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Aljassem A, Spickler M, Kapur N. A path to recovery for overlooked populations and their unique challenges: integrating rehabilitation in palliative care for patients with substance use disorders. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1373857. [PMID: 38756191 PMCID: PMC11096464 DOI: 10.3389/fresc.2024.1373857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2024] [Accepted: 04/17/2024] [Indexed: 05/18/2024]
Abstract
Palliative care is a growing medical specialty focusing on providing compassionate and holistic management for those facing life-threatening diseases. These patients frequently present with physical, functional, emotional, and psychosocial problems that require comprehensive interdisciplinary management. However, there is a substantial opportunity to improve care for patients in palliative care who also have a substance use disorder (SUD). These opportunities include direct provision of SUD treatments by specialist palliative care providers and the integration of physical medicine and rehabilitation services. The purpose of this article is to examine the misunderstood and underutilized interaction between palliative care and SUDs, as well as describing the unique opportunities provided by physical medicine and rehabilitation providers to achieve a patient's palliative care goals and optimize overall quality of life. Substance Use Disorder is a chronic, often relapsing, illness that is relevant to palliative care practice due to the potential for significant morbidity and mortality through organ failure, chronic infections, and overdose syndromes. In traditional palliative care practice, it has been observed that past or current SUD diagnoses are often left untreated, resulting in increased distress, and exacerbating an already complex medical situation. Furthermore, many of these patients also experience physical, functional, or psychosocial changes that, when left untreated, will worsen distress and quality of life. To provide more comprehensive and successful palliative care for patients with SUD, the authors recommend an increased emphasis on specialist palliative care training in SUD management, proactive integration of rehabilitation services into the palliative care team, and consistent advocacy for these steps in various arenas. Combined, these actions can improve the care team's ability to provide a holistic, patient-centered approach that can have substantial positive outcomes for patients, health systems, and society.
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Affiliation(s)
- Annas Aljassem
- Department of Physical Medicine and Rehabilitation, Oakland University William Beaumont School of Medicine, Royal Oak, MI, United States
| | - Michael Spickler
- Department of Physical Medicine and Rehabilitation, Corwell Health William Beaumont University Hospital, Royal Oak, MI, United States
| | - Nandita Kapur
- Department of Physical Medicine and Rehabilitation, Oakland University William Beaumont School of Medicine, Royal Oak, MI, United States
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Fernández SD, Miranda JJF, Pastor FP, Muñoz FL. Gender and addiction and other mental disorders comorbidity: sociodemographic, clinical, and treatment differences. Arch Womens Ment Health 2023; 26:639-650. [PMID: 37540344 PMCID: PMC10491505 DOI: 10.1007/s00737-023-01353-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Accepted: 07/21/2023] [Indexed: 08/05/2023]
Abstract
The co-occurrence of substance use disorders (SUD) and other mental disorders (OMD) is assumed to be high, but the details are uncertain in Spain. The objective of the present study was to know the prevalence of this comorbidity, as well as the pharmacological treatment, both in specific addiction treatment networks and in mental health networks, with a gender perspective. Observational, multicenter study, with a randomized sample, of patients under treatment for SUD or OMD in Spain (N = 1783). A specific questionnaire, collecting sociodemographic and clinical variables, diagnosed SUD and OMD, and prescribed psychotropic drugs, was completed by treating clinicians. Differences between females and males were searched. A high prevalence of OMD was found in those patients treated for their SUD (71%), and also of diagnoses of SUD (59%) in people treated for OMD. Significant relationships between addiction to certain substances and specific mental disorders were found (with no main differences between women and men). The treatments for OMD were very common in the addiction treatment networks, but that of SUDs in those patients treated in the mental health networks was less than expected. A high prescription of benzodiazepines was found. Women were less frequently diagnosed with cannabis, opioid, and especially cocaine use disorders, and they had fewer psychotic disorders and more affective, anxiety, sleep, and eating disorders, with the rest being the same, including personality disorders. Women had fewer treatments with agonists and more with antagonists, and more prescriptions of anxiolytics and antidepressants. This study provides preliminary information on the coexistence in routine clinical practice of addictive disorders and other mental disorders in Spain, and on the treatment provided, and shows differences in prevalence and clinical characteristics, and especially in treatment approaches between women and men. Thus, should be useful to adapt the treatment response with greater precision, and with a gender perspective.
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Affiliation(s)
- Silvia Díaz Fernández
- Asturian Mental Health Service Area V- Hospital Univ. Cabueñes, Servicio de Salud del Principado de Asturias (SESPA), Gijón, Spain.
- Asturian Institute on Health Research (Instituto para la Investigación Sanitaria del P° de Asturias-ISPA), Oviedo, Spain.
| | - Juan José Fernandez Miranda
- Asturian Mental Health Service Area V- Hospital Univ. Cabueñes, Servicio de Salud del Principado de Asturias (SESPA), Gijón, Spain
- Asturian Institute on Health Research (Instituto para la Investigación Sanitaria del P° de Asturias-ISPA), Oviedo, Spain
| | - Francisco Pascual Pastor
- Unidad de conductas adictivas, Servicio Valenciano de Salud (SVS), Alcoi, Spain
- PREVENGO, University Miguel Hernández, Elche, Spain
| | - Francisco López Muñoz
- Faculty of Health Sciences, University Camilo José Cela, Madrid, Spain
- Neuropsychopharmacology Unit, Hospital 12 de Octubre Research Institute, Madrid, Spain
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Differences in Substance Use Disorders and Other Mental Disorders in Mental Health and Addiction Settings: Sociodemographic, Clinical, Drug Treatment, and Gender Differences. Int J Ment Health Addict 2022. [DOI: 10.1007/s11469-022-00989-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Abstract
Different care networks in Spain evaluate the co-occurrence of substance use disorders (SUD) and other mental disorders (OMDs). This study aimed to explore the differences in prevalence, sociodemographic and clinical profile, pharmacological treatment, and gender perspective of the co-occurrence of SUD and OMD between specific addiction treatment networks and mental health networks. This is an observational, cross-multicenter study with a randomized sample of patients under treatment for SUD or OMDs in different autonomous communities of Spain (N = 1783). Sixty-seven health professionals completed an ad hoc online questionnaire, collecting sociodemographic variables with patients diagnosed with SUD and OMDs, and their pharmacological treatments. The findings revealed a high prevalence of OMD in patients treated for SUD (71%) and those for OMD diagnosed with SUD (59%). Specific relationships between the SUDs and OMDs were identified. In networks treating SUDs, the increase in treatment for OMDs was widespread. However, the addition of SUD treatments in mental health networks was less frequent than expected. In addition, an elevated benzodiazepine prescription was detected in both settings. Some possible gender biases in treatments were found. This study provides preliminary information on the coexistence in routine clinical practice of addictive disorders and other mental disorders in Spain. The results revealed that the treatments provided are inefficient for SUDs in patients treated in mental health settings. Furthermore, a high prescription of anxiolytics and differences by sex are shown. These findings may contribute to adapting the treatment response with greater precision and effectiveness.
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Vink JM, Treur JL, Pasman JA, Schellekens A. Investigating genetic correlation and causality between nicotine dependence and ADHD in a broader psychiatric context. Am J Med Genet B Neuropsychiatr Genet 2021; 186:423-429. [PMID: 32909657 PMCID: PMC9292706 DOI: 10.1002/ajmg.b.32822] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 11/26/2019] [Accepted: 08/12/2020] [Indexed: 12/28/2022]
Abstract
People with attention-deficit/hyperactivity disorder (ADHD) or other psychiatric disorders show high rates of nicotine dependence (ND). This comorbidity might be (partly) explained by shared genetic factors. Genetic correlations between ND and ADHD (or other psychiatric disorders) have not yet been estimated. A significant genetic correlation might indicate genetic overlap, but could also reflect a causal relationship. In the present study we investigated the genetic correlation (with LD score regression analyses) between ND and ADHD, as well as between ND and other major psychiatric conditions (major depressive disorder, schizophrenia, anxiety, bipolar disorder, autism spectrum, anorexia nervosa, and antisocial behavior) based on the summary statistics of large Genome Wide Association studies. We explored the causal nature of the relationship between ND and ADHD using two-sample Mendelian randomization. We found a high genetic correlation between ND and ADHD (rg = .53, p = 1.85 × 10-13 ), and to a lesser extent also between ND-major depressive disorder (rg = .42, p = 3.6 × 10-11 ) and ND-schizophrenia (rg = .18, p = 1.1 × 10-3 ). We did not find evidence for a causal relationship from liability for ADHD to ND (which could be due to a lack of power). The strong genetic correlations might reflect different phenotypic manifestations of (partly) shared underlying genetic vulnerabilities. Combined with the lack of evidence for a causal relationship from liability for ADHD to ND, these findings stress the importance to further investigate the underlying genetic vulnerability explaining co-morbidity in psychiatric disorders.
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Affiliation(s)
| | - Jorien L. Treur
- Department of Psychiatry, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Joëlle A. Pasman
- Behavioural Science InstituteRadboud UniversityNijmegenThe Netherlands
| | - Arnt Schellekens
- Department of PsychiatryRadoudumc, Donders Centre for Medical NeuroscienceNijmegenThe Netherlands,Nijmegen Institute for Scientist Practitioners in AddictionNijmegenThe Netherlands
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Prevalence and Demographic Correlates of Substance Use among Adults with Mental Illness in Eastern Cape, South Africa: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18105428. [PMID: 34069572 PMCID: PMC8161045 DOI: 10.3390/ijerph18105428] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Revised: 03/28/2021] [Accepted: 03/29/2021] [Indexed: 11/21/2022]
Abstract
This study reports on the prevalence and demographic correlates of substance use among individuals with mental illness in the Eastern Cape, South Africa. This cross-sectional study was conducted in the Outpatient Clinic of a large hospital in the Eastern Cape, South Africa. A pre-validated tool on alcohol and psychoactive drug use was administered to 390 individuals with mental illness. Multivariable logistic regression models were fitted to explore the demographic correlates of alcohol and psychoactive drug use. Of the total participants (N = 390), 64.4% and 33.3% reported lifetime (ever used) and past-year use of alcohol, respectively, but the prevalence of risky alcohol use was 18.5%. After adjusting for relevant covariates, only male sex, younger age, and rural residence remained significantly associated with risky alcohol use. The prevalence of ever-use and past-year use of psychoactive substances was 39.7% and 17.4%, respectively. The most common substance ever used was cannabis (37.4%). Male sex, younger age, owning a business, and being unemployed were significantly associated with higher odds of lifetime and past-year use of psychoactive substances. Findings highlight the need for dedicated infrastructure and staff training in the management of these dual diagnoses in the region.
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Facal F, Flórez G, Blanco V, Rodríguez J, Pereiro C, Fernández JM, Fariñas E, Estévez V, Gómez-Trigo J, Gurriarán X, Sáiz P, Vázquez FL, Arrojo M, Costas J. Genetic predisposition to alcohol dependence: The combined role of polygenic risk to general psychopathology and to high alcohol consumption. Drug Alcohol Depend 2021; 221:108556. [PMID: 33561667 DOI: 10.1016/j.drugalcdep.2021.108556] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Revised: 11/25/2020] [Accepted: 01/04/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND High alcohol consumption and alcohol dependence are only partly genetically correlated and they differ considerably in their correlations with other traits. The existence of genetic correlation among alcohol dependence and psychiatric disorders may be attributed to the presence of a general psychopathology factor, the p factor. This study investigates the relationship of polygenic risk to general psychopathology and to high alcohol consumption on alcohol dependence. METHODS Participants were 524 alcohol-dependent patients and 729 controls. Polygenic risk scores (PRS) were computed for alcohol consumption (drinks per week) and nine psychiatric disorders. Principal component analysis (PCA) applied to the psychiatric PRS was used to calculate the first principal component as a proxy of the polygenic p factor. RESULTS Both the polygenic p factor and the drinks per week PRS were associated with alcohol dependence in our sample. Both variables are only weakly correlated, contributing additively to the risk for alcohol dependence. Sensitivity analyses showed that the polygenic p factor was also associated with alcohol dependence in the subset of patients without any psychiatric or substance use comorbidity. CONCLUSIONS Polygenic risk for alcohol dependence can be split at least into two components, involved in general psychopathology and high alcohol consumption. The first component of PCA based on PRS for different psychiatric disorders allows estimation of the contribution of the polygenic p factor to alcohol dependence. The pleiotropic effects of genetic variants across psychiatric disorders are mainly manifested as alcohol dependence in some patients.
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Affiliation(s)
- Fernando Facal
- Instituto de Investigación Sanitaria (IDIS) de Santiago de Compostela, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Galicia, Spain; Servizo de Psiquiatría, Complexo Hospitalario Universitario de Santiago de Compostela, Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Galicia, Spain; Universidade de Santiago de Compostela (USC), Galicia, Spain
| | - Gerardo Flórez
- Unidade de Conductas Adictivas, Servizo de Psiquiatría, Complexo Hospitalario Universitario de Ourense (CHUO), Servizo Galego de Saúde (SERGAS), Ourense, Galicia, Spain
| | - Vanessa Blanco
- Department of Evolutionary and Educational Psychology, Universidade de Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Julio Rodríguez
- Instituto de Investigación Sanitaria (IDIS) de Santiago de Compostela, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Galicia, Spain
| | - César Pereiro
- Unidade Asistencial de Drogodependencias (ACLAD), A Coruña, Galicia, Spain
| | | | - Emilio Fariñas
- Unidade Municipal de Atención a Drogodependientes (UMAD), Santiago de Compostela, Galicia, Spain
| | - Valentín Estévez
- Unidade de Conductas Adictivas, Servizo de Psiquiatría, Complexo Hospitalario Universitario de Ourense (CHUO), Servizo Galego de Saúde (SERGAS), Ourense, Galicia, Spain
| | - Jesús Gómez-Trigo
- Servizo de Psiquiatría, Complexo Hospitalario Universitario de Santiago de Compostela, Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Galicia, Spain; Unidade de Conductas Adictivas, Servizo de Psiquiatría, Complexo Hospitalario Universitario de Ourense (CHUO), Servizo Galego de Saúde (SERGAS), Ourense, Galicia, Spain
| | - Xaquín Gurriarán
- Instituto de Investigación Sanitaria (IDIS) de Santiago de Compostela, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Galicia, Spain
| | - Pilar Sáiz
- Department of Psychiatry, Universidad of Oviedo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain
| | - Fernando Lino Vázquez
- Department of Clinical Psychology and Psychobiology, Universidade de Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Manuel Arrojo
- Instituto de Investigación Sanitaria (IDIS) de Santiago de Compostela, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Galicia, Spain; Servizo de Psiquiatría, Complexo Hospitalario Universitario de Santiago de Compostela, Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Galicia, Spain
| | - Javier Costas
- Instituto de Investigación Sanitaria (IDIS) de Santiago de Compostela, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Galicia, Spain.
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Vergara-Moragues E, González-Saiz F. Predictive Outcome Validity of General Health Questionnaire (GHQ-28) in Substance Abuse Patients Treated in Therapeutic Communities. J Dual Diagn 2020; 16:218-227. [PMID: 31608803 DOI: 10.1080/15504263.2019.1674465] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Objective: The use of psychoactive substances has been one of the most important global public health problems over the last few decades. Among the problems associated with substance use, dual diagnosis is one of the most relevant. This study aims to investigate the predictive validity of the GHQ-28 (General Health Questionnaire-28; "probable psychiatric cases") in relation to poor treatment outcome measured by (a) "early treatment dropout" and (b) "nonclinically relevant improvement at discharge." Methods: A longitudinal prospective design was used. A sample of 219 substance use disorder patients, who received treatment in a therapeutic community, was selected. Patients were assessed using the GHQ-28 and the outcome variables were registered. A hierarchical logistic regression model was performed to identify factors independently associated with the outcome measure ("early treatment dropout" and "nonclinically relevant improvement at discharge"). Results: Of the total sample, 79 subjects (36%) were considered "early treatment dropouts" and 56.6% (102) presented a "nonclinically relevant improvement at discharge." The two hierarchical logistic regression results show that being classified as a "probable psychiatric case" was significantly and directly associated with "early treatment dropout" and "nonclinically relevant improvement at discharge," as a poor in-treatment outcome indicator. Conclusions: The results of this study support the notion that the probable psychiatric cases identified by the GHQ-28 scale have a greater probability of "early treatment dropout" and have a greater probability of "nonclinically relevant improvement in discharge" of the therapeutic community. These data indicate that GHQ-28 is a suitable clinical instrument for predicting dropout and treatment effect in residential substance use disorder treatment.
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Affiliation(s)
- Esperanza Vergara-Moragues
- Departamento de Psicobiología y Metodología en Ciencias del Comportamiento, Universidad Complutense de Madrid (UCM), Madrid, Spain.,Universidad Internacional de la Rioja (UNIR), Logroño, Spain
| | - Francisco González-Saiz
- Unidad de Salud Mental Comunitaria de Jerez, UGC Salud Mental, Área de Gestión Sanitaria Norte de Cádiz, Servicio Andaluz de Salud, Cádiz, Spain.,Departamento de Neurociencias, Área de Psiquiatría, Universidad de Cádiz, Cádiz, Spain.,Instituto de Investigación e Innovación Biomédica de Cádiz (INiBICA), Cádiz, Spain
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Ebenau A, Dijkstra B, ter Huurne C, Hasselaar J, Vissers K, Groot M. Palliative care for patients with substance use disorder and multiple problems: a qualitative study on experiences of healthcare professionals, volunteers and experts-by-experience. BMC Palliat Care 2020; 19:8. [PMID: 31937289 PMCID: PMC6961318 DOI: 10.1186/s12904-019-0502-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2019] [Accepted: 12/08/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND There is little information about how healthcare professionals feel about providing palliative care for patients with a substance use disorder (SUD). Therefore, this study aims to explore: 1) the problems and needs experienced by healthcare professionals, volunteers and experts-by-experience (HCP/VE) during their work with patients with SUD in a palliative care trajectory and; 2) to make suggestions for improvements using the quality of care model by Donabedian (Structure, Process, Outcome). METHODS A qualitative study was conducted, consisting of six focus group interviews which consisted of HCP/VE working with patients with SUD in a palliative care phase. At the end of the focus group interviews, participants structured and summarized their experiences within a Strengths, Weaknesses, Opportunities and Threats (SWOT) framework. Interview transcripts (other than the SWOT) were analysed by the researchers following procedures from the Grounded Theory Approach ('Grounded Theory Lite'). SWOT-findings were not subjected to in-depth analysis. RESULTS HCP/VE stated that within the Structure of care, care networks are fragmented and HCP/VE often lack knowledge about patients' multiplicity of problems and the time to unravel these. Communication with this patient group appears limited. The actual care-giving Process requires HCP/VE a lot of creativity and time spent seeking for cooperation with other caregivers and appropriate care settings. The latter is often hindered by stigma. Since no formalized knowledge is available, care-delivery is often exclusively experience-based. Pain-medication is often ineffective due to active substance use. Finally, several Outcomes were brought forward: Firstly, a palliative care phase is often identified only at a late stage. Secondly, education and a (mobile) team of expertise are desired. Thirdly, care for the caregivers themselves is often de-prioritized. CONCLUSIONS Better integration and collaboration between the different professionals with extensive experience in addiction, palliative and general curative care is imperative to assure good palliative care for patients with SUD. Currently, the resources for this care appear to be insufficient. Development of an educational program and social mapping may be the first steps in improving palliative care for patients with severe SUD.
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Affiliation(s)
- Anne Ebenau
- Department of Anesthesiology, Pain and Palliative Care, Radboudumc Expertise centre for Pain and Palliative Medicine, Internal Post 549, Radboud University Medical Centre (Radboudumc), P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
- Salvation Army, Central Netherlands, Zandvoortweg 211, 3741 BE Baarn, The Netherlands
| | - Boukje Dijkstra
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Postbus 9104, 6500 HE Nijmegen, The Netherlands
| | - Chantal ter Huurne
- Tactus Addiction Care, Lokatie Ripperdastraat, Ripperdastraat 8, 7511 JR Enschede, The Netherlands
| | - Jeroen Hasselaar
- Department of Anesthesiology, Pain and Palliative Care, Radboudumc Expertise centre for Pain and Palliative Medicine, Internal Post 549, Radboud University Medical Centre (Radboudumc), P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Kris Vissers
- Department of Anesthesiology, Pain and Palliative Care, Radboudumc Expertise centre for Pain and Palliative Medicine, Internal Post 549, Radboud University Medical Centre (Radboudumc), P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
| | - Marieke Groot
- Department of Anesthesiology, Pain and Palliative Care, Radboudumc Expertise centre for Pain and Palliative Medicine, Internal Post 549, Radboud University Medical Centre (Radboudumc), P.O. Box 9101, 6500 HB Nijmegen, The Netherlands
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Risk Factors Associated With Psychiatric Comorbidity in a Sample of Male Egyptian Patients With Substance Use Disorder. ADDICTIVE DISORDERS & THEIR TREATMENT 2019. [DOI: 10.1097/adt.0000000000000158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Ebenau A, Dijkstra B, Ter Huurne C, Hasselaar J, Vissers K, Groot M. Palliative care for people with substance use disorder and multiple problems: a qualitative study on experiences of patients and proxies. BMC Palliat Care 2019; 18:56. [PMID: 31299956 PMCID: PMC6626397 DOI: 10.1186/s12904-019-0443-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2019] [Accepted: 07/03/2019] [Indexed: 01/03/2023] Open
Abstract
Background Systematic research into palliative care (PC) for people with substance use disorder (SUD) and multiple problems is scarce. The existing literature shows problems in the organizational structure of this care, e.g., lack of clear care pathways. Furthermore, negative attitudes of healthcare professionals (HCPs) and stigmatization surrounding SUD, and patients’ care-avoidance and non-disclosure of substance use are hindering factors in providing timely and person-centered PC. Furthermore, the experiences and needs of patients and proxies themselves are unknown. Therefore, this study aims to explore which problems and needs patients with SUD and multiple problems, and their proxies, experience in a PC phase. Methods Data-collection of this qualitative study consisted of semi-structured interviews with patients with SUD and multiple problems in a PC phase, and their proxies, about their experiences in PC and their well-being. Interviews were inductively analyzed. Results Nine patients and three proxies were included. Six patients suffered from COPD, one patient from cirrhosis of the liver and two patients from both. Seven patients stayed in a nursing home and two had a room in either a social care service (hostel) or an assisted living home where medical care was provided. Five themes were identified: 1) healthcare delivery (including HCPs behaviour and values); 2) end-of-life (EOL) preferences (mostly concerning only the individual patient and the ‘here-and-the-now’); 3) multidimensional problems; 4) coping (active and passive) and; 5) closed communication. Proxies’ experiences with healthcare differed. Emotionally, they were all burdened by their histories with the patients. Conclusions This study shows that talking about and anticipating on PC with this patient-group appears hard due to patients’ closed and avoiding communication. Furthermore, some of patients’ EOL-preferences and needs, and coping-strategies, seem to differ from the more generally-accepted ideas and practices. Therefore, educating HCPs in communicating with this patient-group, is needed. Electronic supplementary material The online version of this article (10.1186/s12904-019-0443-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Anne Ebenau
- Department of Anaesthesiology Pain and Palliative Care Expertise Centre for Palliative Care, Internal Post 549, Radboud University Medical Centre (Radboudumc), P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands. .,Salvation Army, Central Netherlands, Zandvoortweg 211, 3741 BE, Baarn, The Netherlands.
| | - Boukje Dijkstra
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud Universiteit, Postbus 9104, 6500 HE, Nijmegen, The Netherlands
| | - Chantal Ter Huurne
- Tactus Addiction Care, Location Ripperdastraat, Ripperdastraat 8, 7511 JR, Enschede, The Netherlands
| | - Jeroen Hasselaar
- Department of Anaesthesiology Pain and Palliative Care Expertise Centre for Palliative Care, Internal Post 549, Radboud University Medical Centre (Radboudumc), P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Kris Vissers
- Department of Anaesthesiology Pain and Palliative Care Expertise Centre for Palliative Care, Internal Post 549, Radboud University Medical Centre (Radboudumc), P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
| | - Marieke Groot
- Department of Anaesthesiology Pain and Palliative Care Expertise Centre for Palliative Care, Internal Post 549, Radboud University Medical Centre (Radboudumc), P.O. Box 9101, 6500 HB, Nijmegen, The Netherlands
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Nevid JS, Gordon AJ, Barris A, Sperber JE, Haggerty G. Personality profiles of patients with alcohol use disorder and opioid use disorder in an inpatient treatment setting. J Subst Abuse Treat 2019; 97:91-96. [DOI: 10.1016/j.jsat.2018.11.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 11/06/2018] [Accepted: 11/29/2018] [Indexed: 10/27/2022]
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Ebenau A, Dijkstra B, Stal-Klapwijk M, ter Huurne C, Blom A, Vissers K, Groot M. Palliative care for patients with a substance use disorder and multiple problems: a study protocol. BMC Palliat Care 2018; 17:97. [PMID: 30075776 PMCID: PMC6091086 DOI: 10.1186/s12904-018-0351-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2017] [Accepted: 07/18/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The specific palliative care needs and problems of patients with a substance use disorder and multiple problems, and those of their proxies, are under recognized Besides, the organization of palliative care, including the division of health care professionals' responsibilities, is often unclear. Perspectives of patients and proxies are hardly known. We describe the outline of a study designed to explore how palliative care for patients with a substance use disorder is organized in the Netherlands and to explore problems and needs, as well as possible improvements from the healthcare professionals', patients' and proxies' perspective. The aim of this protocol paper is to provide insights in ways to conduct research with vulnerable research participants and to offer a detailed description of the study design. The broader study aims to gain insight in and formulate recommendations on how to improve palliative care for patients with a substance use disorder. METHODS A qualitative study with patients, proxies and healthcare professionals. Semi-structured interviews will be held with 10-15 patients who suffer from a severe substance use disorder. They are in a palliative care trajectory and either diagnosed with a chronic or life-threatening disease or, as a result of addictive behavior, a physical deterioration without the prospect of cure. Semi-structured interviews will also be held with 5-10 proxies. Healthcare professionals, volunteers and/or 'experts-by-experience' (n = 24-40) will be participating in semi-structured group interviews. All (group) interviews will be thematically analyzed. Additionally, a strengths, weaknesses, opportunities and threats (SWOT) analysis will be applied to the group interview data with the aim to summarize and concretize the findings. DISCUSSION Everyone has a right to an optimal end-of-life phase of life and a dignified dying process. This study will provide valuable knowledge about palliative care for patients with a substance use disorder and explicitly bring to light the needs and problems of the patients and their proxies and healthcare professionals in a palliative care phase.
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Affiliation(s)
- Anne Ebenau
- Salvation Army, Central Netherlands, Zandvoortweg 211; 3741 BE, Baarn, the Netherlands
| | - Boukje Dijkstra
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), P.O. Box 6909, 6503 GK Nijmegen, the Netherlands
| | | | - Chantal ter Huurne
- Tactus Addiction care, Lokatie Ripperdastraat, Ripperdastraat 8, 7511 JR Enschede, The Netherlands
| | - Ans Blom
- Network Palliative Care region Arnhem and de Liemers, Hospice Rozenheuvel, Rosendaalselaan 20, 6891 DD Rozendaal, the Netherlands
| | - Kris Vissers
- Department of Anesthesiology, Radboud University Medical Center, Pain and Palliative Care, Expertise Center for Palliative Care, Internal Post 549, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
| | - Marieke Groot
- Salvation Army, Central Netherlands, Zandvoortweg 211; 3741 BE, Baarn, the Netherlands
- Department of Anesthesiology, Radboud University Medical Center, Pain and Palliative Care, Expertise Center for Palliative Care, Internal Post 549, P.O. Box 9101, 6500 HB Nijmegen, the Netherlands
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Rodríguez-López J, Flórez G, Blanco V, Pereiro C, Fernández JM, Fariñas E, Estévez V, Gómez-Trigo J, Gurriarán X, Calvo R, Sáiz P, Vázquez FL, Arrojo M, Costas J. Genome wide analysis of rare copy number variations in alcohol abuse or dependence. J Psychiatr Res 2018; 103:212-218. [PMID: 29890507 DOI: 10.1016/j.jpsychires.2018.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2018] [Revised: 04/30/2018] [Accepted: 06/01/2018] [Indexed: 11/18/2022]
Abstract
Genetics plays an important role in alcohol abuse/dependence. Its heritability has been estimated as 45-65%. Rare copy number variations (CNVs) have been confirmed as relevant genetic factors in other neuropsychiatric disorders, such as autism spectrum disorders, schizophrenia, epilepsy, or Tourette syndrome. In the present study, we analyzed the role of rare CNVs affecting exons of coding genes in a sample from Northwest Spain genotyped using the Illumina Infinium PsychArray Beadchip. After rigorous genotyping quality control procedure, 712 patients with alcohol abuse or dependence and 804 controls were used for CNV detection. CNV calling was performed using PennCNV and cnvPartition, and analyses were restricted to CNVs of at least 100 kb and including at least 10 single nucleotide polymorphisms. Logistic regression was used to test for the effect of CNV as well as number of genes affected by CNVs on case/control status, after adjustment for demographic and experimental covariates. We have found an excess of deletions (p = 0.008) and genes affected by deletions (p = 0.017) in cases. This effect was restricted to the 14.8% of affected genes that are intolerant to loss-of-function mutations (gene count p = 0.009). The importance of this subset of genes is emerging in other psychiatric disorders of neurodevelopmental origin, suggesting that disturbance in neurodevelopment mediated by genetic alterations may be a risk factor for alcohol use disorder.
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Affiliation(s)
- Julio Rodríguez-López
- Instituto de Investigación Sanitaria (IDIS) de Santiago de Compostela, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Galicia, Spain
| | - Gerardo Flórez
- Unidade de Conductas Adictivas, Servizo de Psiquiatría, Complexo Hospitalario Universitario de Ourense (CHUO), Servizo Galego de Saúde (SERGAS), Ourense, Galicia, Spain
| | - Vanessa Blanco
- Departament of Evolutionary and Educational Psychology, Universidade de Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - César Pereiro
- Unidade Asistencial de Drogodependencias (ACLAD), A Coruña, Galicia, Spain
| | | | - Emilio Fariñas
- Unidade Municipal de Atención a Drogodependientes (UMAD), Santiago de Compostela, Galicia, Spain
| | - Valentín Estévez
- Unidade de Conductas Adictivas, Servizo de Psiquiatría, Complexo Hospitalario Universitario de Ourense (CHUO), Servizo Galego de Saúde (SERGAS), Ourense, Galicia, Spain
| | - Jesús Gómez-Trigo
- Unidade de Conductas Adictivas, Servizo de Psiquiatría, Complexo Hospitalario Universitario de Ourense (CHUO), Servizo Galego de Saúde (SERGAS), Ourense, Galicia, Spain; Servizo de Psiquiatría, Complexo Hospitalario Universitario de Santiago de Compostela, Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Galicia, Spain
| | - Xaquín Gurriarán
- Instituto de Investigación Sanitaria (IDIS) de Santiago de Compostela, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Galicia, Spain
| | - Raquel Calvo
- Instituto de Investigación Sanitaria (IDIS) de Santiago de Compostela, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Galicia, Spain
| | - Pilar Sáiz
- Department of Psychiatry, Universidad de Oviedo, Centro de Investigación Biomédica en Red de Salud Mental (CIBERSAM), Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain
| | - Fernando Lino Vázquez
- Departament of Clinical Psychology and Psychobiology, Universidade de Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Manuel Arrojo
- Instituto de Investigación Sanitaria (IDIS) de Santiago de Compostela, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Galicia, Spain; Servizo de Psiquiatría, Complexo Hospitalario Universitario de Santiago de Compostela, Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Galicia, Spain
| | - Javier Costas
- Instituto de Investigación Sanitaria (IDIS) de Santiago de Compostela, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Servizo Galego de Saúde (SERGAS), Santiago de Compostela, Galicia, Spain.
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14
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Roncero C, Barral C, Rodríguez-Cintas L, Pérez-Pazos J, Martinez-Luna N, Casas M, Torrens M, Grau-López L. Psychiatric comorbidities in opioid-dependent patients undergoing a replacement therapy programme in Spain: The PROTEUS study. Psychiatry Res 2016; 243:174-81. [PMID: 27416536 DOI: 10.1016/j.psychres.2016.06.024] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 06/13/2016] [Accepted: 06/16/2016] [Indexed: 12/31/2022]
Abstract
Opioid-dependent patients show a high rate of psychiatric comorbidities. The prevalence and characteristics of patients with dual diagnosis have not been well established in Spanish opioid agonist treatment (OAT) programmes. Thus, 621 opioid-dependent patients enrolled in OAT programmes were assessed, using the EuropASI questionnaire, for psychiatric comorbidities, which were detected in 67% of patients (anxiety 53%, mood disorders 48%, sleep disorders 41%, substance-related disorders 36%). In addition, compared with patients without a dual diagnosis, patients with dual pathology were significantly older, used benzodiazepines and cannabis in significantly greater percentages, and showed significantly more frequent infectious and non-infectious comorbidities, worse overall working status, a lower proportion of drivers and higher levels of severity regarding medical, employment, alcohol, legal, family and psychological issues. Therefore, the data showed a very high prevalence of psychiatric comorbidity in opioid-dependent patients receiving OAT in Spain and several problems frequently associated with patients with dual diagnosis. Physicians treating opioid-dependent patients should be aware of these facts to correctly identify and manage patients with a dual diagnosis.
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Affiliation(s)
- Carlos Roncero
- Addition and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron University Hospital, Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain; Department of Psychiatry, Vall d'Hebron University Hospital, CIBERSAM, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Carmen Barral
- Addition and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron University Hospital, Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain; Department of Psychiatry, Vall d'Hebron University Hospital, CIBERSAM, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Laia Rodríguez-Cintas
- Addition and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron University Hospital, Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Jesús Pérez-Pazos
- Addition and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron University Hospital, Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain; Department of Psychiatry, Vall d'Hebron University Hospital, CIBERSAM, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Nieves Martinez-Luna
- Addition and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron University Hospital, Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain; Department of Psychiatry, Vall d'Hebron University Hospital, CIBERSAM, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Miguel Casas
- Department of Psychiatry, Vall d'Hebron University Hospital, CIBERSAM, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Marta Torrens
- Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; Institute of Neuropsychiatry and Addiction, Hospital del Mar, Barcelona, Spain
| | - Lara Grau-López
- Addition and Dual Diagnosis Unit, Department of Psychiatry, Vall d'Hebron University Hospital, Public Health Agency, Barcelona (ASPB), CIBERSAM, Barcelona, Spain; Department of Psychiatry, Vall d'Hebron University Hospital, CIBERSAM, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
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15
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Kamal RM, Dijkstra BAG, de Weert-van Oene GH, van Duren JAM, de Jong CAJ. Psychiatric comorbidity, psychological distress, and quality of life in gamma-hydroxybutyrate-dependent patients. J Addict Dis 2016; 36:72-79. [DOI: 10.1080/10550887.2016.1214000] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Rama M. Kamal
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
- Novadic-Kentron Addiction Care Network, Vught, The Netherlands
| | - Boukje A. G. Dijkstra
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
| | - Gerdien H. de Weert-van Oene
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
- Victas, Centre for Addiction Care, Utrecht, The Netherlands
| | - Josja A. M. van Duren
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
| | - Cornelis A. J. de Jong
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
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16
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Roncero C, Szerman N, Terán A, Pino C, Vázquez JM, Velasco E, García-Dorado M, Casas M. Professionals' perception on the management of patients with dual disorders. Patient Prefer Adherence 2016; 10:1855-1868. [PMID: 27698553 PMCID: PMC5034926 DOI: 10.2147/ppa.s108678] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND There is a need to evaluate the professionals' perception about the consequences of the lack of therapeutic adherence in the evolution of patients with co-occurring disorders. METHODS An online survey, released on the Socidrogalcohol [Spanish Scientific Society for Research on Alcohol, Alcoholism and other Drug Addictions] and Sociedad Española de Patología Dual [the Spanish Society of Dual Pathology] web pages, was answered by 250 professionals who work in different types of Spanish health centers where dual diagnosis patients are assisted. RESULTS Most professionals perceived the existence of noncompliance among dual diagnosis patients. Almost all of these professionals (99%) perceived that noncompliance leads to a worsening of the progression of the patient's disorder, in both the exacerbation of mental disorders and the consumption of addictive substances. Most of the professionals (69.2%) considered therapeutic alliance as the main aspect to take into account to improve the prognosis in this population. The primary purpose of treatment must be the improvement of psychotic-phase positive symptoms, followed by the control of behavior disorders, reduction of craving, improvement of social and personal performances, and reduction of psychotic-phase negative symptoms. CONCLUSION Most professionals perceived low adherence among dual diagnosis patients. This lack of adherence is associated with a worsening of their disease evolution, which is reflected in exacerbations of the psychopathology and relapse in substance use. Therefore, we propose to identify strategies to improve adherence.
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Affiliation(s)
- Carlos Roncero
- Addiction and Dual Diagnosis Unit, CIBERSAM, Hospital Vall Hebron, Barcelona Public Health Agency (ASPB), Barcelona, Spain
- Department of Psychiatry, Autonomous University of Barcelona, Barcelona, Spain
- Correspondence: Carlos Roncero, Addiction and Dual Diagnosis Unit, CIBERSAM, Hospital Vall Hebron, Barcelona Public Health Agency (ASPB), Paseo Vall d’Hebron 119-129, 08035 Barcelona, Spain, Tel +34 93 489 4294, Fax +34 93 489 4587, Email
| | - Néstor Szerman
- Outpatient Mental Health Clinic El Retiro, Gregorio Marañón University Hospital, Madrid, Spain
| | - Antonio Terán
- Outpatient Drug Clinic, Hospital San Juan de Dios, Palencia, Spain
| | - Carlos Pino
- Pontevedra City Council Drug Dependence Service, Galician Health Service (Xunta de Galicia), Pontevedra, Spain
| | - José María Vázquez
- Outpatient Drug Clinic Sants, Barcelona Public Health Agency (ASPB), Barcelona, Spain
| | - Elena Velasco
- Medical Affairs Department, Janssen-Cilag S.A., Madrid, Spain
| | | | - Miguel Casas
- Addiction and Dual Diagnosis Unit, CIBERSAM, Hospital Vall Hebron, Barcelona Public Health Agency (ASPB), Barcelona, Spain
- Department of Psychiatry, Autonomous University of Barcelona, Barcelona, Spain
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17
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Flórez G, López-Durán A, Triñanes Y, Osorio J, Fraga J, Fernández JM, Becoña E, Arrojo M. First-time admissions for opioid treatment: cross-sectional and descriptive study of new opioid users seeking treatment. Neuropsychiatr Dis Treat 2015; 11:2431-40. [PMID: 26445539 PMCID: PMC4590586 DOI: 10.2147/ndt.s84431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND The purpose of this study was to gain an understanding of the profiles of the new treatment demands posed by opioid addicts between 2005 and 2010 at the addictive disorders assistance units in Galicia, Spain. METHODS A cluster analysis was performed using data from 1,655 treatment entrants. Clusters were constructed using sociodemographic and medicolegal variables. A cluster analysis was also conducted according to age. Once clusters were defined, their association with the following variables was analyzed: age at first use of opioids, years of use, frequency of opioid use in the previous month, psychiatric treatment, cocaine use, existence of a drug-dependent partner, and source of referral. RESULTS Four clusters were obtained in the main analysis. Cluster 1 (34.01%) consisted of young males, cluster 2 (16.19%) consisted of not-so-young males, cluster 3 (32.62%) consisted mainly of older males and a small group of females, and cluster 4 (17.18%) was made up entirely of women. With regard to age-related clusters, two clusters were obtained in those under the age of 30 years: cluster 1 (73%) without medicolegal complications and cluster 2 (27%) with medicolegal complications. For those over the age of 30 years, two clusters were obtained: cluster 1 (53.92%) with hardly any medicolegal complications and cluster 2 (46.08%) with medicolegal complications. CONCLUSION Cluster analysis suggests that there have been no substantial changes in variables indicating greater severity in this new group of patients. Women are likely to seek help earlier, which reduces their duration of opioid use. The younger the patient, the shorter the duration of opioid use and the greater the likelihood of cessation of intravenous use. Public health systems should use a two-pronged treatment strategy of short but intense cessation therapies for women and younger treatment entrants and longer maintenance and replacement therapies for older treatment entrants with more psychosocial and medical complications.
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Affiliation(s)
- Gerardo Flórez
- Addictive Disorders Assistance Unit, Complejo Hospitalario, Ourense, Spain ; Center for Biomedical Research in Mental Health (CIBERSAM), Oviedo, Spain
| | - Ana López-Durán
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Spain
| | - Yolanda Triñanes
- Galician Agency for Health Technology Assessment, Directorate General for Innovation and Management of Public Health, Galicia, Spain
| | - Jesús Osorio
- Directorate General of Health Assistance, Galician Health Service, Galicia, Spain
| | - Jaime Fraga
- Directorate General of Health Assistance, Galician Health Service, Galicia, Spain
| | | | - Elisardo Becoña
- Department of Clinical Psychology and Psychobiology, University of Santiago de Compostela, Spain
| | - Manuel Arrojo
- Directorate General of Health Assistance, Galician Health Service, Galicia, Spain
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Okpataku CI, Kwanashie HO, Ejiofor JI, Olisah VO. Prevalence and socio-demographic risk factors associated with psychoactive substance use in psychiatric out-patients of a tertiary hospital in Nigeria. Niger Med J 2014; 55:460-4. [PMID: 25538362 PMCID: PMC4262840 DOI: 10.4103/0300-1652.144695] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
BACKGROUND The co-morbidity of psychoactive substance use and other mental disorders is a major challenge to the management of both conditions in several parts of the world. There is relative dearth of information on co-morbidity and its predictors in Nigeria. This study determined the prevalence and socio-demographic risk factors associated with psychoactive substance use in the psychiatric out-patients of a tertiary hospital in Nigeria. STUDY DESIGN A cross-sectional study. MATERIALS AND METHODS From routine clinic visits over a 4-month period, each consecutive 4(th) adult patients (>18 years) who had previously attended the clinic at least for 1 year, completed a socio-demographic and semi-structured drug use questionnaires and interview with the Schedule for Clinical Assessment in Neuropsychiatry (SCAN) to generate substance use diagnosis. Data was analysed using the statistical package for social sciences (SPSS), version 16. Level of significance was set at P < 0.05. RESULTS The lifetime prevalence for the use of substance was 29.3%, while that for multiple substances was 17.7%. The most commonly used substances were alcohol, cannabis and tobacco and they were also the ones mostly used in combination with one or the other. A total of 10.1% of the patients had a psychoactive substance use disorder. Being male, married with at least primary education and unemployed were significant risk factors for substance use. CONCLUSION Psychoactive substance is common among the psychiatric outpatients of the hospital with males, those with formal education, the married and unemployed being at high risk of substance use.
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