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Wölfling K, Dreier M, Beutel ME, Müller KW. Inanspruchnehmende einer Spielsuchtambulanz mit „Doppeldiagnosen“. SUCHT 2022. [DOI: 10.1024/0939-5911/a000781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Zusammenfassung: Zielsetzung: Internetnutzungsstörungen werden als wichtiges gesundheitsrelevantes Phänomen akzeptiert und sind bekanntermaßen mit hohen Raten an komorbiden psychischen Erkrankungen assoziiert. Jedoch ist das Wissen über das gleichzeitige Auftreten mit einer weiteren Verhaltenssucht begrenzt. Die vorliegende Arbeit bietet eine erste klinische Charakterisierung bei gleichzeitig auftretender Internetnutzungs- und Glücksspielstörung (Doppeldiagnose). Methodik: Die Analyse beruhte auf einer konsekutiven klinischen Stichprobe von Betroffenen ( N=1813), die sich wegen einer Verhaltenssucht ambulant vorstellten. Daten wurden aus der klinischen Exploration sowie psychometrischen Verfahren zur Erfassung von Depressivität, Stress, Angstsymptomen und Funktionsniveau erhoben und mit Betroffenen, die entweder eine Computerspiel- oder Glücksspielstörung aufwiesen, verglichen. Ergebnisse: Bei n=46 Betroffenen wurde eine Doppeldiagnose gestellt. Diese Gruppe wies zudem eine höhere Anzahl weiterer psychischer Störungen auf. Die Auswertung der klinischen Inventare wies auf eine insgesamt hohe Symptombelastung hin, ohne dass sich die Gruppen signifikant voneinander unterschieden. Schlussfolgerungen: Eine kleine Gruppe Inanspruchnehmender erfüllt die Kriterien einer Internetnutzungs- und einer Glücksspielstörung. Es ergeben sich keine auffälligen Unterschiede in der Symptombelastung zu Betroffenen mit singulärer Abhängigkeit, jedoch ist zu vermuten, dass Doppeldiagnosen eine differenzierte therapeutische Herangehensweise erfordern.
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Affiliation(s)
- Klaus Wölfling
- Ambulanz für Spielsucht der Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Deutschland
| | - Michael Dreier
- Ambulanz für Spielsucht der Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Deutschland
| | - Manfred E. Beutel
- Ambulanz für Spielsucht der Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Deutschland
| | - Kai W. Müller
- Ambulanz für Spielsucht der Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Deutschland
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Hernandez M, Barrio C, Helu-Brown P, Lim C, Gaona L. Substance Use in Relation to Mental Illness: A Study of Mexican-Origin Latinos with Schizophrenia and Their Family Members. HEALTH & SOCIAL WORK 2022; 47:175-183. [PMID: 35708649 PMCID: PMC9280320 DOI: 10.1093/hsw/hlac014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 04/21/2021] [Accepted: 06/02/2021] [Indexed: 06/15/2023]
Abstract
Little is known about family context and substance use behaviors among Latinos with schizophrenia. Learning about patient and family caregiver perceptions of use is critical to our understanding of how best to support these vulnerable patients and family caregivers. This study explored perceptions of substance use in relation to mental illness among Latinos primarily of Mexican origin with schizophrenia and their family caregivers. Semistructured interviews were conducted with 34 participants (20 family caregivers; 14 patients) with direct and indirect substance use experience, in their preferred language. Data were analyzed using thematic analysis, which consisted of comparing codes across and within patient and family caregiver transcripts. Findings revealed that substance use affected well-being, particularly patient recovery and caregiver burden. Strategies to address well-being included limiting substance use, being vigilant about patient use, and communicating the negative impact of use. The environmental impact and stigma of substance use were major contextual challenges. Patients addressed these by limiting their socialization. Family social context was important to how substance use was perceived and managed by patients and caregivers. As such, treatment models should consider a holistic perspective that incorporates family context when addressing substance use among Latinos with schizophrenia.
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Caregiving for Relatives with Psychiatric Disorders vs. Co-Occurring Psychiatric and Substance Use Disorders. Psychiatr Q 2018; 89:631-644. [PMID: 29417307 DOI: 10.1007/s11126-017-9557-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Despite the high comorbidity of psychiatric and substance use disorders, extremely little research has examined the experience of caregiving for relatives with co-occurring psychiatric and substance use disorders (COD). The primary objective of the present article is to identify characteristics pertaining to care recipients, family caregivers, and the experience of providing caregiving associated with care recipients having COD vs. only having psychiatric disorders (PD). A U.S. community recruited sample of 1394 family caregivers of persons with COD or PD was employed. Chi-square and Mann-Whitney-Wilcoxon tests were conducted. Compared to caregivers of persons with only PD, caregivers of persons with COD provided slightly less caregiving but experienced significantly greater negative effects from providing care. Caregivers of persons with COD were also more likely to fear care recipients would engage in multiple problematic behaviors. Most significant differences found in providing care to recipients with COD vs. only PD persisted when examining care recipients with severe psychiatric disorders or more moderate psychiatric disorders. Additional findings and treatment implications are described.
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Pérez-López A, Marín-Navarrete R, Villalobos-Gallegos L, Sánchez-Domínguez R, Toledo-Fernández A, Ambriz-Figueroa AK. Effects of co-occurring disorders on the perception of family functioning. JOURNAL OF SUBSTANCE USE 2017. [DOI: 10.1080/14659891.2017.1405092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Alejandro Pérez-López
- Clinical Trial Unit on Addiction and Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz (INPRFM), Mexico City, Mexico
| | - Rodrigo Marín-Navarrete
- Clinical Trial Unit on Addiction and Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz (INPRFM), Mexico City, Mexico
| | - Luis Villalobos-Gallegos
- Clinical Trial Unit on Addiction and Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz (INPRFM), Mexico City, Mexico
| | - Ricardo Sánchez-Domínguez
- Clinical Trial Unit on Addiction and Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz (INPRFM), Mexico City, Mexico
| | - Aldebarán Toledo-Fernández
- Clinical Trial Unit on Addiction and Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz (INPRFM), Mexico City, Mexico
| | - Ana Karen Ambriz-Figueroa
- Clinical Trial Unit on Addiction and Mental Health, National Institute of Psychiatry Ramón de la Fuente Muñiz (INPRFM), Mexico City, Mexico
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Abstract
Dual diagnosis of schizophrenia and substance-related disorders is common in psychiatric practice. Epidemiologic studies and report have established that the risk of a substance-related disorder was 4 to 5 times higher in a population of psychiatric patients than in the general population. However, little is known on the reason of this relationship and the treatments required. It's well known that a family history of psychosis is a risk factor of schizophrenia. Similarly a family history of substance use disorders increases the risk of using substances. Because the two disorders often occurred together, it could be hypothesized that a genetic risk factor is common. However, recent studies did not confirm this hypothesis and it seems that their genetic risks factor would be unrelated. Evidence now exists describing the different profiles of patients whether they used substance or not. Concerning negative symptoms clinical studies and meta-analyses have described fewer symptoms in schizophrenia patients with a substance use disorder. Among the different explanations that have been addressed, it seems that a lower capability of obtaining the substance could partly explain this relationship. Perhaps because patients with social withdrawal have more difficulties to find and spend the time required to obtain abused substances. At the opposite some products such as cocaine may relieve some symptoms especially anhedonia and alogia. However the link between substance-related disorders and negative symptoms is weak and decreases in more recent studies, probably because negative symptoms as well as addiction disorders are better characterized. Considering that treating psychiatric symptoms may not always lead to a decrease in the substance-related disorders but that patients who give up substances improve their psychotic symptoms, a therapeutic strategy should be planned for these dual disorders patients combining psychiatry and addiction interventions.
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Noel V, Woods M, Routhier J, Drake R. Planning Treatment and Assessing Recovery in Participants With Dual Diagnosis: Preliminary Evaluation of a New Clinical Tool. J Dual Diagn 2016; 12:55-62. [PMID: 26828850 DOI: 10.1080/15504263.2016.1146555] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Integrated treatment for people with co-occurring mental illness and substance use disorder would be enhanced by a simple, recovery-oriented instrument to plan treatment and monitor progress toward dual recovery. This paper describes the development of a clinical instrument, the WestBridge Dual Recovery Inventory, and presents a preliminary evaluation of its usability. METHODS In collaboration with participants in treatment, family members, clinicians, and program leaders, we developed an inventory on dual recovery and then examined its utility through a series of iterative steps. First, we tested the inventory for inter-rater reliability among 10 program participants (rated independently by the first and last author). Second, we examined concordance by having a separate group of 10 program participants and their care managers complete the inventory independently. Third, we observed 3 care managers and 10 participants working together to complete the inventory as part of routine care during the quarterly assessment; we evaluated shared decision making based on the process they used to resolve differences and on a brief survey completed by program participants as the end of the session. Finally, to measure the inventory's capacity to detect change over time, we analyzed the ratings from admission to one year for 43 participants with quarterly assessments available for that time period. RESULTS The WestBridge Dual Recovery Inventory assesses 14 domains of recovery, each rated on 5-point scales. Inter-rater reliability was high (Kappa = .82 to 1.00); agreement between independent ratings by care managers and participants varied considerably (Kendall's tau = -.83 to +.87); and collaborative ratings demonstrated high scores on shared decision making. Participants improved significantly on 11 of 14 domains during the initial residential treatment phase (admission to six months) and sustained gains during outpatient assertive community treatment (6 to 12 months). CONCLUSIONS This preliminary assessment of the WestBridge Dual Recovery Inventory suggests that it reliably assesses dual recovery, facilitates shared decision making, and captures changes over time. The inventory appears to be usable, well received by participants and care managers, specific for program goals, and sensitive to changes in the participants. Recovery measures may need to be program-specific.
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Affiliation(s)
- Valerie Noel
- a Dartmouth Psychiatric Research Center , Lebanon , New Hampshire , USA
| | - Mary Woods
- b WestBridge Community Services , Manchester , New Hampshire , USA
| | | | - Robert Drake
- a Dartmouth Psychiatric Research Center , Lebanon , New Hampshire , USA
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Smeerdijk M, Keet R, van Raaij B, Koeter M, Linszen D, de Haan L, Schippers G. Motivational interviewing and interaction skills training for parents of young adults with recent-onset schizophrenia and co-occurring cannabis use: 15-month follow-up. Psychol Med 2015; 45:2839-2848. [PMID: 25959502 DOI: 10.1017/s0033291715000793] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is a clear need for effective interventions to reduce cannabis use in patients with first-episode psychosis. This follow-up of a randomized trial examined whether an intervention for parents, based on motivational interviewing and interaction skills (Family Motivational Intervention, FMI), was more effective than routine family support (RFS) in reducing cannabis use in patients with recent-onset schizophrenia. METHOD In a single-blind trial with 75 patients in treatment for recent-onset schizophrenia, 97 parents were randomly assigned to either FMI or RFS. Assessments were conducted at baseline and at 3 and 15 months after the interventions had been ended. Analyses were performed on an intention-to-treat basis using mixed-effect regression models. RESULTS From baseline to the 15-month follow-up, there was a significantly greater reduction in FMI compared to RFS in patients' quantity (p = 0.01) and frequency (p < 0.01) of cannabis use. Patients' craving for cannabis use was also significantly lower in FMI at 15 months follow-up (p < 0.01). Both groups improved in parental distress and sense of burden; however, only FMI parents' appraisal of patients' symptoms showed further improvement at the 15-month follow-up (p < 0.05). CONCLUSIONS The results support the sustained effectiveness of FMI in reducing cannabis use in patients with recent-onset schizophrenia at 15 months follow-up. Findings were not consistent with regard to the long-term superiority of FMI over RFS in reducing parents' distress and sense of burden.
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Affiliation(s)
- M Smeerdijk
- Department of Psychiatry,Academic Medical Centre,Amsterdam,The Netherlands
| | - R Keet
- Mental Health Service North Holland North,Alkmaar,The Netherlands
| | - B van Raaij
- Training Company 'Bureau de Mat',Haarlem,The Netherlands
| | - M Koeter
- Department of Psychiatry,Academic Medical Centre,Amsterdam,The Netherlands
| | - D Linszen
- Department of Psychiatry,Academic Medical Centre,Amsterdam,The Netherlands
| | - L de Haan
- Department of Psychiatry,Academic Medical Centre,Amsterdam,The Netherlands
| | - G Schippers
- Department of Psychiatry,Academic Medical Centre,Amsterdam,The Netherlands
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Kronenberg LM, Goossens PJJ, van Etten DM, van Achterberg T, van den Brink W. Need for care and life satisfaction in adult substance use disorder patients with and without attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD). Perspect Psychiatr Care 2015; 51:4-15. [PMID: 24410895 DOI: 10.1111/ppc.12056] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 10/25/2013] [Accepted: 11/07/2013] [Indexed: 01/10/2023] Open
Abstract
PURPOSE To identify care needs of adult substance use disorder (SUD) patients with and without co-occurring attention deficit hyperactivity disorder (ADHD) or autism spectrum disorder (ASD). DESIGN AND METHODS An exploratory study using the European Addiction Severity Index, the Camberwell Assessment of Needs, and the Manchester Short Assessment of Quality of Life to assess and compare care needs and perceived quality of life. FINDINGS All patients are dissatisfied with parts of their existence. SUD patients have fewer care needs than SUD patients with co-occurring ADHD or ASD. The SUD and SUD + ADHD groups report needs in similar domains. The SUD + ASD group shows a greater number of and more extensive care needs. PRACTICE IMPLICATIONS Differences in the care needs of adult SUD patients with and without ADHD or ASD should be taken into account when developing evidence-based nursing care interventions.
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Affiliation(s)
- Linda M Kronenberg
- Advanced Nurse Practitioner Dual Diagnosis Department, Dimence, Deventer, The Netherlands
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Frieri T, Montemagni C, Crivelli B, Scalese M, Villari V, Rocca P, Scalese M, Mara S, Villari V, Vincenzo V, Rocca P, Paola R. Substance use disorders in hospitalized psychiatric patients: the experience of one psychiatric emergency service in Turin. Compr Psychiatry 2014; 55:1234-43. [PMID: 24791682 DOI: 10.1016/j.comppsych.2014.03.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2013] [Revised: 03/10/2014] [Accepted: 03/26/2014] [Indexed: 10/25/2022] Open
Abstract
In the present study we sought: 1) to estimate the frequency of substance use disorders (SUD), and 2) to investigate whether there is a mere association between diagnosis and SUD in a large cohort of patients with severe psychiatric disorders representative of the usual setting and modality of care of a psychiatric emergency service in a geographically well-defined catchment area in Italy, independent of sociodemographic features, anamnestic data and clinical status. The study was conducted between January 2007 and December 2008. The following rating scales were performed: the Clinical Global Impression-Severity (CGI-S), the Global Assessment of Functioning scale (GAF) and the Brief Psychiatric Rating Scale (BPRS). Factors found to be associated (p<0.05) with SUD[+] in the univariate analyses were subjected to multilevel logistic regression model with a backward stepwise procedure. Among 848 inpatients of our sample 29.1% had a SUD codiagnosis. Eleven factors accounted for 30.6% of the variability in SUD[+]: [a] a Personality Disorder diagnosis, [b] a Depressive Disorder diagnosis, [c] male gender, [d] previous outpatient contacts, [e] single marital status, [f] no previous psychiatric treatments, [g] younger age, [h] lower scores for BPRS Anxiety-depression and [i] BPRS Thought Disturbance, [l] higher scores for BPRS Activation and [m] BPRS Hostile-suspiciousness. The findings are important in identifying (1) the complexity of the clinical presentation of SUD in a inpatients sample, (2) the need for collaboration among health care workers, and (3) the need to develop and apply treatment programs that are targeted at particular risk groups.
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Affiliation(s)
| | | | | | | | | | - Paola Rocca
- Psychiatric Section, Department of Neuroscience, University of Turin, Italy.
| | | | - Scalese Mara
- Psychiatric Section, Department of Neuroscience, University of Turin, Italy
| | | | - Villari Vincenzo
- Department of Neuroscience and Mental Health, Psychiatric Emergency Service, A.O. Città della Salute e della Scienza di Torino - Presidio Molinette, Turin, Italy
| | - Paola Rocca
- Psychiatric Section, Department of Neuroscience, University of Turin, Italy.
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van den Berk-Clark C, McGuire J. Elderly homeless veterans in Los Angeles: chronicity and precipitants of homelessness. Am J Public Health 2013; 103:S232-8. [PMID: 24148059 DOI: 10.2105/ajph.2013.301309] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We compared the characteristics of chronically homeless and acutely homeless elderly veterans to better understand precipitants of homelessness. METHODS We conducted interviews with 33 chronically and 26 acutely homeless veterans aged 65 years and older receiving transitional housing services in Los Angeles, California, between 2003 and 2005. We asked questions regarding their sociodemographic characteristics and other social status measures. Other precipitants of homelessness were acquired via observation and open-ended and structured questions. RESULTS Both veterans groups were more similar than different, with substantial levels of physical, psychiatric, and social impairment. They differed significantly in homelessness history, with chronically homeless veterans having more homelessness episodes and more total time homeless. They were also less educated and had smaller social networks. In response to open-ended questioning, elderly homeless veterans revealed how health and substance use issues interacted with loss of social support and eviction to exacerbate homelessness. CONCLUSIONS Assessment of a range of factors is needed to address risk factors and events leading to homelessness. Further research with larger samples is needed to confirm the characteristics and needs of the elderly homeless veteran population.
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Affiliation(s)
- Carissa van den Berk-Clark
- Carissa van den Berk-Clark and James McGuire are with the US Department of Veterans Affairs, St. Louis Healthcare Center (van den Berk-Clark) and West Los Angles Healthcare Center (McGuire). Carissa van den Berk-Clark is also with the Department of Psychiatry, School of Medicine, Washington University, St. Louis, MO
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Mueser KT, Glynn SM, Cather C, Xie H, Zarate R, Smith LF, Clark RE, Gottlieb JD, Wolfe R, Feldman J. A randomized controlled trial of family intervention for co-occurring substance use and severe psychiatric disorders. Schizophr Bull 2013; 39:658-72. [PMID: 22282453 PMCID: PMC3627753 DOI: 10.1093/schbul/sbr203] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/25/2011] [Indexed: 11/13/2022]
Abstract
Substance use disorders have a profound impact on the course of severe mental illnesses and on the family, but little research has evaluated the impact of family intervention for this population. To address this question, a randomized controlled trial was conducted comparing a brief (2-3 mo) Family Education (ED) program with a longer-term (9-18 mo) program that combined education with teaching communication and problem-solving skills, Family Intervention for Dual Disorders (FIDD). A total of 108 clients (77% schizophrenia-spectrum) and a key relative were randomized to either ED or FIDD and assessed at baseline and every 6 months for 3 years. Rates of retention of families in both programs were moderate. Intent-to-treat analyses indicated that clients in both programs improved in psychiatric, substance abuse, and functional outcomes, as did key relatives in knowledge of co-occurring disorders, burden, and mental health functioning. Clients in FIDD had significantly less severe overall psychiatric symptoms and psychotic symptoms and tended to improve more in functioning. Relatives in FIDD improved more in mental health functioning and knowledge of co-occurring disorders. There were no consistent differences between the programs in substance abuse severity or family burden. The findings support the utility of family intervention for co-occurring disorders, and the added benefits of communication and problem-solving training, but also suggest the need to modify these programs to retain more families in treatment in order to provide them with the information and skills they need to overcome the effects of these disorders.
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Affiliation(s)
- Kim T Mueser
- Center for Psychiatric Rehabilitation, Department of Occupational Therapy, Boston University, 940 Commonwealth Avenue, West, Boston, MA 02215, USA.
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O'Grady CP, Skinner WJW. Journey as destination: a recovery model for families affected by concurrent disorders. QUALITATIVE HEALTH RESEARCH 2012; 22:1047-1062. [PMID: 22609633 DOI: 10.1177/1049732312443736] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
We conducted a study offering peer support and education to members of families affected by concurrent disorders (CD). This article is an analysis of the qualitative data from a mixed methods study. Using constructivist grounded theory, we analyzed semistructured interviews with participants, with half attending a 12-week support group and reading weekly workbook assignments, and the others receiving the workbook only and being interviewed 3 months later. We developed a model that describes family journeys into, through, and beyond CD, involving three phases connected by two transitional constructs. Preoccupation with the unresolved CD of an ill family member characterized the journey into and through illness, the first two phases, whereas renewal characterized the passage from illness to journeying on toward recovery. Participants had strong comments about health care providers and the service system, and spoke of the need for self-care, empowerment, support, and inclusion.
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Affiliation(s)
- Caroline P O'Grady
- Addictions Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada. caroline_o'
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Domenech D, Mann R, Strike C, Brands B, Khenti A. Estudio de la prevalencia de la comorbilidad entre el distrés psicológico y el abuso de drogas en usuarios del Portal Amarillo, Montevideo - Uruguay. TEXTO & CONTEXTO ENFERMAGEM 2012. [DOI: 10.1590/s0104-07072012000500022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
La comorbilidad psiquiátrica en personas con trastorno por consumo de alcohol y otras drogas tiene alta prevalencia, impacta en la salud individual y familiar y genera mayores costos. Este estudio epidemiológico descriptivo, multicéntrico, transversal, estima la prevalencia de la comorbilidad del distrés psicológico en 134 pacientes mayores de 18 años en tratamiento en el Portal Amarillo de Montevideo - Uruguay. Describe las características sociodemográficas, consumo de drogas, funcionalidad familiar, y grado de satisfacción de la población usuaria. Para la recolección de datos se usaron los cuestionarios EULAC-CICAD, K-10 y APGAR-familiar. La prevalencia de distrés severo y muy severo fue de un 71.6%; el 90.6% refirió estar satisfecho con la atención recibida y el 48% percibió que su familia no presentaba disfunción. Por ende, es necesario contemplar la presencia de comorbilidad psiquiátrica en el abordaje de usuarios con trastorno por consumo de sustancias en Centros de tratamiento.
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Leal EM, Delgado PGG, Mann R, Strike C, Brands B, Khenti A. Estudo de comorbidade: sofrimento psíquico e abuso de drogas em pessoas em centros de tratamento, Macaé - Brasil. TEXTO & CONTEXTO ENFERMAGEM 2012. [DOI: 10.1590/s0104-07072012000500013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Estudo da prevalência de sofrimento psíquico entre pessoas em tratamento em um serviço de atenção diário público e dois centros de internação privados, sendo um prestador de serviços ao Sistema Único de Saúde, da cidade de Macaé, Rio de Janeiro, Brasil. Estudo transversal. Foi aplicado questionário para caracterização dos participantes, adaptado do formulário EULAC-CICAD. A escala de Kessler-10 foi utilizada para rastreamento do sofrimento psíquico. Participaram 60 pessoas, sendo 88,3% homens. Do total, 51,5% estavam na faixa de 24 a 39 anos de idade. Depressão foi o principal diagnóstico prévio referido em 35%, seguido por ansiedade em 33,33%. Durante o tratamento atual, a ansiedade foi o principal diagnóstico referido em 8,3%, seguido de depressão em 28,3%. Dos entrevistados, 34% apresentaram níveis severos e 27,2% muito severos de sofrimento psiquico. Conclui-se que os níveis de sofrimento psíquico severo e muito severo em 61,2% encontrados com a escala K-10, especialmente sensível para ansiedade e depressão, são semelhantes para esta população nos estudos internacionais.
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Affiliation(s)
| | | | | | | | | | - Akwatu Khenti
- Office International Health; University of Toronto; Dalla Lana School of Public Health, Canada
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Vásquez Espinoza E, Herrera Rodriguez A, Strike C, Brands B, Khenti A. Comorbilidad entre el distrés psicologico y el abuso de drogas en pacientes en centros de tratamiento, en la ciudad de Leon - Nicaragua: implicaciones para políticas y programas. TEXTO & CONTEXTO ENFERMAGEM 2012. [DOI: 10.1590/s0104-07072012000500019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
La presencia de trastornos de salud mental y consumo de drogas ambos se conocen como comorbilidad. Este estudio tuvo como objetivo determinar la prevalencia de la comorbilidad entre el distrés psicológico y el abuso/dependencia de drogas en pacientes de Centros de tratamiento en León, Nicaragua. La mayoría de participantes del estudio eran hombres y 68.5% eran menor de 40 años, solteros (58.5%), con bajo nivel de educación, trabajo de forma autónoma (51.2%), y 41.5% viven con su madre biológica. El 65.9% de los pacientes llegaron al centro por cuenta propia. Las drogas más consumida fueron alcohol, marihuana y crack (59.7%, 58.2% y 53.7%). Los trastornos concurrente más comunes fueron, ansiedad (29.3%), depresión (24.1%), esquizofrenia 9.8% y trastorno bipolar 2,4% y según la escala de Kessler K-10, el 56% de los participantes fueron diagnosticados con distrés psicológico severo. Según la escala de APGAR-familiar, el 26% percibieron familias como disfuncionales.
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Affiliation(s)
- Eddy Vásquez Espinoza
- Universidad Nacional Autónoma de Nicaragua (UNAN); Facultad de Ciencias Juridicas y Sociales, Nigaragua
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Basso Musso L, Mann R, Strike C, Brands B, Khenti A. El distrés psicológico y abuso de drogas en pacientes en centros de tratamiento del gran Valparaíso - Chile: implicaciones para las políticas y los programas. TEXTO & CONTEXTO ENFERMAGEM 2012. [DOI: 10.1590/s0104-07072012000500015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
El objetivo fue determinar la prevalencia de comorbilidad entre distrés psicológico y abuso/dependencia de drogas en pacientes en centros de tratamiento. Este estudio epidemiológico, multicéntrico, de corte transversal, realizado en 107 pacientes mayor es de 18 años, en tratamiento por abuso/dependencia de drogas, en centros de tratamiento de Valparaíso, Chile, mostró además otros factores involucrados como: aspectos sociodemográficos, funcionalidad familiar, características del consumo de drogas y aspectos de la atención otorgada. Para recolección de datos se usó el EULAC (Instrumento para diagnostico rápido de situación de tratamiento para problemas por consumo de drogas en el ámbito local) el K 10 y Apgar familiar. Resultados: 48.6% presentaron distrés psicológico; 88.8% refirieron satisfacción por el tratamiento actual. 66.4% pertenece a una familia normo funcional. Los resultados obtenidos permitirán mejorar las intervenciones en pacientes que están en tratamiento y rehabilitación en los centros de tratamiento.
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Mueser KT, Gottlieb JD, Cather C, Glynn SM, Zarate R, Smith LF, Clark RE, Wolfe R. Antisocial Personality Disorder in People with Co-Occurring Severe Mental Illness and Substance Use Disorders: Clinical, Functional, and Family Relationship Correlates. PSYCHOSIS 2012; 4:52-62. [PMID: 22389652 PMCID: PMC3289140 DOI: 10.1080/17522439.2011.639901] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Antisocial personality disorder (ASPD) is an important correlate of substance abuse severity in the addiction population and in people with co-occurring serious mental illness and addiction. Because family members often provide vital supports to relatives with co-occurring disorders, this study explored the correlates of ASPD in 103 people with co-occurring disorders (79% schizophrenia-schizoaffective, 21% bipolar disorder) in high contact with relatives participating in a family intervention study. Clients with ASPD were more likely to have bipolar disorder and to have been married, but less likely to have graduated from high school. ASPD was associated with more severe drug abuse and depression, worse functioning, and less planning-based social problem solving. The relatives of clients with ASPD also reported less planning-based problem solving, worse attitudes towards the client, and worse mental health functioning. Client ASPD was associated with less long-term exposure to family intervention. The findings suggest that clients with ASPD in addition to co-occurring disorders are a particularly disadvantaged group with greater illness severity, more impaired functioning, and more strained family relationships. These difficulties may pose special challenges to delivering family intervention for this group.
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Affiliation(s)
- Kim T. Mueser
- Center for Psychiatric Rehabilitation, Boston University
- Department of Occupational Therapy, Boston University
| | - Jennifer D. Gottlieb
- Center for Psychiatric Rehabilitation, Boston University
- Department of Occupational Therapy, Boston University
| | - Corrine Cather
- Dartmouth Psychiatric Research Center, Concord, NH
- Department of Psychiatry, Harvard Medical School, Boston, MA
| | - Shirley M. Glynn
- VAGreater Los Angeles Healthcare System at West Los Angeles, CA
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
| | - Roberto Zarate
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA
- Pacific Clinics, Los Angeles, CA
| | - Lindy F. Smith
- Department of Psychiatry, Dartmouth Medical School, Hanover, NH
- Dartmouth Psychiatric Research Center, Concord, NH
| | - Robin E. Clark
- Center for Health Policy and Research, University of Massachusetts Medical School
| | - Rosemarie Wolfe
- Department of Psychiatry, Dartmouth Medical School, Hanover, NH
- Dartmouth Psychiatric Research Center, Concord, NH
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Brems C, Namyniuk LL. Comorbidity and Related Factors Among Ethnically Diverse Substance Using Pregnant Women. JOURNAL OF ADDICTIONS & OFFENDER COUNSELING 2011. [DOI: 10.1002/j.2161-1874.1999.tb00212.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Vincent PC, Bradizza CM, Carey KB, Maisto SA, Stasiewicz PR, Connors GJ, Mercer ND. Validation of the revised Problems Assessment for Substance Using Psychiatric Patients. Addict Behav 2011; 36:494-501. [PMID: 21330064 DOI: 10.1016/j.addbeh.2011.01.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2010] [Revised: 12/09/2010] [Accepted: 01/14/2011] [Indexed: 11/16/2022]
Abstract
This study assessed the factor structure, internal consistency, test-retest reliability, and construct validity of the Problems Assessment for Substance Using Psychiatric Patients (PASUPP; Carey, Roberts, Kivlahan, Carey, & Neal, 2004) with a sample of 278 men and women seeking outpatient dual-diagnosis treatment. All participants were diagnosed with a current AUD and schizophrenia and/or bipolar disorder. Initial confirmatory factor analysis did not support the 1-factor model for the 50-item measure found by Carey and colleagues. Instead, exploratory factor analysis yielded a shorter (27-item) scale with four distinct, yet related factors (Physical Problems, Aggression, Social and Financial Consequences, and Psychological Problems). The factor-based scales had good internal consistency (α=.77-.81) and 1-week test-retest reliability (r=.67-.73). The revised PASUPP (PASUPP-R) was associated with measures of psychiatric symptoms/adjustment, substance use/dependence, and another measure of substance use problems, providing evidence for convergent validity. Subgroup comparisons suggested few demographic differences on the PASUPP-R, but differential patterns of problems endorsement emerged as a function of mental health and substance use diagnosis. Overall, this study provides preliminary evidence for the psychometric soundness of the PASUPP-R as a measure of problems experienced by persons with co-occurring psychiatric and substance use disorders.
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Affiliation(s)
- Paula C Vincent
- Research Institute on Addictions, 1021 Main Street, Buffalo, NY 14203-1016, USA.
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Morrens M, Dewilde B, Sabbe B, Dom G, De Cuyper R, Moggi F. Treatment outcomes of an integrated residential programme for patients with schizophrenia and substance use disorder. Eur Addict Res 2011; 17:154-63. [PMID: 21447952 DOI: 10.1159/000324480] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Accepted: 01/17/2011] [Indexed: 11/19/2022]
Abstract
BACKGROUND About half of all schizophrenic patients have a co-occurring substance use disorder, leading to poorer social and functional outcomes than obtained in non-abusing patients. To improve outcomes, integrated treatments have been designed that address the two conditions simultaneously. Results are, however, conflicting because the available effect studies are hampered by various methodological issues, among which are heterogeneous patient samples. METHODS In this comparative study, two well-described patient samples diagnosed with schizophrenia and co-morbid substance abuse disorders either received an integrated treatment (IDDT) or treatment as usual (TAU). RESULTS Patients in the IDDT condition showed significant reductions in illicit drug and alcohol use, improvements on all psychiatric symptom domains, reported higher quality of life and improved on social and community functioning. In contrast, patients' improvements in the TAU group were moderate and limited to a few substance use and psychiatric outcomes. The TAU group had significantly higher dropout rates 6 and 12 months after baseline, suggesting that the IDDT programme was more successful in committing patients. CONCLUSIONS Our results suggest that an integrated approach to schizophrenic patients and co-morbid substance use disorders is superior to standard treatment and may be considered as the treatment of choice for this patient group.
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Affiliation(s)
- Manuel Morrens
- Collaborative Antwerp Psychiatric Research Institute, Antwerp, Belgium.
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Abstract
OBJECTIVE To determine if substance use (particularly cannabis) is more frequent among first episode psychosis patients and associated with a more problematic clinical presentation. METHOD All first episode psychosis (FEP) patients presenting to secondary services were recruited from London and Nottingham, over 2 years, in the Aetiology and Ethnicity of Schizophrenia and Other Psychoses study broad framework. Clinical and sociodemographic variables were assessed using a set of standardized instruments. A schedule was created to retrospectively collate substance use data from patients, relatives and clinicians. RESULTS Five hundred and eleven FEP were identified. They used three to five times more substances than general population. Substance use was associated with poorer social adjustment and a more acute mode of onset. Cannabis use did not affect social adjustment, but was associated with a more acute mode of onset. CONCLUSION Cannabis has a different impact on FEP than other substances. Large epidemiological studies are needed to disentangle cannabis effect.
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Mueser KT, Glynn SM, Cather C, Zarate R, Fox L, Feldman J, Wolfe R, Clark RE. Family intervention for co-occurring substance use and severe psychiatric disorders: participant characteristics and correlates of initial engagement and more extended exposure in a randomized controlled trial. Addict Behav 2009; 34:867-77. [PMID: 19375870 PMCID: PMC3262454 DOI: 10.1016/j.addbeh.2009.03.025] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2009] [Revised: 03/22/2009] [Accepted: 03/26/2009] [Indexed: 11/29/2022]
Abstract
Clients with severe mental illness and substance use disorder (i.e., dual disorders) frequently have contact with family members, who may provide valuable emotional and material support, but have limited skills and knowledge to promote recovery. Furthermore, high levels of family conflict and stress are related to higher rates of relapse. The present study was a two-site randomized controlled trial comparing a comprehensive, behaviorally-based family intervention for dual disorders program (FIDD) to a shorter-term family psychoeducational program (FPE). The modal family was a single male son in his early 30s diagnosed with both alcohol and drug problems and a schizophrenia-spectrum disorder participating with his middle-aged mother, with whom he lived. Initial engagement rates following consent to participate in the study and the family intervention programs were moderately high for both programs (88% and 84%, respectively), but rates of longer term retention and exposure to the core elements of each treatment model were lower (61% and 55%, respectively). Characteristics of the relatives were the strongest predictors of successful initial engagement in the family programs with the most important predictor being relatives who reported higher levels of benefit related to the relationship with the client. Subsequent successful exposure to the family treatment models was more strongly associated with client factors, including less severity of drug abuse and male client gender. The results suggest that attention to issues of motivating relatives to participate in family intervention, and more focused efforts to address the disruptive effects of drug abuse on the family could improve rates of engagement and retention in family programs for dual disorders.
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Affiliation(s)
- Kim T Mueser
- Department of Psychiatry, Dartmouth Medical School, Hanover, NH, USA.
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Kavanagh DJ, Connolly JM. Interventions for co-occurring addictive and other mental disorders (AMDs). Addict Behav 2009; 34:838-45. [PMID: 19345511 DOI: 10.1016/j.addbeh.2009.03.005] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2008] [Revised: 02/25/2009] [Accepted: 03/02/2009] [Indexed: 11/26/2022]
Abstract
While research on the management of co-occurring addictive and mental disorders (AMDs) has grown substantially in recent years, we still have little guidance on specific strategies. Consideration of epidemiological research and ethical principles can supplement existing clinical trials in providing a way forward. High frequencies of co-occurring disorders, equity of access for affected individuals and potential clashes between services in priorities and procedures, suggest that a stepped model of care by a single service may often be required. Typically, problems are multiple rather than dual, with potential for mutual influence, suggesting a need for interventions that are sensitive to and encompass complex co-occurring problems. Motivational problems are endemic, initial gains are often partial and unstable, and relapses potentially have serious consequences, suggesting a need for long-term, assertive follow-up. Principles such as these provide a solid framework for designing both services and interventions. However, there is a continuing need for controlled trials that unpack effective components of interventions, and increase their impact.
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Niv N, Lopez SR, Glynn SM, Mueser K. The role of substance use in families' attributions and affective reactions to their relative with severe mental illness. J Nerv Ment Dis 2007; 195:307-14. [PMID: 17435480 DOI: 10.1097/01.nmd.0000243793.64279.48] [Citation(s) in RCA: 16] [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: 11/27/2022]
Abstract
This study compared relatives' attributions and affective reactions toward patients with severe mental illness (SMI) only (N = 32) and patients with dual SMI and a substance use disorder (N = 36). Family members of patients with dual disorders perceived their ill relatives to have greater control over the causes of their psychiatric symptoms and to be more responsible for their symptoms than did family members of patients with SMI only. Key relatives of dual-diagnosed patients also reported more negative affect toward the patient than did key relatives of patients with SMI only, but the two groups did not differ in their level of positive affect. Consistent with attribution theory, severity of patients' substance abuse was positively associated with relatives' attributions of controllability, which, in turn, were positively associated with judgments of responsibility. Furthermore, judgments of responsibility were positively related to negative affect and inversely related to positive affect.
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Affiliation(s)
- Noosha Niv
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, California 90025, USA.
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Meade CS. Sexual risk behavior among persons dually diagnosed with severe mental illness and substance use disorder. J Subst Abuse Treat 2006; 30:147-57. [PMID: 16490678 DOI: 10.1016/j.jsat.2005.11.005] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2005] [Revised: 10/31/2005] [Accepted: 11/23/2005] [Indexed: 11/30/2022]
Abstract
Persons dually diagnosed with severe mental illness (SMI) and substance use disorder (SUD) have disproportionately high rates of HIV and other sexually transmitted infections (STIs). This study examined the relationship between multiple sexual risk behaviors among persons with active, remitted, and no SUD. Participants were 152 adults with SMI recruited from multiple treatment sites. A structured interview assessed the participants' psychiatric, psychosocial, and behavioral factors. Rates of sexual risk behavior in the past 3 months were high and differed across the SUD groups. Multivariate logistic regression models found that lifetime SUD predicted sexual activity and partner-related risk whereas active substance abuse predicted condom-related risk. The results also support indirect effects of interpersonal and psychiatric factors (e.g., romantic partnership and psychotic disorder). Findings underscore the need for integrated HIV/STI prevention interventions targeting dually diagnosed patients.
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Drake RE, McHugo GJ, Xie H, Fox M, Packard J, Helmstetter B. Ten-year recovery outcomes for clients with co-occurring schizophrenia and substance use disorders. Schizophr Bull 2006; 32:464-73. [PMID: 16525088 PMCID: PMC2632251 DOI: 10.1093/schbul/sbj064] [Citation(s) in RCA: 97] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The long-term courses of people with schizophrenia and of those with substance use disorder have been studied separately and extensively. The long-term course of clients with co-occurring schizophrenic and substance use disorders has, however, not been examined. This article reports 10-year outcomes for 130 clients with co-occurring schizophrenic and substance use disorders in the New Hampshire Dual Diagnosis Study. In addition, we report on 6 "recovery outcomes," identified by dual diagnosis clients, as examples of positive coping behaviors. Longitudinal data were modeled using generalized estimating equation (GEE) methods. Participants improved steadily over 10 years in the outcome domains of symptoms, substance abuse, institutionalization, functional status, and quality of life. Further, at the 10-year follow-up, substantial proportions were above cutoffs selected by dual diagnosis clients as indicators of recovery: 62.7% were controlling symptoms of schizophrenia; 62.5% were actively attaining remissions from substance abuse; 56.8% were in independent living situations; 41.4% were competitively employed; 48.9% had regular social contacts with non-substance abusers; and 58.3% expressed overall life satisfaction. These 6 outcomes were only weakly interrelated over time, suggesting that recovery, as defined by clients, is a multidimensional concept. Overall, the 10-year findings on recovery outcomes provide a hopeful long-term perspective for dual diagnosis clients.
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Affiliation(s)
- Robert E Drake
- Departmetn of Psychiatry, Dartmouth Medical School, USA.
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Rosenfarb IS, Bellack AS, Aziz N. A sociocultural stress, appraisal, and coping model of subjective burden and family attitudes toward patients with schizophrenia. JOURNAL OF ABNORMAL PSYCHOLOGY 2006; 115:157-65. [PMID: 16492106 DOI: 10.1037/0021-843x.115.1.157] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
A sociocultural stress, appraisal, and coping model was developed to understand relatives' burden of care and negative affective attitudes toward patients with schizophrenia. Ninety-two African American and 79 White patients and a significant other (80% mothers) completed 2 10-min family problem-solving discussions. In addition, the Kreisman Rejection Scale and a global self-report rating of family burden were administered to relatives, and a self-report rating of substance use was administered to patients. Results indicated that subjective burden of care and patients' odd and unusual thinking during the family discussion each independently predicted relatives' attitudes toward patients, suggesting that negative attitudes are based in part on both patients' symptoms and perceived burden of care. African American relatives' perceived burden was also predicted by patients' substance abuse. Finally, White family members were significantly more likely than African Americans to feel burdened by and have rejecting attitudes toward their schizophrenic relative suggesting that cultural factors play an important role in determining both perceived burden and relatives' attitudes toward patients.
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Affiliation(s)
- Irwin S Rosenfarb
- California School of Professional Psychology, Alliant International University, San Diego, CA 92131, USA.
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Barrowclough C, Ward J, Wearden A, Gregg L. Expressed emotion and attributions in relatives of schizophrenia patients with and without substance misuse. Soc Psychiatry Psychiatr Epidemiol 2005; 40:884-91. [PMID: 16217595 DOI: 10.1007/s00127-005-0976-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/14/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To test the hypotheses that carers of patients with schizophrenia (single diagnosis) and schizophrenia and co-occurring drug or alcohol misuse (dual diagnosis) will differ in terms of expressed emotion (EE) and their attributions for patient problems. METHOD In a cross-sectional study, two samples of 42 single- and dual-diagnosis carers are compared in terms of EE and attributions. Patient symptoms are assessed to control for differences other than substance misuse. RESULTS The study supports the hypothesis that high-EE, dual-diagnosis carers tend to see patient problems as more blaming (internal, controllable and personal) than do single-diagnosis patients. This difference was particularly marked when making causal ascriptions for deficit behaviours. Although there were no differences in overall EE levels in the two groups, there were significantly more carers who were rated as hostile and rejecting in the dual-diagnosis group. CONCLUSIONS The findings highlight the importance of family intervention for this patient group.
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Resnick SG, Rosenheck RA, Dixon L, Lehman AF. Correlates of family contact with the mental health system: allocation of a scarce resource. ACTA ACUST UNITED AC 2005; 7:113-21. [PMID: 15974157 DOI: 10.1007/s11020-005-3782-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This study explored correlates of informal and formal contact between clinicians and families of individuals with schizophrenia. We reanalyzed data from 902 individuals with schizophrenia from the Schizophrenia Patient Outcomes Research Team (PORT) client survey and a Veterans Affairs extension. Only 31% of families had any informal contact with a clinician and 7.8% attended a formal support program. Logistic regression showed that younger age, greater education, drug problems, receiving psychiatric inpatient and day treatment services, and participants' satisfaction with their family were all positively and significantly associated with informal contact. Receipt of formal family services was associated with intensity of social contact between participants and families. These results suggest that formal services for families of individuals with schizophrenia are not commonly available, and that informal pathways are the most common, although still limited, mechanism through which families of those patients who are receiving intensive services communicate with clinicians.
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Affiliation(s)
- Sandra G Resnick
- VA Connecticut Healthcare System, NEPEC (182), 950 Campbell Avenue, West Haven, CT 06516, USA.
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Xie H, McHugo GJ, Helmstetter BS, Drake RE. Three-year recovery outcomes for long-term patients with co-occurring schizophrenic and substance use disorders. Schizophr Res 2005; 75:337-48. [PMID: 15885525 DOI: 10.1016/j.schres.2004.07.012] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2004] [Revised: 07/14/2004] [Accepted: 07/21/2004] [Indexed: 11/22/2022]
Abstract
Little is known about the expected treatment outcomes of patients with co-occurring schizophrenic and substance use disorders. This paper reports 3-year outcomes for 152 patients with schizophrenia or schizoaffective disorder and substance use disorders, all of whom received integrated dual disorders treatments in the New Hampshire Dual Diagnosis Study. Outcomes are defined as positive coping behaviors identified by consumers as indicators of recovery. Participants improved steadily in terms of controlling symptoms of schizophrenia, actively attaining remissions from substance abuse, increasing competitive employment, increasing social contacts with non-substance abusers, and improving life satisfaction. Though successful in reducing hospitalization and homelessness, they did not increase time in independent living situations. Outcomes were only weakly interrelated, suggesting that recovery is a multidimensional concept. Neither psychotic diagnosis (schizophrenia vs. schizoaffective disorder) nor substance abuse diagnosis (alcohol vs. other drug disorder vs. both) was related to outcomes. However, these patients with co-occurring schizophrenic and substance use disorders did significantly less well than patients with co-occurring bipolar and substance use disorders in terms of hospitalization, independent living, and quality of life. Overall, the findings provide a hopeful long-term perspective for dual diagnosis patients.
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Affiliation(s)
- Haiyi Xie
- Departments of Psychiatry and Community and Family Medicine, Dartmouth Medical School, Lebanon, NH 03766, USA.
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Abstract
In order to more effectively treat substance use disorders in persons with severe mental illness, integrated treatment models have been developed for these 'co-occurring disorders.' The nature of clinical services provided in these programs is described in this article, with brief attention to research on these programs. Clinical services are generally guided by a stage model of change, in which the client's motivation to change (or stage of treatment: engagement, persuasion, active treatment, relapse prevention) informs the optimal selection of appropriate interventions. Psychotherapeutic services for co-occurring disorders include a range of individual (motivational interviewing, cognitive-behavioral counseling), group (stage-wise groups, social skills training, self-help), and family (single family, multifamily formats) interventions. Supplementary interventions are also commonly provided, including psychopharmacological, residential, coerced and involuntary, and vocational rehabilitation. Access to a range of different interventions for co-occurring disorders may improve the ability of clinicians to engage and tailor treatment to meet clients' unique needs. The research base supporting integrated treatment for co-occurring disorders is limited at this time owing to the small number of methodologically rigorous studies from which to draw conclusions. Nevertheless, the available evidence suggests that integrated treatment programs improve outcomes compared with nonintegrated approaches, and that more research is needed to evaluate the benefits of these programs.
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Affiliation(s)
- K T Mueser
- 1Department of Psychiatry and Community and Family Medicine, Dartmouth Medical School, Lebanon, NH, USA
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Rosenfarb IS, Bellack AS, Aziz N, Kratz KM, Sayers S. Race, Family Interactions, and Patient Stabilization in Schizophrenia. JOURNAL OF ABNORMAL PSYCHOLOGY 2004; 113:109-15. [PMID: 14992663 DOI: 10.1037/0021-843x.113.1.109] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study examined family interactions associated with a failure to stabilize in schizophrenia. Fifty-eight patient and parent dyads completed a problem-solving task soon after an acute episode. Stabilization was assessed over the following 6 months. African American patients' self-initiated discussions of substance use and increased anxiety during the interaction were associated with a failure to stabilize. Nonstabilization in White patients was associated with high levels of both the patients' odd thinking and the parents' criticism. White patients who were depressed during the interaction were also less likely to stabilize. Findings suggest that family relationships may play in important role in determining whether patients stabilize after an acute episode. Results also point to the importance of cultural factors in predicting patient stabilization.
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Affiliation(s)
- Irwin S Rosenfarb
- California School of Professional Psychology, Alliant International University, San Diego, CA 92131, USA.
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Abstract
OBJECTIVE To provide a rationale for working with families of clients with psychiatric and substance use disorder, and to describe a new program, family intervention for dual disorders (FIDD). METHOD We developed and manualized the FIDD program, which includes both single-family and multiple-family group formats. We trained several clinicians at a local mental health center in the model and conducted a small pilot study. RESULTS Clinicians were able to implement the program, and to successfully engage families in treatment. Most clients demonstrated significant improvements in substance abuse over one to two years of treatment. CONCLUSIONS The FIDD program is feasible and appears to promote collaboration between families and professionals, thereby improving the course of dual disorders. Controlled research is underway to evaluate the effects of the FIDD program on client and family outcomes.
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Affiliation(s)
- Kim T Mueser
- Department of Psychiatry, Dartmouth Medical School, New Hampshire-Dartmouth Psychiatric Research Center, Concord 03301, USA.
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Abstract
Substance use in the general population is a significant public health problem. Problems associated with substance use are aggravated by concomitant psychiatric illness, particularly schizophrenia and schizoaffective disorder. Although there is a general agreement on the need to address this problem, a wide range of opinions exists on exactly what is the best modality. In this article, we provide a brief overview of the etiology and consequences of substance use in individuals with schizophrenia, followed by a more detailed review of pharmacological and psychotherapeutic trends in the treatment of this population. Research studies indicate that, while some evidence supports the self-medication hypothesis, individuals with schizophrenia or schizoaffective disorder frequently use substances for the same reasons and in the same manner as the general population. In the pharmacotherapy section, we briefly discuss the rationale for current medication strategies, their efficacy, and directions for future research. This is followed by an assessment of current psychotherapeutic interventions, their limitations, and potential modifications to improve treatment outcome. The research literature suggests that integrated treatment and well-tailored interventions that take into account psychosocial factors and motivation offer the most promise for the future. More controlled trials are necessary to validate this hypothesis.
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Affiliation(s)
- Evaristo O Akerele
- Columbia University College of Physicians and Surgeons and New York State Psychiatric Institute, NY 10032, USA
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Drake RE, Wallach MA, Alverson HS, Mueser KT. Psychosocial aspects of substance abuse by clients with severe mental illness. J Nerv Ment Dis 2002; 190:100-6. [PMID: 11889363 DOI: 10.1097/00005053-200202000-00006] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
As the literature on co-occurring substance abuse in persons with severe mental illnesses has evolved, emphasis on biologic and pharmacologic factors has diverted attention from important psychosocial issues. The authors review recent research showing that a) psychosocial risk factors may explain consistently high rates of substance abuse by these persons, b) substance abuse is for most clients a socio-environmental phenomenon embedded in interpersonal activities, and c) both natural recovery processes and effective treatments rely on developing new relationships, activities, coping strategies, and identities. Thus, psychosocial issues are critical in our attempts to understand and address substance abuse in this population.
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Affiliation(s)
- Robert E Drake
- New Hampshire-Dartmouth Psychiatric Research Center, 2 Whipple Place, Lebanon, New Hampshire 03766, USA
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Salyers MP, Mueser KT. Social functioning, psychopathology, and medication side effects in relation to substance use and abuse in schizophrenia. Schizophr Res 2001; 48:109-23. [PMID: 11278158 DOI: 10.1016/s0920-9964(00)00063-3] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To identify correlates of self-reported substance use and problems associated with that use in people with schizophrenia. METHODS A sample of 404 patients with schizophrenia, schizoaffective disorder, or schizophreniform disorder and longitudinal assessments of substance use were examined. Three groups were formed according to consistency of substance use over time: No/Low Alcohol, Alcohol Only, and Drug Use (with or without alcohol use). Similar groups were formed regarding problems associated with alcohol use. Groups were compared on demographics, psychiatric history, psychopathology, medication side effects, and social functioning. RESULTS Substance users were more likely to be young, male, and to have lower levels of education. Substance users generally had fewer negative symptoms, more social contacts, and better social-leisure functioning. However, substance users, especially drug users, also were rated as having more interpersonal and family problems, had an earlier age at first psychiatric hospitalization, and were more likely to have been recently hospitalized. Patients reporting problems with alcohol use reported more frequent alcohol and drug use, greater severity of akathisia, and problems in interpersonal, family, and self-efficacy domains. CONCLUSIONS Many of the same variables that correlate with substance use disorder also correlated with moderate substance use in this sample of people with schizophrenia. Although moderate users of alcohol and drugs may have better social functioning in some areas, they also are likely to have substantial problems in interpersonal relationships, especially those involving family members.
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Affiliation(s)
- M P Salyers
- Department of Psychology, Indiana University-Purdue University Indianapolis, LD 124, 402 North Blackford Street, Indianapolis, IN 46202-3275, USA.
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Primm AB, Gomez MP, Tzolova-Iontchev I, Perry W, Crum RM. Chronically mentally ill patients with and without substance use disorders: a pilot study. Psychiatry Res 2000; 95:261-70. [PMID: 10974365 DOI: 10.1016/s0165-1781(00)00180-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
The study was designed to assess characteristics of chronic mentally ill patients with and without a substance use disorder. Study patients (n=48) had either psychiatric illness alone (they received conventional psychiatric rehabilitation) or dual diagnoses (they received mental illness and substance abuse services). All patients were administered the Brief Symptom Inventory (BSI), the Client Satisfaction Questionnaire, the Perceived Social Support Scales, and the Composite International Diagnostic Interview. Higher proportions of dually diagnosed patients had schizophrenia, had higher scores on the BSI, and were less satisfied with treatment.
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Affiliation(s)
- A B Primm
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD 21287, USA.
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Carey KB, Purnine DM, Maisto SA, Carey MP, Simons JS. Treating substance abuse in the context of severe and persistent mental illness: clinicians' perspectives. J Subst Abuse Treat 2000; 19:189-98. [PMID: 10963931 DOI: 10.1016/s0740-5472(00)00094-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Patients with comorbid substance use and major mental disorders are treated frequently in the mental health system. Treatment models relevant for this subset of patients have emerged in recent years, however, few have been validated empirically and so relatively few sites benefit from this treatment development activity. Important additional sources of information about good treatment practices are the clinicians who have adopted the treatment of patients with dual disorders as a specialty. We conducted four focus groups (N = 12) with clinicians who were nominated by their peers as experienced and/or expert in treating persons with comorbid substance use and psychiatric disorders. Discussions followed a four-part outline that included (a) general questions about training and experience with the population, (b) preferred treatment methods, (c) motivational issues, and (d) recommendations to the field. Participants were trained in a variety of mental health disciplines and pursued substance abuse treatment credentials or other educational experiences outside of their primary training programs. Their treatment approaches emphasized psychoeducation, a good therapeutic relationship, and the need to be flexible regarding methods and goals. Abstinence was the preferred goal among most clinicians; even so, they expressed a pragmatic flexibility and other views consistent with the principles of harm reduction. Clinicians tended to respond to patients' ambivalent motivational states by addressing the consequences of behaviors in a nonconfrontive style; they also made use of positive incentives and external support. A number of recommendations were made to improve treatment, including greater institutional and programmatic support for the unique needs of this population.
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Affiliation(s)
- K B Carey
- Department of Psychology, Syracuse University, 430 Huntington Hall, 13244-2340, Syracuse, NY, USA.
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Primm AB, Gomez MB, Tzolova-Iontchev I, Perry W, Vu HT, Crum RM. Severely mentally ill patients with and without substance use disorders: characteristics associated with treatment attrition. Community Ment Health J 2000; 36:235-46. [PMID: 10933241 DOI: 10.1023/a:1001953030073] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
We aimed to describe characteristics associated with attrition for patients in community mental health treatment with chronic mental illness with and without substance use disorders. Baseline assessments included symptom severity, treatment satisfaction, social support, and a structured diagnostic interview. Treatment attrition was assessed at six months. At six months, 36% of the dual diagnosis group (n = 25), and 61% of the mental illness alone group (n = 23) were lost to follow-up. Attrition in the dually diagnosed group tended to be associated with less satisfaction with treatment, and higher mean symptom scores. There were no characteristics associated with attrition in the group of patients with mental illness alone. However, client satisfaction tended to increase among the mental illness alone patients that were successfully followed. The dually diagnosed group that remained in treatment had a significantly lower mean treatment satisfaction score than the mental illness alone group at six months. This type of investigation should aid in patient care and evaluation of treatment programs for persons with severe mental illness and co-occurring substance use disorders.
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Affiliation(s)
- A B Primm
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA.
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Primm AB, Tzolova-Iontchev I, Taylor CM. An Integrated Approach for Dually Diagnosed Patients in a Substance Abuse Treatment Program: Case Presentation. Subst Abus 2000; 21:121-126. [PMID: 12466652 DOI: 10.1080/08897070009511424] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Patients with co-occurring psychiatric and substance use disorders experience worse social and clinical outcomes and are in need of adequate and simultaneous treatment for both disorders. The case presented illustrates the diversity of psychosocial, health, and behavioral problems and the complexity of treatment of a dually diagnosed patient. The authors discuss the benefits of using an integrated approach in an addiction treatment setting. The authors also review the importance of an integrated treatment model for populations with inadequate health care resources who are at high risk for medical and psychiatric complications.
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Affiliation(s)
- Annelle B. Primm
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Health Policy and Management, Johns Hopkins University School of Hygiene and Public Health, Baltimore, Maryland; Johns Hopkins Hospital Community Psychiatry Program, Baltimore, Maryland
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Barrowclough C, Haddock G, Tarrier N, Moring J, Lewis S. Cognitive Behavioral Intervention for Individuals with Severe Mental Illness Who Have a Substance Misuse Problem. ACTA ACUST UNITED AC 2000. [DOI: 10.1080/10973430008408407] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Levin FR, Evans SM, Coomaraswammy S, Collins ED, Regent N, Kleber HD. Flupenthixol treatment for cocaine abusers with schizophrenia: a pilot study. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 1998; 24:343-60. [PMID: 9741939 DOI: 10.3109/00952999809016902] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Cocaine use is common among individuals with schizophrenia and schizoaffective illness, with a prevalence ranging from 15-60% of patient samples. It is hypothesized that some schizophrenic cocaine abusers may use cocaine as an attempt to improve anhedonic symptoms or combat neuroleptic side-effects. Flupenthixol (FLX) has the distinct advantage of being both a neuroleptic medication and a potential treatment for cocaine abuse. We evaluated the efficacy of FLX in this dually diagnosed population in an open pilot study consisting of a 4-week inpatient phase and a 6-week outpatient phase. Eight individuals were initially cross-tapered off their neuroleptic medication and were given FLX in a dose of 40 mg of the decanoate every 2 weeks. Psychiatric symptomatology was assessed weekly, using the Positive and Negative Symptom Scale (PANSS) and the Beck Depression Inventory (BDI). Medication side-effects were monitored weekly, using the Simpson Neurological Rating Scale and the Abnormal Involuntary Movement Scale (AIMS). Substantial improvement in psychiatric symptomatology was noted when preadmission scores were compared to scores obtained during the last week of study enrollment. On the PANSS, positive symptom scores and negative symptom scores decreased by 31% and 29%, respectively. Similarly, BDI scores decreased by 57%. Comparing preadmission urine results to those for the last 6 weeks of enrollment in the study showed that cocaine-positive urines decreased by 28%, although most of the patients had a reduction of >75%. Missed clinic visits decreased by 26%. Thus, FLX was well-tolerated by schizophrenic cocaine abusers, suggesting that FLX may be useful for the treatment of this dually diagnosed population.
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Affiliation(s)
- F R Levin
- New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York 10032, USA
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Dixon L, Stewart B, Krauss N, Robbins J, Hackman A, Lehman A. The participation of families of homeless persons with severe mental illness in an outreach intervention. Community Ment Health J 1998; 34:251-9. [PMID: 9607162 DOI: 10.1023/a:1018713707283] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES This study describes how an Assertive Community Treatment (ACT) team which employs a family outreach worker (FOW) interacts with homeless persons with severe mental illness and their families. METHODS The team's ratings of the frequency and importance of clients' and treatment team's family contact are summarized and compared with independent research reports on patients' satisfaction with family relations, housing and hospitalization outcomes. RESULTS 73% of clients had contact with their families. ACT worked with families of 61% of clients. ACT had less contact with the families of men (p < .01) and substance abusers (p < .01). Client days in stable housing were associated with increased ACT family contact (p < .05). CONCLUSIONS Most ACT clients had significant family contact. ACT established contact with most families, and the work with families appeared to be associated with higher levels of satisfaction with family relations and housing. The role of the FOW should be explored further.
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Affiliation(s)
- L Dixon
- University of Maryland, Department of Psychiatry, Baltimore 21201, USA
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Tómasson K, Vaglum P. Social consequences of substance abuse: the impact of comorbid psychiatric disorders. A prospective study of a nation-wide sample of treatment-seeking patients. SCANDINAVIAN JOURNAL OF SOCIAL MEDICINE 1998; 26:63-70. [PMID: 9526766 DOI: 10.1177/14034948980260010101] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This is both a retrospective and a 16 and 28 months prospective study of the association between psychiatric comorbidity and social consequences (accidents, fights, broken relationships, drunken driving arrest, and reduced employment) related to alcohol in a nation-wide sample (n = 351) of substance abusers seeking inpatient treatment. Psychiatric comorbidity was evaluated with the Diagnostic Interview Schedule, while drinking history and social consequences were assessed with a structured questionnaire. The social consequences had a high rate of re-occurrence. Controlled for alcohol consumption, polysubstance abuse predicted accidents (OR = 2.9) and fights (OR = 3.9) among men, while among pure alcoholics of both sexes phobia (OR = 4.3) and antisocial personality disorder (OR = 3.0) predicted fights. Only level of abuse predicted broken relationships. Antisocials had most drunken driving arrests. Attempts to reduce these social consequences should aim at treating polysubstance abuse, phobia, and antisocial personality disorder. However, the overriding aim should be the promotion of abstinence.
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Affiliation(s)
- K Tómasson
- Department of Psychiatry, National University Hospital, Reykjavík, Iceland
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Drake RE, Brunette MF. Complications of severe mental illness related to alcohol and drug use disorders. RECENT DEVELOPMENTS IN ALCOHOLISM : AN OFFICIAL PUBLICATION OF THE AMERICAN MEDICAL SOCIETY ON ALCOHOLISM, THE RESEARCH SOCIETY ON ALCOHOLISM, AND THE NATIONAL COUNCIL ON ALCOHOLISM 1998; 14:285-99. [PMID: 9751950 DOI: 10.1007/0-306-47148-5_12] [Citation(s) in RCA: 66] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
In this chapter we review research on the relationships between substance use disorder and 11 domains of adjustment for people with severe mental illness. Studies are divided into correlational research and prospective, longitudinal research, with greater weight given to those in the latter category. The weight of the evidence indicates that substance abuse severely complicates severe mental illness in the following domains: relapse of psychiatric illness, hospitalization, disruptive behavior, familial problems, residential instability, decreased functional status, HIV infection, and medication noncompliance. We discuss the limits of causal inference in these studies and the possible mechanisms that relate substance abuse to various complications.
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Affiliation(s)
- R E Drake
- Psychiatric Research Center, Dartmouth Medical School, Lebanon, New Hampshire 03766, USA
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Russo J, Roy-Byrne P, Reeder D, Alexander M, Dwyer-O'Connor E, Dagadakis C, Ries R, Patrick D. Longitudinal assessment of quality of life in acute psychiatric inpatients: reliability and validity. J Nerv Ment Dis 1997; 185:166-75. [PMID: 9091598 DOI: 10.1097/00005053-199703000-00006] [Citation(s) in RCA: 78] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
This study examined the reliability, validity, and responsiveness of Lehman's Quality of Life Interview (QOLI) as an outcome measure on 981 acutely ill psychiatric inpatients assessed longitudinally at admission and discharge. Patients were stratified into five diagnostic (DX) (depressed bipolar, depressed unipolar, schizophrenia, mania, and other diagnoses) and two substance use disorder (SA) strata (with and without concurrent substance abuse/dependence) based on DSM-III-R criteria. There was good replication of the factor structure, excellent internal consistency, overall and within DX and SA groups. Intercorrelations showed that the functional and satisfaction indices measure unique aspects of the quality of life. The construct consistency of the QOLI was dependent upon psychiatric diagnosis and life domain. Intercorrelations of functional and satisfaction indices for patients with depression were greater than for manic patients. We demonstrated strong consistency of construct validity for family and social relation domains, but not safety or leisure activities. Construct validity was shown to hold longitudinally. Analyses of DX and SA group differences on satisfaction and functional indices of the 8 life domains supported discriminative validity: Depressed patients reported the most dissatisfaction, followed by schizophrenic patients, and manic patients reported the greatest satisfaction in most life domains. Patients with concurrent substance abuse generally reported less satisfaction and lower quality of life than patients without a dual diagnosis. Examination of longitudinal changes in satisfaction indicated the QOLI is responsive to changes in global life, leisure activities, living situation, and social relations from hospital admission to discharge (an average of 2 weeks). This study supports the use of the QOLI as an outcome measure to assess quality of life in acutely ill hospitalized psychiatric patients.
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Affiliation(s)
- J Russo
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Harborview Medical Center, Seattle 98104, USA
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Abstract
Previous work posits that severity of substance abuse and severity of schizophrenic symptoms should be linked by either or both of two mechanisms: self-regulation of symptoms and drug-induced exacerbation of symptoms. Research on these relationships has yielded mixed results. We examined the interrelationships of schizophrenic symptoms and substance abuse in 172 patients with co-occurring disorders. Relationships were weak or nonexistent, without any consistent pattern. Our findings do not support the view that substances are used to self-regulate symptoms. In addition, our results suggest that substance abuse may lead to higher rates of institutionalization through mechanisms other than by exacerbating symptoms.
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Affiliation(s)
- M F Brunette
- New Hampshire-Dartmouth Psychiatric Research Center, Dartmouth Medical School, Concord 03301, USA
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