Characteristics of persons with severe mental illness and substance abuse in rural areas

Brief interventions for patients presenting to the Psychiatric Emergency Service (PES) with major mental illnesses and at-risk drinking

The presentation for care in psychiatric emergency setting provides an opportunity to assist individuals with mental health disorders and problems related to alcohol use. The purpose of this pilot study was to determine whether clinician-administered brief alcohol interventions are effective in reducing alcohol consumption in patients who screen positive for at-risk drinking in the psychiatric emergency setting. A total of 390 PES patients were screened; 87 (schizophrenia/bipolar disorder, n = 34; depression/anxiety, n = 53) met criteria for the study and received a brief alcohol intervention. Both groups dropped their drinking by approximately 7 drinks/week over the 6-months of the study (P < .05). The results of this study suggest that individuals with mental illnesses who drink at risk levels may benefit from a short, targeted brief alcohol intervention directed at changing their alcohol-related behavior and that, delivery of these interventions is feasible in a psychiatric emergency setting.

Religiosity and decreased risk of substance use disorders: is the effect mediated by social support or mental health status?

OBJECTIVE

The negative association between religiosity (religious beliefs and church attendance) and the likelihood of substance use disorders is well established, but the mechanism(s) remain poorly understood. We investigated whether this association was mediated by social support or mental health status.

METHOD

We utilized cross-sectional data from the 2002 National Survey on Drug Use and Health (n = 36,370). We first used logistic regression to regress any alcohol use in the past year on sociodemographic and religiosity variables. Then, among individuals who drank in the past year, we regressed past year alcohol abuse/dependence on sociodemographic and religiosity variables. To investigate whether social support mediated the association between religiosity and alcohol use and alcohol abuse/dependence we repeated the above models, adding the social support variables. To the extent that these added predictors modified the magnitude of the effect of the religiosity variables, we interpreted social support as a possible mediator. We also formally tested for mediation using path analysis. We investigated the possible mediating role of mental health status analogously. Parallel sets of analyses were conducted for any drug use, and drug abuse/dependence among those using any drugs as the dependent variables.

RESULTS

The addition of social support and mental health status variables to logistic regression models had little effect on the magnitude of the religiosity coefficients in any of the models. While some of the tests of mediation were significant in the path analyses, the results were not always in the expected direction, and the magnitude of the effects was small.

CONCLUSIONS

The association between religiosity and decreased likelihood of a substance use disorder does not appear to be substantively mediated by either social support or mental health status.

Sixteen-year predictors of substance use disorder diagnoses for patients with mental health disorders

Individuals with substance use disorders (SUDs). including co-occurring disorders, are among the highest-risk populations for medical and psychiatric rehospitalizations, and are often underdiagnosed at initial hospitalization. This study examined predictors for these individuals at baseline hospitalization and subsequent rehospitalizations. Three groups were compared from a sample of individuals admitted to inpatient psychiatry (1982 to 1987) with at least one rehospitalization within a 16-year period. Multivariate logistical regressions were used to determine associations with predictor variables. The data showed that individuals' diagnosed with a SUD after baseline hospitalization were more likely to have more medical hospitalizations and to be diagnosed with schizophrenia compared to those who were diagnosed with a SUD, including co-occurring disorders, at baseline. The results of this study indicate the importance of substance use screening to enhance service resources and treatment outcomes for medically and psychiatrically complex populations.

Prevalence of psychotic symptoms in substance users: a comparison across substances

BACKGROUND

Psychotic symptoms (delusions and hallucinations) are reported to be increased among persons using illicit substances, but little is known about the comparative frequency with which the symptoms occur with abuse of different substances. To establish this, we interviewed individuals who had wide experience of commonly used drugs.

METHODS

Four hundred seventy-six intravenous drug users, crack-cocaine users, and heroin snorters recruited via street outreach were interviewed using the Composite International Diagnostic Interview-Substance Abuse Model to assess dependence on a number of substances including amphetamines, cannabis, cocaine, and opioids. As a part of this assessment, we assessed a history of delusions and hallucinations in the context of use of, or withdrawal from, these specific substances.

RESULTS

From 27.8% to 79.6% users of amphetamine, cannabis, cocaine, and opiates met Diagnostic and Statistical Manual of Mental Disorders, Third Edition, Revised, dependence for that specific substance. The prevalence of psychotic symptoms associated with each specific substance ranged from users with no diagnosis to users with severe dependence as follows: amphetamines (5.2%-100%), cannabis (12.4%-80.0%), cocaine (6.7%-80.7%), and opiates (6.7%-58.2%). The risk of psychotic symptoms increased for respondents who abused (odds ratio [OR], 12.2) or had mild (OR, 17.1), moderate (OR, 47.0), or severe dependence (OR, 114.0) on cocaine when compared to those who were users with no diagnosis. A similar pattern was evident in cannabis, opiate, and amphetamine users.

CONCLUSIONS

Most users dependent on illicit substances experience psychotic symptoms in the context of use of, or withdrawal from, these substances. Psychotic symptoms increased with the severity of the substance use disorders for all 4 substances. These findings emphasize the importance of developing services to target this population as they are at a heightened risk for developing psychotic symptoms.

Prevalence and profile of people with co-occurring mental and substance use disorders within a comprehensive mental health system

OBJECTIVE

To examine the prevalence and profile of people with co-occurring mental and substance use disorders in relation to numerous demographic, diagnostic, and needs-related variables across a comprehensive system of mental health services using a standard methodology.

METHOD

Data were collected on cases (n = 9839) sampled from specialty tertiary inpatient, specialty outpatient, and community-based mental health programs. Status with respect to co-occurring disorders was based on recorded diagnosis of substance use disorder and the substance abuse measure within the Colorado Client Assessment Record. The demographic and needs profile was compared across groups with or without co-occurring disorders within each level of care.

RESULTS

Overall, the prevalence of co-occurring disorders was 18.5%, and highest among clients receiving specialty tertiary inpatient care (28%), and within selected subpopulations such as younger adults (55%) and those with personality disorders (34%). There were few differences between groups based on co-occurring disorders in the specialty inpatient programs. For outpatient and community settings, the clients with co-occurring disorders were distinguished by a more impaired and complex needs profile and more likely to be young, single, male, and of low education. Across all levels of care, having a co-occurring disorder was strongly associated with antisocial and challenging behaviour, legal involvement, and risk of suicide or self-harm.

CONCLUSION

The prevalence estimate of co-occurring disorders is likely representative of a multilevel system of care that serves a large, mixed urban and rural population. Results highlight the need to focus on specific subpopulations and sectors in pursuit of more integrated treatment and support for their mental health and addictions problems.

Screening psychiatric patients for illicit drug use disorders and problems

BACKGROUND

Illicit drug use is prevalent but under-detected among psychiatric patients. This paper reviews the need for a valid, practical screening instrument for detecting drug problems and disorders among psychiatric patients, and describes the appropriateness of existing screening instruments for this purpose.

METHODS

Research literature on illicit drug screening instruments is reviewed.

RESULTS

All existing instruments lack one or more of the following characteristics that would enable them to be used routinely in psychiatric settings: brief and easy to administer, demonstrated validity for male and female psychiatric patients, measuring illicit drug use problems without confounding with alcohol use problems, and assessing drug problems over an optimal timeframe for screening (e.g., past 12 months).

CONCLUSION

Current instruments are not appropriate for routine drug screening of psychiatric patients. A brief, easy to use drug screen should be developed and validated on male and female psychiatric patients for routine screening of drug disorders and problems.

Correlates of substance use disorder among psychiatric outpatients: focus on cognition, social role functioning, and psychiatric status

This study compared psychiatric outpatients who were never, former, and current substance abusers on psychiatric, social, and cognitive functioning. Fifty-six outpatients with schizophrenia spectrum and bipolar disorders volunteered to complete diagnostic and social role function interviews, self-report inventories, and neuropsychological tests. Multinomial logit regression analyses indicated that current and former abusers reported greater subjective feelings of distress than those who never abused. Contrary to expectations, however, both groups of substance abusers performed better on nonverbal cognitive tests compared with those who never abused. Differences in social functioning were also observed: former abusers demonstrated better instrumental role functioning than those who never abused. This pattern of findings challenges assumptions about additive effects of comorbid disorders on cognitive and social functioning.

Substance Use Among Persons with Serious Mental Illness in Eastern Ontario

One hundred and eighty persons with serious mental illness (SMI) in eastern Ontario, receiving services from assertive community treatment teams in Brockville and Kingston were interviewed about substance use. Data were compared to survey findings for the Ontario population. Tobacco use was higher among both men and women in the SMI sample, but use of alcohol and drugs in the past 12 months was lower than population data. The frequency of alcohol use was significantly greater than drug use among the SMI sample.

A family intervention program for dual disorders

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.

[Extended main family and mental disease in a rural health area]

OBJECTIVE

To check the association between souche family and the incidence of mental illness.

DESIGN

A case-control study.

SETTING

Health Rural Zone (Tineo-Asturias-Spain).

PATIENTS

CASE

every person with a new diagnosis of mental illness who has been compiled (CIE-9-CM) the clinical records of the Mental Health Centre. Field-work from 1-1-1996 until 31-12-1997; they could be dead or alive and of fourteen or more years of age, including suicide and suicide attempts without clinical records in the mental health centre and excluding organic psychosis, mental illness caused by organic damage lesion and mentally handicapped (n = 162).

CONTROL

living people of fourteen or more years of age, with diagnosis of current mental illness, after more than one year since their discharge from a mental illness. They will mark five or less than five in the GHQ-28 scale. A systematic random sample was done among all patients registered by computer from the health centre (n = 378). We compiled information about: age, sex, family and personal backgrounds of mental illness, rural or urban context, marital status, education level, family structure and GHQ-28. We carried out univariant and bivariant analysis also we adjusted a logistic regression model (SPSSW7.1).

MAIN RESULTS

In the souche family we obtained a odds ratio equal 3.29 (95% CI, 1.69-6.43).

CONCLUSIONS

The souche family is a risk of mental illness. Research into dynamics and performance should be done.

Aftercare Compliance: Perceptions of People with Dual Diagnoses

This descriptive study was designed to learn, from the perspective of dually diagnosed inpatients, what factors affect their maintenance of an aftercare program. Ten audio-recorded focus groups were conducted using a structured interview schedule; additionally, patients participated in structured brief individual interviews, and their medical records were reviewed for demographic data and chief complaints on admission. Despite the numerous obstacles encountered by this population intrapersonally, interpersonally, environmentally, and socially, participants were able to provide (a) specific information to increase the understanding of compliance from their perspective and (b) recommendations for health care professionals to facilitate adherence to aftercare treatment plans.

Complications of severe mental illness related to alcohol and drug use disorders

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.