (ASPD) among individuals with heroin addiction, but the reported proportion of
Chinese individuals with heroin addiction who have co-morbid ASPD varies widely, possibly because Chinese
clinicians do not consider personality issues when treating substance abuse problems. Aim Conduct a meta-analysis of studies that assessed the proportion of Chinese individuals with heroin
dependence who have comorbid ASPD. Methods We searched for relevant studies in both Chinese databases (China National Knowledge
Infrastructure, Wanfang Data Knowledge Service Platform, Taiwan Electronic Periodical Services) and
western databases (PubMed, EMBASE, and PsycInfo). Two authors independently retrieved the literature,
identified studies that met pre-defined inclusion and exclusion criteria, assessed the quality of included
studies, and extracted the data used in the analysis. Statistical analysis was performed using StatsDirect 3.0
and R software. Results The search yielded 15 eligible studies with a total of 3692 individuals with heroin dependence. Only
2 of the studies were rated as high-quality studies. All studies were conducted in rehabilitation centers or
hospitals. The pooled lifetime prevalence of ASPD in these subjects was 30% (95%CI: 23%-38%), but the
heterogeneity of results across studies was great (I2
=95%, p<0.001). Men had a higher prevalence than
women (44% vs. 21%), and injection heroin users had higher prevalence than those who smoked heroin
(44% vs. 27%). Studies that were methodologically stronger had higher reported prevalence of ASPD among
heroin dependent individuals. Conclusions There are substantial methodological problems in the available literature about ASPD in
Chinese individuals receiving treatment for heroin dependence, but we estimate that about one-third
of them meet criteria for ASPD. Further work is needed to increase clinicians’ awareness of this issue; to
compare the pathogenesis, treatment responsiveness and recidivism of those with and without ASPD; and
to develop and test targeted interventions for this difficult-to-treat subgroup of individuals with heroin
dependence.
Collapse
Affiliation(s)
- Baoliang Zhong
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China ; Affiliated Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Yutao Xiang
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China ; Affiliated Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China ; Faculty of Health Sciences, University of Macau, Macao SAR, China ; Mood Disorders Centre, Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Xiaolan Cao
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Yan Li
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| | - Junhong Zhu
- Affiliated Mental Health Center, Tongji Medical College of Huazhong University of Science & Technology, Wuhan, China
| | - Helen F K Chiu
- Department of Psychiatry, Chinese University of Hong Kong, Hong Kong SAR, China
| |
Collapse
|
6
|
Fan CY, Tan HKL, Chien IC, Chou SY. Prevalence of psychiatric disorders among heroin users who received methadone maintenance therapy in Taiwan. Am J Addict 2014; 23:249-56. [DOI: 10.1111/j.1521-0391.2014.12090.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 05/06/2013] [Accepted: 06/01/2013] [Indexed: 12/01/2022] Open
Affiliation(s)
- Chiung-Yueh Fan
- Department of Health; Taoyuan Mental Hospital; Taoyuan Taiwan
| | | | - I-Chia Chien
- Department of Health; Taoyuan Mental Hospital; Taoyuan Taiwan
- Department of Public Health and Institute of Public Health; National Yang-Ming University; Taipei Taiwan
| | - Sun-Yuan Chou
- Department of Health; Taoyuan Mental Hospital; Taoyuan Taiwan
| |
Collapse
|
7
|
Abstract
PURPOSE OF REVIEW Studying comorbidities between substance use disorders (SUDs) and psychiatric disorders in different regions is important from public health and heuristic perspectives. In this study we review recent studies conducted in Asian countries on these comorbidities. RECENT FINDINGS Comprehensive and methodologically sound studies conducted with focus on comorbidity between SUDs and psychiatric disorders are few and far between in Asian countries. Studies differ widely in their focus and methodological rigor. Some studies from China, Japan and Taiwan report fairly low rates of comorbidity of SUDs, particularly with illicit substances, among individuals with psychiatric disorders. Similar findings exist for rates of psychiatric disorders among those with SUDs. Recent research is lacking in several Asian countries on the issue of comorbidity. SUMMARY Interesting regional differences exist in the rates of comorbidity both across the Asian countries and between these countries and the west. Genetic and socio-cultural differences may be responsible for these differences. Methodologically sound, multicenter studies, involving several Asian countries, specifically examining the epidemiology of comorbidity between SUDs and psychiatric disorders, will have the potential to provide useful insights in this regard.
Collapse
|
8
|
Chen IC, Chie WC, Hwu HG, Chou SY, Yeh YC, Yu CY, Tan HKL. Alcohol use problem among patients in methadone maintenance treatment in Taiwan. J Subst Abuse Treat 2011; 40:142-9. [DOI: 10.1016/j.jsat.2010.09.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2010] [Revised: 09/01/2010] [Accepted: 09/15/2010] [Indexed: 10/18/2022]
|
9
|
Sakai JT, Risk NK, Tanaka CA, Price RK. Conduct disorder among Asians and Native Hawaiian/Pacific Islanders in the USA. Psychol Med 2008; 38:1013-1025. [PMID: 17803831 DOI: 10.1017/s0033291707001316] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Conduct disorder (CD) is a relatively common disorder of childhood and adolescence in the USA with substantial associated morbidity, yet little has been published on CD among Asians and Native Hawaiian/Pacific Islanders (NH/PI) in the USA. METHOD We used the National Epidemiological Survey on Alcohol and Related Conditions (NESARC) to examine the prevalence and correlates of retrospectively reported CD within Asians and NH/PI (18 years and older). We also completed logistic regressions to explore factors associated with CD within Asians (n=1093) and, separately, NH/PI (n=139) and to explain racial differences in CD prevalence. RESULTS Asians were about a third as likely [odds ratio (OR) 0.4, 95% confidence interval (CI) 0.22-0.58] whereas NH/PI were about two and half times more likely (OR 2.6, 95% CI 1.31-5.06) to have had CD compared with Caucasian respondents. Within Asians and NH/PI, CD was strongly associated with adult antisocial behavior, substance use and affective disorders. Demographic factors, the age that subjects came to the USA, measures of family environment and family history could not explain the observed differences in prevalence of CD for NH/PI relative to Caucasians. CONCLUSIONS Asian and NH/PI youth with CD represent a subgroup of Asian youth at very high risk for a number of serious psychiatric disorders. Further investigation is needed to explain the high CD prevalence among NH/PI.
Collapse
Affiliation(s)
- J T Sakai
- University of Colorado School of Medicine, Denver, CO, USA.
| | | | | | | |
Collapse
|
10
|
Astals M, Domingo-Salvany A, Buenaventura CC, Tato J, Vazquez JM, Martín-Santos R, Torrens M. Impact of substance dependence and dual diagnosis on the quality of life of heroin users seeking treatment. Subst Use Misuse 2008; 43:612-32. [PMID: 18393080 DOI: 10.1080/10826080701204813] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
In 189 opioid-dependent subjects on methadone maintenance treatment in Barcelona (Spain), we assessed the prevalence of co-occurrence substance use and non-substance-use disorders (dual diagnosis) by the Psychiatric Research Interview for Substance and Mental Disorders [PRISM], and the impact on quality of life (HRQoL) by the SF-12 (PCS-12 and MCS-12 scales). Rates of substance and non-substance-use diagnoses were 59% and 32%, respectively. Mean scores for PCS-12 and MCS-12 were 44.1+/-10.1 and 39.9+/-11.7, without differences by presence or absence of dual diagnosis. Heroin users on methadone treatment showed a high prevalence of dual diagnosis and a very impaired HRQoL.
Collapse
Affiliation(s)
- Mònica Astals
- Department of Psychiatry and Drug Abuse and Psychiatric Research Group, Hospital del Mar (IAPS) and Institut Municipal d'Investigació Mèdica (IMIM), and Departament de Psiquiatria i Medicina Legal, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | | | | | | | | |
Collapse
|
11
|
Chiang SC, Chan HY, Chang YY, Sun HJ, Chen WJ, Chen CK. Psychiatric comorbidity and gender difference among treatment-seeking heroin abusers in Taiwan. Psychiatry Clin Neurosci 2007; 61:105-11. [PMID: 17239047 DOI: 10.1111/j.1440-1819.2007.01618.x] [Citation(s) in RCA: 46] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The objectives of the present study were to estimate the psychiatric comorbidity of Taiwanese heroin users seeking treatment and to identify the gender differences in psychiatric comorbidity and drug use behavior. Subjects were interviewed using a structured questionnaire on drug use behavior and the Mini International Neuropsychiatric Interview for psychiatric disorders. Of the subjects, 58.5% of the male and 62.5% of the female subjects had at least one non-substance-use axis I psychiatric disorder or antisocial personality disorder. Compared to male subjects, female subjects were younger, were less educated, had higher rates of unemployment and had earlier onset of illicit drug use. Female subjects were 11-fold more likely than male subjects to exhibit suicidal behavior. Among heroin abusers in the present study, female subjects were more widely exposed to unfavorable social factors and had substantially higher incidence of suicidal behavior than male subjects. Drug treatment centers should be aware of these gender differences and pay particular attention to comorbid depressive disorders and suicidal behavior of female heroin abusers.
Collapse
Affiliation(s)
- Shu-Chuan Chiang
- Tao-Yuan Psychiatric Center, Department of Health, Executive Yuan, Taoyuan, Taiwan
| | | | | | | | | | | |
Collapse
|
12
|
Lukasiewicz M, Falissard B, Michel L, Neveu X, Reynaud M, Gasquet I. Prevalence and factors associated with alcohol and drug-related disorders in prison: a French national study. Subst Abuse Treat Prev Policy 2007; 2:1. [PMID: 17204156 PMCID: PMC1779267 DOI: 10.1186/1747-597x-2-1] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2006] [Accepted: 01/04/2007] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Most studies measuring substance-use disorders in prisons focus on incoming or on remand prisoners and are generally restricted to drugs. However, there is evidence that substance use initiation or continuation occurs in prison, and that alcohol use is common. The aim of this study is 1) to assess prevalence of both drug and alcohol abuse and dependence (DAD/AAD) in a national randomised cohort of French prisoners, short or long-term sentence 2) to assess the risk factors associated with DAD/AAD in prison. a stratified random strategy was used to select 1) 23 prisons among the different types of prison 2) 998 prisoners. Diagnoses were assessed according to a standardized procedure, each prisoner being assessed by two psychiatrists, one junior, using a structured interview (MINI 5 plus), and one senior, completing the procedure with an open clinical interview. At the end of the interview the clinicians met and agreed on a list of diagnoses. Cloninger's Temperament and Character Inventory (TCI) was also used. RESULTS More than a third of prisoners presented either AAD or DAD in the last 12 months. Cannabis was the most frequent drug and just under a fifth of prisoners had AAD. AAD and DAD were clearly different for the following: socio-demographic variables, childhood history, imprisonment characteristics, psychiatric comorbidity and Cloninger's TCI. Profiles of AAD in prison are similar to type II alcoholism. CONCLUSION Regular screening of AAD/DAD in prison, and specific treatment programmes taking into account differences between prisoners with an AAD and prisoners with a DAD should be a public health priority in prison.
Collapse
Affiliation(s)
- Michael Lukasiewicz
- INSERM, U669, Paris, F-75014 France ; Univ Paris-sud 11, Le Kremlin Bicêtre, F-94000 France; Univ Paris 5, Paris, F-75015 France; AP-HP, Villejuif, F-94804, France
- Centre de Recherche et de Traitement des Addictions., Assistance Publique-Hopitaux de Paris, Hôpital Paul Brousse, 14 avenue PV Couturier, Villejuif 94804, France
| | - Bruno Falissard
- INSERM, U669, Paris, F-75014 France ; Univ Paris-sud 11, Le Kremlin Bicêtre, F-94000 France; Univ Paris 5, Paris, F-75015 France; AP-HP, Villejuif, F-94804, France
| | - Laurent Michel
- Centre de Recherche et de Traitement des Addictions., Assistance Publique-Hopitaux de Paris, Hôpital Paul Brousse, 14 avenue PV Couturier, Villejuif 94804, France
| | - Xavier Neveu
- INSERM, U669, Paris, F-75014 France ; Univ Paris-sud 11, Le Kremlin Bicêtre, F-94000 France; Univ Paris 5, Paris, F-75015 France; AP-HP, Villejuif, F-94804, France
| | - Michel Reynaud
- Centre de Recherche et de Traitement des Addictions., Assistance Publique-Hopitaux de Paris, Hôpital Paul Brousse, 14 avenue PV Couturier, Villejuif 94804, France
| | - Isabelle Gasquet
- INSERM, U669, Paris, F-75014 France ; Univ Paris-sud 11, Le Kremlin Bicêtre, F-94000 France; Univ Paris 5, Paris, F-75015 France; AP-HP, Villejuif, F-94804, France
- Direction de la politique Médicale, Assistance Publique – Hôpitaux de Paris, 3 avenue Victoria, 75184 Paris cedex 4, France
| |
Collapse
|
13
|
Nocon A, Bergé D, Astals M, Martín-Santos R, Torrens M. Dual diagnosis in an inpatient drug-abuse detoxification unit. Eur Addict Res 2007; 13:192-200. [PMID: 17851240 DOI: 10.1159/000104881] [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: 11/19/2022]
Abstract
In Spain, detoxification in general hospitals plays an important role in the medical care of patients. We aim to provide clinicians with information on the prevalence and correlates of psychiatric co-morbidity in drug abusers in detoxification. A sample of 115 substance-abuse inpatients (mean age 31.9 +/- 6.4 years) in a Detoxification Unit of a general university hospital was studied using the Spanish version of the PRISM. Most of the patients had multiple dependence diagnoses and co-morbid axis I or axis II psychiatric disorders. Patients with dual diagnosis showed lower psychosocial functioning than patients without co-morbidity and more dependence diagnoses due to cannabis and sedatives. A total of 80% of the patients successfully completed the detoxification process. The present results enhance the value of detoxification in a general hospital as a first step of the overall treatment strategy.
Collapse
Affiliation(s)
- Agnes Nocon
- Department of Psychiatry, Hospital del Mar, Barcelona, Spain
| | | | | | | | | |
Collapse
|
14
|
Hu HM, Kline A, Huang FY, Ziedonis DM. Detection of co-occurring mental illness among adult patients in the New Jersey substance abuse treatment system. Am J Public Health 2006; 96:1785-93. [PMID: 17008574 PMCID: PMC1586138 DOI: 10.2105/ajph.2005.072736] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We assessed the detection of mental illness in an adult population of substance abuse patients and the rate of referral for mental health treatment. METHODS We obtained combined administrative records from 1994 to 1997 provided by the New Jersey substance abuse and mental health systems and estimated detection and referral rates of patients with co-occurring disorders (n = 47,379). Mental illness was considered detected if a diagnosis was in the record and considered undetected if a diagnosis was not in the record but the patient was seen in both treatment systems within the same 12-month period. Predictors of detection and referral were identified. RESULTS The detection rate of co-occurring mental illness was 21.9% (n=10364); 57.9% (n=6001) of these individuals were referred for mental health treatment. Methadone maintenance clinics had the lowest detection rate but the highest referral rate. Male, Hispanic, and African American patients, as well as those who used heroin or were in the criminal justice system, had a higher risk of mental illness not being detected. Once detected, African American patients, heroin users, and patients in the criminal justice system were less likely to be referred for treatment. CONCLUSIONS There is a need to improve the detection of mental illness among substance abuse patients and to provide integrated treatment.
Collapse
Affiliation(s)
- Hsou Mei Hu
- Institute for Health, Health Care Policy, and Aging Research at Rutgers, The State University of New Jersey, New Brunswick, USA.
| | | | | | | |
Collapse
|
15
|
Rodríguez-Llera MC, Domingo-Salvany A, Brugal MT, Silva TC, Sánchez-Niubó A, Torrens M. Psychiatric comorbidity in young heroin users. Drug Alcohol Depend 2006; 84:48-55. [PMID: 16388919 DOI: 10.1016/j.drugalcdep.2005.11.025] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2005] [Revised: 11/28/2005] [Accepted: 11/30/2005] [Indexed: 11/25/2022]
Abstract
In order to determine the prevalence of psychiatric comorbidity in a population of young heroin users recruited from outside of the healthcare context, a sample was assembled by targeted sampling and nomination techniques; it was comprised of regular current users of heroin aged between 18 and 30 years and resident in Barcelona, Spain. Psychiatric evaluation was done with the Psychiatric Research Interview for Substance and Mental Disorders (PRISM) semi-structured interview. Of 149 individuals evaluated, 33% were women, whose mean age was 25.1 years; 93% received a diagnosis of heroin dependence and 71% of cocaine dependence. Thirty-two percent of the subjects had never been treated for substance use. Around two-thirds (67.1%, 95% CI: 59.6-74.7%) of the sample had lifetime psychiatric comorbidity, with antisocial personality and mood disorders being the most frequent conditions (33% and 26%, respectively). Mood, anxiety and eating disorders were more common among women than men. There were no differences in ever having been in treatment for drug use according to the presence of psychiatric comorbidity, although comorbidity was lower among those currently in treatment. Young heroin users recruited on the street presented a high prevalence of psychiatric comorbidity which was unrelated to past treatment history.
Collapse
Affiliation(s)
- M C Rodríguez-Llera
- Health Services Research Unit, Institut Municipal d'Investigació Mèdica (IMIM), Dr. Aiguader 80, E-08003 Barcelona, Spain
| | | | | | | | | | | |
Collapse
|
16
|
Chiang SC, Chan HY, Chen CH, Sun HJ, Chang HJ, Chen WJ, Lin SK, Chen CK. Recidivism among male subjects incarcerated for illicit drug use in Taiwan. Psychiatry Clin Neurosci 2006; 60:444-51. [PMID: 16884446 DOI: 10.1111/j.1440-1819.2006.01530.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Illicit drug users are generally considered both patients and criminals in Taiwan. This study presents drug use behaviors and criminal recidivism of male subjects incarcerated for illicit drug use in Taiwan after detoxification at a detention center. This study also examined the relationship between drug use behaviors and subsequent recidivism. Charts and crime records of 794 male patients from the acute detoxification unit in a detention center in northern Taiwan were reviewed. These subjects were incarcerated for methamphetamine or/and heroin use. The authors examined the relationship between the variables collected during detoxification and subsequent recidivism of illicit drug use in the following 5 years after detoxification. Of 794 subjects, 539 (67.9%) were repeat offenders during the following 5 years after detoxification. Their recidivism occurred primarily within the first 2 years after being released into the community. The recidivism rate for heroin users was significantly higher than that of methamphetamine users. Aged under 30 years, a previous criminal record, and a positive urine analyses test for illicit drugs upon entering the detoxification unit were significantly associated with recidivism. Recidivism rates of illicit drug users in Taiwan after detoxification in the detention center were substantially high. The efficacy of detoxification programs at detention centers in Taiwan needs to be re-evaluated.
Collapse
Affiliation(s)
- Shu-Chuan Chiang
- Department of Health, Executive Yuan, Tao-Yuan Psychiatric Center, Tao-Yuan, Taiwan
| | | | | | | | | | | | | | | |
Collapse
|
17
|
Andersen HS. Mental health in prison populations. A review--with special emphasis on a study of Danish prisoners on remand. Acta Psychiatr Scand 2004:5-59. [PMID: 15447785 DOI: 10.1111/j.1600-0447.2004.00436_2.x] [Citation(s) in RCA: 77] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To review the literature on mental health and psychiatric morbidity in prison populations and relate findings to a Danish study on remand prisoners. METHOD The literature is reviewed and subdivided in the following section: validity of psychometrics in prison populations, prevalence of psychiatric disorders prior to imprisonment, incidence of psychiatric disorders during imprisonment, psychopathy related to psychiatric comorbidity, dependence syndromes with special emphasis on different administrations of heroin use (smoke vs. injection). The results are compared with a longitudinal Danish study on remand prisoners in either solitary confinement (SC) or non-SC. RESULTS Many factors must be taken into consideration when dealing with prisoners and mental health, e.g. international differences, the prison setting, demographics and methodological issues. The prison populations in general are increasing worldwide. Psychometrics may perform differently in prison populations compared with general populations with the General Health Questionnaire-28 having a low validity in remand prisoners. Psychiatric morbidity including schizophrenia is higher and perhaps increasing in prison populations compared with general populations with dependence syndromes being the most frequent disorders. The early phase of imprisonment is a vulnerable period with a moderately high incidence of adjustment disorders and twice the incidence in SC compared with non-SC. Prevalence of psychopathy is lower in European than North American prisons. Medium to high scores of psychopathy is related to higher psychiatric comorbidity. Opioid dependence is the most frequent drug disorder with subjects using injection representing a more dysfunctional group than subjects using smoke administration. Many mentally ill prisoners remain undetected and undertreated. CONCLUSION There is a growing population of mentally ill prisoners being insufficiently detected and treated.
Collapse
Affiliation(s)
- H S Andersen
- Psychiatric Department, Bispebjerg University Hospital, Copenhagen Hospital Cooperation, Denmark.
| |
Collapse
|
18
|
Lin SK, Ball D, Hsiao CC, Chiang YL, Ree SC, Chen CK. Psychiatric comorbidity and gender differences of persons incarcerated for methamphetamine abuse in Taiwan. Psychiatry Clin Neurosci 2004; 58:206-12. [PMID: 15009828 DOI: 10.1111/j.1440-1819.2003.01218.x] [Citation(s) in RCA: 57] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Methamphetamine (MAP) abuse has been common in Taiwan for the past decade. The purpose of the present study was to investigate MAP abuse in Taiwan, with specific attention to psychiatric comorbidity and gender differences. A total of 325 MAP abuse subjects (180 male, 145 female) from a detention center in Taipei were assessed with the Diagnostic Interview for Genetic Studies. The following were studied: drug use behavior, treatment-seeking behavior, lifetime prevalence of mood disorders, MAP psychosis, alcohol use disorders, pathological gambling and antisocial personality. The MAP-abuse subjects in Taiwan had high psychiatric morbidity and low access to mental health services. There also exist certain differences in the prevalence of psychiatric illnesses and treatment-seeking behavior between male and female subjects. Compared with their male counterparts, more female subjects reported experience of mental disturbance and experience of psychiatric treatment. The female subjects more commonly reported suicidal behaviors than the male subjects.
Collapse
Affiliation(s)
- Shih-Ku Lin
- Department of Addiction Science, Taipei City Psychiatric Center, Taipei, Taiwan
| | | | | | | | | | | |
Collapse
|
19
|
Martyres RF, Clode D, Burns JM. Seeking drugs or seeking help? Escalating "doctor shopping" by young heroin users before fatal overdose. Med J Aust 2004; 180:211-4. [PMID: 14984339 DOI: 10.5694/j.1326-5377.2004.tb05887.x] [Citation(s) in RCA: 83] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2002] [Accepted: 12/17/2003] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To identify prescription drug-seeking behaviour patterns among young people who subsequently died of heroin-related overdose. DESIGN Linkage of Medicare and Pharmaceutical Benefits Scheme and Coroner's Court records from Victoria. SUBJECTS Two hundred and two 15-24-year-olds who died of heroin-related overdose between 6 January 1994 and 6 October 1999. MAIN OUTCOME MEASURES Patterns of use of medical services and prescription drugs listed on the Pharmaceutical Benefits Scheme in the years before death, and use of all drugs just before death. RESULTS Polydrug use was reported in 90% of toxicology reports, and prescription drugs were present in 80% of subjects. Subjects accessed medical services six times more frequently than the general population aged 14-24 years, and more than half of all prescribed drugs were those prone to misuse, such as benzodiazepines and opioid analgesics. A pattern of increasing drug-seeking behaviour in the years before death was identified, with doctor-visitation rates, number of different doctors seen and rates of prescriptions peaking in the year before death. CONCLUSIONS An apparent increase in "doctor shopping" in the years before heroin-related death may reflect the increasing misuse of prescription drugs, but also an increasing need for help. Identification of a pattern of escalating doctor shopping could be an opportunity for intervention, and potentially, reduction in mortality.
Collapse
|
20
|
Abstract
BACKGROUND The clinical and etiologic implications of comorbid psychiatric and substance-use disorders are relevant across countries and cultures. The DSM-IV now places greater emphasis on the clinical and research utility of the substance-induced disorders classification, and clarifies several important diagnostic issues specific to primary and substance-induced disorders. However, no research consensus exists over the core problem of identifying and differentiating the drug and alcohol intoxication and withdrawal symptoms that can mimic psychiatric symptoms in heavy drinkers and drug users. OBJECTIVE To investigate how various diagnostic instruments have measured comorbid psychiatric and substance-use disorders and how each instrument operationalizes the DSM-IV classification. METHOD We review the evolution of the concept of comorbidity beginning with its formalization as the 'primary-secondary' distinction in the Feighner Criteria. We address the 'organic-non-organic' distinction found in the RDC, DSM-III, and DSM-III-R; and finally, review the 'primary' and 'substance-induced' categories of DSM-IV, DSM-IV-TR and ICD-10. We describe how these distinctions have been operationalized in widely used diagnostic instruments. CONCLUSION Further understanding of these classifications and the relationship of co-occurring psychiatric and substance disorders can be accomplished with the range of available measures, particularly the Psychiatric Research Interview for Substance and Mental Disorders (PRISM), which reliably utilizes and refines DSM-IV classification distinctions.
Collapse
Affiliation(s)
- S Samet
- 1New York State Psychiatric Institute
| | - E V Nunes
- 1New York State Psychiatric Institute
| | - D Hasin
- 1New York State Psychiatric Institute
| |
Collapse
|
21
|
Abstract
A propensity for violent behaviors to develop in chronic methamphetamine (METH) abusers has been noted. The idea that increased aggressiveness might result from chronic METH administration was tested in mice after chronic (long-term intermittent, 8 weeks) or single exposures to the drug. A single injection of METH (6 mg/kg) did not augment fighting. In contrast, chronic METH administration significantly increased the number of animals that initiated bite attacks. This regimen also shortened the latency before the first attack. Latency before the first attack was shorter at 20 h after the METH injection than at 15 min after injection. Locomotor activity was not different at 20 h after METH injection, indicating that increased fighting was not secondary to METH-induced hyperactivity. METH-induced increases in fighting were not related to the duration of persistent sniffing after the initial encounter with an intruder since the duration of this behavior was significantly increased at 15 min after METH but not at 20 h post drug. These results indicate that repeated injections of METH can increase fighting behaviors and also alter social interactions in mice. Thus, intermittent administration of METH might be useful as a pharmacological model to study the biochemical and molecular bases of aggressiveness.
Collapse
Affiliation(s)
- Boris P Sokolov
- Molecular Neuropsychiatry Branch, National Institute on Drug Abuse, NIH, DHHS, 5500 Nathan Shock Drive, Baltimore, MD 21224, USA
| | | | | |
Collapse
|
22
|
Abstract
The purpose of this article is to provide a review of the prevalence, assessment, and treatment of common psychiatric disorders found among patients with opioid dependence. Dependence on opioids can include both persons who are physically dependent on opioids and persons who fulfill the criteria for a syndrome of opioid dependence, such as that found in the Diagnostic and Statistical Manual, fourth edition (DSM-IV). The latter grouping of persons typically abuse illicit opioids, and prevalence of comorbid conditions and approaches in diagnosis and treatment have been studied in these patients. High rates of other psychiatric disorders--both other substance-use disorders as well as non-substance-use psychiatric disorders--have been reported. The most common non-substance-use psychiatric disorders are depressive, anxiety, and personality disorders. When evaluating and planning treatment of opioid-dependent patients with concurrent psychiatric symptoms, it is important to determine if such symptoms are independent of the substance use or substance induced. In the former case, treatment should follow routine clinical practice, whereas in the latter case, treatment stability in substance use should be the first therapeutic step. The presence of a pain condition can further complicate assessment and treatment, as either pain itself or treatments used for pain may produce symptoms that overlap with psychiatric disorders.
Collapse
Affiliation(s)
- Eric C Strain
- Behavioral Pharmacology Research Unit, Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland 21224, USA.
| |
Collapse
|
23
|
Abstract
BACKGROUND Prior reports suggested that bipolar patients in Taiwan had comparable long-term outcome to Western patients despite markedly lower rates of co-occurring substance use disorders. Thus, predictors of long-term outcome identified from Taiwanese bipolar samples may be less influenced by substance abuse. METHODS One hundred and one patients with bipolar disorder (DSM-III-R) having been naturalistically treated for at least 15 years were recruited. These patients were annually followed for 2 years to assess overall outcome, psychiatric symptoms, rehospitalization, work, and social adjustment. A combination of medical record reviews and direct personal interviews with patients and family members provided the clinical data. RESULTS Of these patients, 16.8% expressed a poor overall long-term outcome, even though only two (2.0%) patients exhibited alcohol dependence during the follow-up period. Multivariate regression showed that full compliance with medication was the strongest predictor of favorable overall long-term outcome, followed by younger age at onset and male sex. Younger age at onset as well as male sex, but not full compliance, also predicted a favorable psychosocial outcome. LIMITATIONS Recruiting our sample from a clinical population with uncontrollable long-term treatment limits the generalizability of the findings. CONCLUSIONS Compliance with pharmacotherapy is important to achieve a favorable overall long-term outcome of bipolar disorder. A portion of bipolar patients may have an unfavorable psychosocial outcome regardless of the psychopharmacological intervention or presence of substance abuse.
Collapse
Affiliation(s)
- S M Tsai
- Department of Psychiatry, Taipei Medical College and Hospital, 252 Wu-Hsing Street, Taipei 110, Taiwan.
| | | | | | | | | | | |
Collapse
|