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Amir CM, Kapler S, Hoftman GD, Kushan L, Zinberg J, Cadenhead KS, Kennedy L, Cornblatt BA, Keshavan M, Mathalon DH, Perkins DO, Stone W, Tsuang MT, Walker EF, Woods SW, Cannon TD, Addington J, Bearden CE. Neurobehavioral risk factors influence prevalence and severity of hazardous substance use in youth at genetic and clinical high risk for psychosis. Front Psychiatry 2023; 14:1143315. [PMID: 37151981 PMCID: PMC10157227 DOI: 10.3389/fpsyt.2023.1143315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 03/31/2023] [Indexed: 05/09/2023] Open
Abstract
Background Elevated rates of alcohol, tobacco, and cannabis use are observed in both patients with psychotic disorders and individuals at clinical high risk for psychosis (CHR-P), and strong genetic associations exist between substance use disorders and schizophrenia. While individuals with 22q11.2 deletion syndrome (22qDel) are at increased genetic risk for psychosis, initial evidence suggests that they have strikingly low rates of substance use. In the current study, we aimed to directly compare substance use patterns and their neurobehavioral correlates in genetic and clinical high-risk cohorts. Methods Data on substance use frequency and severity, clinical symptoms, and neurobehavioral measures were collected at baseline and at 12-month follow-up visits in two prospective longitudinal cohorts: participants included 89 22qDel carriers and 65 age and sex-matched typically developing (TD) controls (40.67% male, Mage = 19.26 ± 7.84 years) and 1,288 CHR-P youth and 371 matched TD controls from the North American Prodrome Longitudinal Study-2 and 3 (55.74% male; Mage = 18.71 ± 4.27 years). Data were analyzed both cross-sectionally and longitudinally using linear mixed effects models. Results Controlling for age, sex, and site, CHR-P individuals had significantly elevated rates of tobacco, alcohol, and cannabis use relative to TD controls, whereas 22qDel had significantly lower rates. Increased substance use in CHR-P individuals was associated with increased psychosis symptom severity, dysphoric mood, social functioning, and IQ, while higher social anhedonia was associated with lower substance use across all domains at baseline. These patterns persisted when we investigated these relationships longitudinally over one-year. CHR-P youth exhibited significantly increased positive psychosis symptoms, dysphoric mood, social functioning, social anhedonia, and IQ compared to 22qDel carriers, and lower rates of autism spectrum disorder (ASD) compared to 22qDel carriers, both at baseline and at 1 year follow-up. Conclusion Individuals at genetic and CHR-P have strikingly different patterns of substance use. Factors such as increased neurodevelopmental symptoms (lower IQ, higher rates of ASD) and poorer social functioning in 22qDel may help explain this distinction from substance use patterns observed in CHR-P individuals.
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Affiliation(s)
- Carolyn M. Amir
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Simon Kapler
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Gil D. Hoftman
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Leila Kushan
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Jamie Zinberg
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA), Los Angeles, CA, United States
| | - Kristin S. Cadenhead
- Department of Psychiatry, University of California, San Diego (UCSD), San Diego, CA, United States
| | - Leda Kennedy
- Department of Psychiatry, University of California, San Diego (UCSD), San Diego, CA, United States
| | - Barbara A. Cornblatt
- Department of Psychiatry, Zucker Hillside Hospital, Long Island, NY, United States
| | - Matcheri Keshavan
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, United States
| | - Daniel H. Mathalon
- Department of Psychiatry, San Francisco Veterans Affairs (SFVA) Medical Center, University of California, San Francisco (UCSF), San Francisco, CA, United States
| | - Diana O. Perkins
- Department of Psychiatry, University of North Carolina, Chapel Hill, NC, United States
| | - William Stone
- Department of Psychiatry, Harvard Medical School at Beth Israel Deaconess Medical Center and Massachusetts Mental Health Center, Boston, MA, United States
| | - Ming T. Tsuang
- Department of Psychiatry, University of California, San Diego (UCSD), San Diego, CA, United States
- Institute of Genomic Medicine, University of California, San Diego, La Jolla, CA, United States
| | - Elaine F. Walker
- Departments of Psychology and Psychiatry, Emory University, Atlanta, GA, United States
| | - Scott W. Woods
- Department of Psychiatry, Yale University, New Haven, CT, United States
| | - Tyrone D. Cannon
- Department of Psychology, Yale University, New Haven, CT, United States
| | - Jean Addington
- Department of Psychiatry, Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
| | - Carrie E. Bearden
- Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, University of California, Los Angeles (UCLA), Los Angeles, CA, United States
- Department of Psychology, University of California, Los Angeles (UCLA), Los Angeles, CA, United States
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Lippard ETC, Kirsch DE, Kosted R, Le V, Almeida JRC, Fromme K, Strakowski SM. Subjective response to alcohol in young adults with bipolar disorder and recent alcohol use: a within-subject randomized placebo-controlled alcohol administration study. Psychopharmacology (Berl) 2023; 240:739-753. [PMID: 36695842 PMCID: PMC10084816 DOI: 10.1007/s00213-023-06315-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Accepted: 01/06/2023] [Indexed: 01/26/2023]
Abstract
Limited data exists on mechanisms contributing to elevated risk for alcohol use disorder (AUD) in bipolar disorder. Variation in subjective response to alcohol may relate to alcohol use and risk for AUD. This study used a randomized, placebo-controlled, cross-over, within-subjects design to investigate differences in subjective response to alcohol in 50 euthymic young adults (n = 24 with and n = 26 without bipolar disorder type I). Eighty-three percent of participants with bipolar disorder were medicated. Participants completed assessments of clinical history, alcohol expectancies, and recent alcohol use. Participants were dosed to a .08 g% breath alcohol concentration. The placebo condition occurred on a separate counter-balanced day. Subjective response to alcohol was investigated at similar time points during both conditions. Group, condition, and group-by-condition interactions were modeled, with condition and time of subjective response assessment as repeated within-subject variables, and subjective response to alcohol as the dependent variable. Greater stimulating effects and liking of alcohol were reported in people with bipolar disorder (group-by-condition interactions, p < .05) than healthy young adults. While young adults with bipolar disorder reported anticipating feeling less "mellow/relaxed" when drinking (p = .02), during both beverage conditions they reported feeling more "mellow/relaxed" (main effect of group, p = .006). Feeling more "mellow/relaxed" during the alcohol condition related to greater recent alcohol use in bipolar disorder (p = .001). Exploratory analyses suggested anticonvulsants and sedatives/antihistamines may relate to differences in subjective response to alcohol in bipolar disorder. Results suggest young adults with bipolar disorder may differ in alcohol expectancies and experience alcohol intoxication differently-with distinct relations between subjective response to alcohol and alcohol use-compared to healthy young adults.
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Affiliation(s)
- Elizabeth T C Lippard
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin, 1601 Trinity Street, Stop Z0600, HDB, Austin, TX, 78712, USA.
- Department of Psychology, University of Texas, Austin, TX, USA.
- Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin, TX, USA.
- Institute for Neuroscience, University of Texas, Austin, TX, USA.
- Institute of Early Life Adversity Research, University of Texas, Austin, TX, USA.
| | - Dylan E Kirsch
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin, 1601 Trinity Street, Stop Z0600, HDB, Austin, TX, 78712, USA
- Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin, TX, USA
- Institute for Neuroscience, University of Texas, Austin, TX, USA
| | - Raquel Kosted
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin, 1601 Trinity Street, Stop Z0600, HDB, Austin, TX, 78712, USA
| | - Vanessa Le
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin, 1601 Trinity Street, Stop Z0600, HDB, Austin, TX, 78712, USA
| | - Jorge R C Almeida
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin, 1601 Trinity Street, Stop Z0600, HDB, Austin, TX, 78712, USA
| | - Kim Fromme
- Department of Psychology, University of Texas, Austin, TX, USA
- Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin, TX, USA
| | - Stephen M Strakowski
- Department of Psychiatry and Behavioral Sciences, University of Texas at Austin, 1601 Trinity Street, Stop Z0600, HDB, Austin, TX, 78712, USA
- Department of Psychology, University of Texas, Austin, TX, USA
- Waggoner Center for Alcohol and Addiction Research, University of Texas, Austin, TX, USA
- Institute for Neuroscience, University of Texas, Austin, TX, USA
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Maclean JC, McClellan C, Pesko MF, Polsky D. Medicaid reimbursement rates for primary care services and behavioral health outcomes. HEALTH ECONOMICS 2023; 32:873-909. [PMID: 36610026 DOI: 10.1002/hec.4646] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 06/17/2023]
Abstract
We study the effects of changing Medicaid reimbursement rates for primary care services on behavioral health outcomes-defined here as mental illness and substance use disorders. Medicaid enrollees are at elevated risk for these, and other, chronic conditions and are likely to have unmet treatment needs. We apply two-way fixed-effects regressions to survey data specifically designed to measure behavioral health outcomes over the period 2010-2016. We find that higher primary care reimbursement rates reduce mental illness and substance use disorders among non-elderly adult Medicaid enrollees, although we interpret findings for substance use disorders with some caution as they may be vulnerable to differential pre-trends. Overall, our findings suggest positive spillovers from a policy designed to target primary care services to behavioral health outcomes.
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Affiliation(s)
- Johanna Catherine Maclean
- Schar School of Policy and Government, George Mason University, Research Associate, National Bureau of Economic Research, Research Affiliate, Institute of Labor Economics, Arlington, Virginia, USA
| | - Chandler McClellan
- Agency for Healthcare Research and Quality, Center for Financing, Access, and Trends, Rockville, Maryland, USA
| | - Michael F Pesko
- Department of Economics, Andrew Young School of Policy Studies, Georgia State University, Research Affiliate, Institute of Labor Economics, Georgia, Atlanta, USA
| | - Daniel Polsky
- Bloomberg Distinguished Professor of Health Economics, Carey Business School and the Department of Health Policy and Management, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
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Deng H, Wen F, Xu H, Yang H, Yan J, Zheng Y, Cui Y, Li Y. Prevalence of affective disorders in Chinese school-attending children and adolescents aged 6-16 based on a national survey by MINI-Kid. J Affect Disord 2023; 331:192-199. [PMID: 36948465 DOI: 10.1016/j.jad.2023.03.060] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Revised: 03/11/2023] [Accepted: 03/18/2023] [Indexed: 03/24/2023]
Abstract
BACKGROUND Major depressive disorder (MDD), dysthymia disorder (DD) and bipolar disorder (BD) are the most prevalent affective disorders. A nationwide epidemiological investigation of MDD, DD and BP in school-attending children and adolescents was carried out, taking the effect of age, gender and comorbidity into consideration. METHODS A two-stage nationwide epidemiological study of point prevalence was conducted. Using a multistage cluster stratified random sampling strategy. The sample distribution was described, and the point prevalence of affective disorders was estimated. Chi-squared tests were used to compare disease prevalence based on sex and age. Comorbid ratios for MDD, DD and BP were calculated. RESULTS The total number of cases in Stage 1 was 72,107 (aged 6-16 years). The point prevalence of MDD, DD and BP were 2.004 % (95 % CI: 1.902 to 2.106), 0.352 % (95 % CI: 0.309 to 0.395) and 0.856 % (95 % CI: 0.788 to 0.923), respectively. The total prevalence of affective disorder was 3.212 % (95 % CI: 3.079 to 3.338). The total prevalence of affective disorders between sexes (female: 3.834 % versus male: 2.587 %, χ2 = 90.155, p < 0.001) was consistent with the gender difference in MDD, DD and MD. The total prevalence of affective disorders in adolescents was higher than that in children (adolescents: 5.024 % versus children: 1.863 %, χ2 = 566.841, p < 0.001). CONCLUSIONS Our study is the first nationwide survey on the prevalence of affective disorders among school-attending children and adolescents aged 6-16 in China. Our results also highlighted the importance of addressing comorbidities in future studies of affective disorders.
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Affiliation(s)
- Hu Deng
- Peking University HuiLongGuan Clinical Medical School, Beijing Huilongguan Hospital, Beijing 100096, China
| | - Fang Wen
- Department of Psychiatry, Beijing Children's Hospital, National Center for Children's Health, China
| | - Hui Xu
- Big Data Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, China
| | - Hanxue Yang
- School of Psychology, Beijing Language and Culture University, Beijing, China
| | - Junjuan Yan
- Department of Psychiatry, Beijing Children's Hospital, National Center for Children's Health, China
| | - Yi Zheng
- Beijing Anding Hospital, Capital Medical University, Beijing, China
| | - Yonghua Cui
- Department of Psychiatry, Beijing Children's Hospital, National Center for Children's Health, China.
| | - Ying Li
- Department of Psychiatry, Beijing Children's Hospital, National Center for Children's Health, China.
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Tokumitsu K, Yasui-Furukori N, Adachi N, Kubota Y, Watanabe Y, Miki K, Azekawa T, Edagawa K, Katsumoto E, Hongo S, Goto E, Ueda H, Kato M, Nakagawa A, Kikuchi T, Tsuboi T, Watanabe K, Shimoda K, Yoshimura R. Predictors of psychiatric hospitalization among outpatients with bipolar disorder in the real-world clinical setting. Front Psychiatry 2023; 14:1078045. [PMID: 37009121 PMCID: PMC10060542 DOI: 10.3389/fpsyt.2023.1078045] [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] [Received: 10/24/2022] [Accepted: 02/20/2023] [Indexed: 03/18/2023] Open
Abstract
BackgroundBipolar disorder is a psychiatric disorder that causes recurrent manic and depressive episodes, leading to decreased levels of social functioning and suicide. Patients who require hospitalization due to exacerbation of bipolar disorder have been reported to subsequently have poor psychosocial functioning, and so there is a need to prevent hospitalization. On the other hand, there is a lack of evidence regarding predictors of hospitalization in real-world clinical practice.MethodsThe multicenter treatment survey on bipolar disorder (MUSUBI) in Japanese psychiatric clinics was an observational study conducted to provide evidence regarding bipolar disorder in real-world clinical practice. Psychiatrists were asked, as part of a retrospective medical record survey, to fill out a questionnaire about patients with bipolar disorder who visited 176 member clinics of the Japanese Association of Neuro-Psychiatric Clinics. Our study extracted baseline patient characteristics from records dated between September and October 2016, including comorbidities, mental status, duration of treatment, Global Assessment of Functioning (GAF) score, and pharmacological treatment details. The incidence and predictors of hospitalization among patients with bipolar disorder over a 1-year period extending from that baseline to September–October 2017 were examined.ResultsIn total, 2,389 participants were included in our study, 3.06% of whom experienced psychiatric hospitalization over the course of 1 year from baseline. Binomial logistic regression analysis revealed that the presence of psychiatric hospitalization was correlated with bipolar I disorder, lower baseline GAF scores, unemployment, substance abuse and manic state.ConclusionsOur study revealed that 3.06% of outpatients with bipolar disorder were subjected to psychiatric hospitalization during a 1-year period that extended to September–October 2017. Our study suggested that bipolar I disorder, lower baseline GAF scores, unemployment, substance abuse and baseline mood state could be predictors of psychiatric hospitalization. These results may be useful for clinicians seeking to prevent psychiatric hospitalization for bipolar disorder.
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Affiliation(s)
- Keita Tokumitsu
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Norio Yasui-Furukori
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
- *Correspondence: Norio Yasui-Furukori
| | - Naoto Adachi
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Yukihisa Kubota
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | | | - Kazuhira Miki
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Takaharu Azekawa
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Koji Edagawa
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Eiichi Katsumoto
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Seiji Hongo
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Eiichiro Goto
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Hitoshi Ueda
- The Japanese Association of Neuro-Psychiatric Clinics, Tokyo, Japan
| | - Masaki Kato
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
- Department of Neuropsychiatry, Kansai Medical University, Osaka, Japan
| | - Atsuo Nakagawa
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
- Department of Neuropsychiatry, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Toshiaki Kikuchi
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
- Department of Neuropsychiatry, Keio University School of Medicine, Tokyo, Japan
| | - Takashi Tsuboi
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Koichiro Watanabe
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
- Department of Neuropsychiatry, Kyorin University School of Medicine, Tokyo, Japan
| | - Kazutaka Shimoda
- Department of Psychiatry, Dokkyo Medical University School of Medicine, Tochigi, Japan
| | - Reiji Yoshimura
- The Japanese Society of Clinical Neuropsychopharmacology, Tokyo, Japan
- Department of Psychiatry, University of Occupational and Environmental Health, Fukuoka, Japan
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Levit JD, Meyers JL, Georgakopoulos P, Pato MT. Risk for alcohol use problems in severe mental illness: Interactions with sex and racial/ethnic minority status. J Affect Disord 2023; 325:329-336. [PMID: 36587907 PMCID: PMC9942932 DOI: 10.1016/j.jad.2022.12.140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 12/22/2022] [Accepted: 12/25/2022] [Indexed: 01/01/2023]
Abstract
BACKGROUND Alcohol use disorder (AUD) is exceedingly common among individuals with bipolar disorder and schizophrenia. However, studies on alcohol use in psychiatric illness rely largely on population surveys with limited representation of severe mental illness (SMI); schizophrenia and bipolar disorder. METHODS Using data from the Genomic Psychiatry Cohort (GPC) (Pato MT, 2013), associations of bipolar disorder and schizophrenia with alcohol use problems were examined in a diverse US based sample, considering the influence of self-described race (African Ancestry (AA), European Ancestry (EA), or Latinx Ancestry (LA)), sex, and tobacco use. Participants answered alcohol use problem items derived from the CAGE instrument, yielding a summed "probable" alcohol use disorder (pAUD) risk score. RESULTS This study included 1952 individuals with bipolar disorder with psychosis (BDwP), 409 with bipolar disorder without psychosis (BD), 9218 with schizophrenia (SCZ), and 10,416 unaffected individuals. We found that SMI (BDwP, BD, SCZ) was associated with elevated AUD risk scores (B = 0.223, p < 0.001), an association which was strongest in females, particularly those of AA and LA, and in tobacco users. Schizophrenia was associated with the greatest increase in pAUD score (B = 0.141, p < 0.001). pAUD risk scores were increased among participants with bipolar disorder, with greater increases in BDwP (B = 0.125, p < 0.001) than in BD without psychosis (B = 0.027, p < 0.001). LIMITATIONS Limitations include reliance on self-report data, screening items for AUD, voluntary recruitment bias, and differences in race/sex distribution between groups, which were statistically adjusted for in analytic models. CONCLUSIONS SMI is associated with risk for AUD, particularly among females from racial minority groups, smokers, and those with psychotic disorders.
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Affiliation(s)
- Jeremy D Levit
- Department of Psychiatry, Weill Cornell Medicine, New York, NY, USA
| | - Jacquelyn L Meyers
- Department of Psychiatry, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | | | - Michele T Pato
- Department of Psychiatry, Rutgers University, Piscataway, NJ, USA.
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Fakhari S, Waszkiewicz N. Old and New Biomarkers of Alcohol Abuse: Narrative Review. J Clin Med 2023; 12:jcm12062124. [PMID: 36983134 PMCID: PMC10054673 DOI: 10.3390/jcm12062124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 03/03/2023] [Accepted: 03/06/2023] [Indexed: 03/11/2023] Open
Abstract
The harmful use of alcohol is responsible for 5.1% of the global burden of disease, and the early detection of alcohol problems may prevent its development and progression. Therefore, the aim of the study is to review traditional and new biomarkers associated with alcohol use. The nature and practical application and limitations of alcohol biomarkers in the diagnosis and monitoring of drinking are reviewed. Despite the limited specificity and sensitivity in alcohol drinking detection, traditional biomarkers are useful in clinical practice, and new generations of biomarkers, e.g., proteomic markers, are in need of further investigation. Traditional biomarkers are broadly available and cost-efficient, providing valuable data on the complications of drinking and prognosis, as well as on concurrent conditions affected by drinking. The most important challenge in the future will be to translate methodically advanced methods of detecting alcohol markers into simpler and cheaper methods. Larger population studies are also needed to test the usefulness of these potential markers of alcohol use.
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Affiliation(s)
- Sara Fakhari
- Department of Psychiatry, Mazowieckie Specjalistyczne Centrum Zdrowia w Pruszkowie, 05-800 Pruszków, Poland
- Correspondence: ; Tel.: +48-69-6963901
| | - Napoleon Waszkiewicz
- Department of Psychiatry, Medical University of Bialystok, 15-089 Bialystok, Poland
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Kato H, Kimura H, Kushima I, Takahashi N, Aleksic B, Ozaki N. The genetic architecture of schizophrenia: review of large-scale genetic studies. J Hum Genet 2023; 68:175-182. [PMID: 35821406 DOI: 10.1038/s10038-022-01059-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 06/12/2022] [Accepted: 06/20/2022] [Indexed: 11/09/2022]
Abstract
Schizophrenia is a complex and often chronic psychiatric disorder with high heritability. Diagnosis of schizophrenia is still made clinically based on psychiatric symptoms; no diagnostic tests or biomarkers are available. Pathophysiology-based diagnostic scheme and treatments are also not available. Elucidation of the pathogenesis is needed for development of pathology-based diagnostics and treatments. In the past few decades, genetic research has made substantial advances in our understanding of the genetic architecture of schizophrenia. Rare copy number variations (CNVs) and rare single-nucleotide variants (SNVs) detected by whole-genome CNV analysis and whole-genome/-exome sequencing analysis have provided the great advances. Common single-nucleotide polymorphisms (SNPs) detected by large-scale genome-wide association studies have also provided important information. Large-scale genetic studies have been revealed that both rare and common genetic variants play crucial roles in this disorder. In this review, we focused on CNVs, SNVs, and SNPs, and discuss the latest research findings on the pathogenesis of schizophrenia based on these genetic variants. Rare variants with large effect sizes can provide mechanistic hypotheses. CRISPR-based genetics approaches and induced pluripotent stem cell technology can facilitate the functional analysis of these variants detected in patients with schizophrenia. Recent advances in long-read sequence technology are expected to detect variants that cannot be detected by short-read sequence technology. Various studies that bring together data from common variant and transcriptomic datasets provide biological insight. These new approaches will provide additional insight into the pathophysiology of schizophrenia and facilitate the development of pathology-based therapeutics.
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Affiliation(s)
- Hidekazu Kato
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Hiroki Kimura
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Itaru Kushima
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Medical Genomics Center, Nagoya University Hospital, Nagoya, Japan
| | - Nagahide Takahashi
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Branko Aleksic
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan.
| | - Norio Ozaki
- Department of Psychiatry, Nagoya University Graduate School of Medicine, Nagoya, Japan.,Medical Genomics Center, Nagoya University Hospital, Nagoya, Japan.,Institute for Glyco-core Research (iGCORE), Nagoya University, Nagoya, Japan
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Validation of the Bipolar Prodrome Symptom Interview and Scale-Abbreviated Prospective (BPSS-AP) in a clinical sample and healthy controls. J Affect Disord 2023; 324:463-468. [PMID: 36586622 DOI: 10.1016/j.jad.2022.12.115] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Revised: 11/16/2022] [Accepted: 12/23/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND After the existence of a bipolar disorder (BD) prodrome was established, the development of clinical rating instruments has become relevant that are sufficiently brief to be implemented in real-world clinical practice and that are designed to identify individuals at-risk for BD. This study aimed to validate a shorter version of the Bipolar Prodrome Symptom Interview and Scale (BPSS), the BPSS-Abbreviated Prospective (BPSS-AP), for use among clinical populations. METHODS Altogether, 104 adults, comprising individuals diagnosed with BD (n = 17, mania: n = 8, hypomania: n = 9), with major depressive disorder (MDD, n = 38, all currently depressed), and healthy controls (HCs, n = 49), underwent BPSS-AP interviews. The psychometric properties of the BPSS-AP were evaluated, including internal consistency, convergent validity, discriminant validity, and factor structure. RESULTS The median (IQR) age was 29 (23-38), 40 (23-55), and 25 (22-28) years, for the BD, MDD, and HC groups, respectively. The BPSS-AP showed excellent internal consistency (Cronbach's α = 0.95). Convergent validity between the BPSS-AP and Young Mania Rating Scale (YMRS) was high (r > 0.7). The BPSS-AP discriminated patients with BD from those with MDD (P < .001) and from HCs (P < .001). LIMITATIONS The study design precludes assessment of the predictive validity of the BPSS-AP. CONCLUSIONS This study found that the BPSS-AP, a more concise and feasible version of the semi-structured interview for identifying individuals at risk of developing BD, has satisfactory psychometric properties. There is room for further validation and application of the BPSS-AP in clinical settings to evaluate its utility in research and clinical care.
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Fang SC, Hung CC, Huang CY, Huang SM, Shao YHJ. Influence of Baseline Psychiatric Disorders on Mortality and Suicide and Their Associations with Gender and Age in Patients with Methamphetamine Use Disorder. Int J Ment Health Addict 2023. [DOI: 10.1007/s11469-023-01025-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/15/2023] Open
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Radua J, Fortea L, Goikolea JM, Zorrilla I, Bernardo M, Arrojo M, Cunill R, Castells X, Becoña E, López-Durán A, Torrens M, Tirado-Muñoz J, Fonseca F, Arranz B, Garriga M, Sáiz PA, Flórez G, San L, González-Pinto A. Meta-analysis of the effects of adjuvant drugs in co-occurring bipolar and substance use disorder. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2023:S1888-9891(23)00006-X. [PMID: 37689524 DOI: 10.1016/j.rpsm.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Individuals with bipolar disorder (BD) often have co-occurring substance use disorders (SUDs), which substantially impoverish the course of illness. Despite the importance of this dual diagnosis, the evidence of the efficacy and safety of adjuvant treatments is mostly unknown. OBJECTIVE To perform a meta-analysis to evaluate the efficacy and safety of adjuvant drugs in patients with co-occurring BD and SUD. METHODS We searched PubMed, Scopus, and Web of Knowledge until 30th April 2022 for randomized clinical trials (RCT) evaluating the efficacy and safety of adjuvant drugs compared to placebo in patients with a dual diagnosis of BD and SUD. We meta-analyzed the effect of adjuvant drugs on general outcomes (illness severity, mania, depression, anxiety, abstinence, substance craving, substance use, gamma-GT, adherence, and adverse events) and used the results to objectively assess the quality of the evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. For completeness, we also report the specific effects of specific adjuvant drugs in patients with specific substance disorders. RESULTS We included 15 RCT studies (9 alcohol, 3 cocaine, 2 nicotine, and 1 cannabis) comprising 628 patients allocated to treatment and 622 to placebo. There was low-quality evidence that adjuvant drugs may reduce illness severity (g=-0.25, 95% CI: -0.44, -0.06), and very-low quality evidence that they may decrease substance use (g=-0.23, 95% CI: -0.44, -0.02) and increase substance abstinence (g=0.21, 95% CI: 0.04, 0.38). DISCUSSION There is low-quality evidence that adjuvant drugs may help reduce illness severity, probably via facilitating abstinence and lower substance use. However, the evidence is weak; thus, these results should be considered cautiously until better evidence exists.
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Affiliation(s)
- Joaquim Radua
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, CIBERSAM, Spain; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Lydia Fortea
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, CIBERSAM, Spain.
| | - José Manuel Goikolea
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, CIBERSAM, Spain
| | - Iñaki Zorrilla
- Instituto de Investigación Sanitaria BIOARABA, OSI Araba, Hospital Universitario, CIBERSAM, UPV/EHU, Vitoria, Spain
| | - Miquel Bernardo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, CIBERSAM, Spain
| | - Manuel Arrojo
- Servicio de Psiquiatría, Instituto de Investigación Sanitaria (IDIS), Complejo Hospitalario Universitario de Santiago, Servicio Gallego de Salud (SERGAS) de Santiago de Compostela, Spain
| | - Ruth Cunill
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, CIBERSAM, Barcelona, Spain
| | - Xavi Castells
- Grupo de Investigación TransLab, Departamento de Ciencias Médicas, Universitat de Girona, Spain
| | - Elisardo Becoña
- Unidad de Tabaquismo y Trastornos Adictivos, Facultad de Psicología, Universidad de Santiago de Compostela, Spain
| | - Ana López-Durán
- Unidad de Tabaquismo y Trastornos Adictivos, Facultad de Psicología, Universidad de Santiago de Compostela, Spain
| | - Marta Torrens
- Institut de Neuropsiquiatria Addiccions - Hospìtal del Mar, Universitat Autònoma de Barcelona, Universitat de Vic-Central de Catalunya, Red de Investigación en Atención Primaria de Adicciones-RIAPAD, Barcelona, Spain
| | - Judit Tirado-Muñoz
- Departamento de Psicología, Facultad de Ciencias Biomédicas y de la Salud, Grupo de Investigación en Conducta, Emociones y Salud, Universidad Europea de Madrid, Madrid, Spain
| | - Francina Fonseca
- Institut de Neuropsiquiatria Addiccions - Hospìtal del Mar, Universitat Autònoma de Barcelona, Universitat de Vic-Central de Catalunya, Red de Investigación en Atención Primaria de Adicciones-RIAPAD, Barcelona, Spain
| | - Belén Arranz
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, CIBERSAM, Barcelona, Spain
| | - Marina Garriga
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, CIBERSAM, Spain
| | - Pilar A Sáiz
- Universidad de Oviedo, CIBERSAM, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Instituto de Neurociencias del Principado de Asturias (INEUROPA), Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain
| | - Gerardo Flórez
- Unidad de Conductas Adictivas, Complejo Hospitalario de Ourense, CIBERSAM, Ourense, Spain
| | - Luis San
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, CIBERSAM, Barcelona, Spain
| | - Ana González-Pinto
- Instituto de Investigación Sanitaria BIOARABA, OSI Araba, Hospital Universitario, CIBERSAM, UPV/EHU, Vitoria, Spain
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Brown E, Castagnini E, Langstone A, Mifsud N, Gao C, McGorry P, Killackey E, O'Donoghue B. High-risk sexual behaviours in young people experiencing a first episode of psychosis. Early Interv Psychiatry 2023; 17:159-166. [PMID: 35355426 DOI: 10.1111/eip.13301] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 03/07/2022] [Accepted: 03/16/2022] [Indexed: 11/29/2022]
Abstract
AIM The sexual health of adults with schizophrenia is poorer than the general population; however, less is known about young people experiencing a first episode of psychosis (FEP). The aim of this study was to explore the high-risk sexual behaviours and sexual well-being indicators of a cohort of young people with FEP. METHODS Data collected from young people (15-24 years) with FEP attending the EPPIC service in Melbourne and participating in a physical health intervention were analysed. Baseline trial data collected on sexual health and high-risk behaviours, psychiatric symptomology, functioning, and substance use are presented by gender. Associations between symptomology and functioning with sexual behaviour are explored. RESULTS A total of 69 young people were included in this study; mean age was 19.6 years (SD±2.8), 53.6% were male, 59.6% identified as heterosexual, and 21.7% were currently in a relationship. Within the cohort, 78.3% had ever been sexually active. Of these, 44.2% consistently used a condom at last sex act and 35.7% used barrier contraception consistently, 22.5% had previously been pregnant, and 18.6% had tested positive for an STI. Finally, young people were more likely to have been sexually active if they were currently using substances. CONCLUSIONS These findings suggest that high rates of high-risk sexual behaviour remain an issue for young people experiencing a first episode of psychosis. Promoting sexual well-being and communication skills between sexual partners should be targeted to ensure that high-risk sexual health outcomes are mitigated as early as possible.
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Affiliation(s)
- Ellie Brown
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Emily Castagnini
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Alison Langstone
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Nathan Mifsud
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Caroline Gao
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Patrick McGorry
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Eoin Killackey
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
| | - Brian O'Donoghue
- Orygen, Melbourne, Australia
- Centre for Youth Mental Health, University of Melbourne, Melbourne, Australia
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Latent Profile Analyses of Addiction and Mental Health Problems in Two Large Samples. Int J Ment Health Addict 2023. [DOI: 10.1007/s11469-022-01003-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
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Schnell T, Grömm CM, Klöckner N. Predictive impact of different acute cannabis intoxication effects with regard to abstinence motivation and cessation of use. Sci Rep 2023; 13:709. [PMID: 36639397 PMCID: PMC9839715 DOI: 10.1038/s41598-023-27592-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 01/04/2023] [Indexed: 01/15/2023] Open
Abstract
Cannabis use is a common risk factor for psychoses. But although prevalence of consumption as well as potency of cannabis increased, the incidence of schizophrenia remained stable. The discontinuation hypothesis suggests that a potential increase of psychoses incidence may be relativized by more frequent cessation of consumption due to higher rates of adverse psychosis-like intoxication effects (PLE), caused by stronger cannabis. A mixed methods online survey was administered to 441 current and past users to analyze the predictive impact of different acute intoxication effects regarding abstinence motivation/cessation of use. Our hypothesis was that PLE would be experienced as the most aversive intoxication effect and therefore have the highest predictive significance. Possible confounds were included (craving, patterns of consumption and sociodemographics). Further analyzes compared past versus current users regarding the quality of intoxication effects, suggesting that past users retrospectively experienced more unpleasant experiences than current users. Free-text data explored subjective reasons for abstinence. We found that paranoid/dysphoric intoxication effects were most predictive for abstinence motivation. Less predictive were psychosis-like intoxication effects such as hallucinations. Group comparisons revealed significant more unpleasurable and less positive intoxication effects in past users compared with current users. Current users with the intention to stop consumption showed significantly more paranoia/dysphoria intoxication compared to users with no intention to stop use. As a conclusion, different intoxication experiences have different effects on abstinence motivation and substance use behavior. They therefore provide a focus that should be increasingly integrated into treatment concepts.
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Affiliation(s)
- Thomas Schnell
- Medical School Hamburg, University of Applied Sciences and Medical University, Am Kaiserkai 1, 20457, Hamburg, Germany.
| | - Christina-Marie Grömm
- Medical School Hamburg, University of Applied Sciences and Medical University, Am Kaiserkai 1, 20457, Hamburg, Germany
| | - Nils Klöckner
- Medical School Hamburg, University of Applied Sciences and Medical University, Am Kaiserkai 1, 20457, Hamburg, Germany
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Jia M, An B, Yan B, Ma Q, Wen B, Zhao S, Gao C, Ma X, Zhang L, Li B, Zhang P, Wang J, Yu H, Wang W. A comparison of clinical characteristics of psychiatric inpatients in three hospitals from Western China and America. BMC Psychiatry 2023; 23:6. [PMID: 36597094 PMCID: PMC9811694 DOI: 10.1186/s12888-022-04500-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Accepted: 12/27/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Different countries have differences in social and cultural context and health system, which may affect the clinical characteristics of psychiatric inpatients. This study was the first to compare cross-cultural differences in the clinical characteristics of psychiatric inpatients in three hospitals from Western China and America. METHODS Overall, 905 and 1318 patients from three hospitals, one in America and two in Western China, respectively, were included. We used a standardised protocol and data collection procedure to record inpatients' sociodemographic and clinical characteristics. RESULTS Significant differences were found between hospitals from the two countries. Positive symptoms were the main reason for admission in the Chinese hospitals, while reported suicide and self-injury symptoms more frequently led to hospital admission in America. Moreover, there were more inpatients with combined substance abuse in the American hospital (97.6% vs. 1.9%, P < 0.001). The length of stay (LOS) in America was generally shorter than in China (10.5 ± 11.9 vs. 20.7 ± 13.4, P < 0.001). The dosage of antipsychotic drugs used in the American hospital was higher than in China (275.1 ± 306.9 mg vs. 238.3 ± 212.5 mg, P = 0.002). Regression analysis showed that male sex, older age, retirees, being admitted because of physical symptoms, and using higher doses of antipsychotic drugs were significantly associated with longer hospitalisation in the American hospital (P < 0.05). Comparatively, patients who were divorced, experiencing suicidal ideation, admitted involuntarily, admitted because of physical, depression, or anxiety symptoms, and using higher doses of antipsychotic drugs had longer hospitalisation in Chinese hospitals (P < 0.05). CONCLUSION Significant variations in clinical characteristics of inpatients were found between hospitals from Western China and America. The LOS in Chinese hospitals was significantly longer, but patients used higher doses of antipsychotic drugs in the American hospital. Admission due to physical symptoms and the use of higher dosage drugs were related to longer LOS in both countries.
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Affiliation(s)
- Min Jia
- grid.452438.c0000 0004 1760 8119Department of Psychiatry, The First Affiliated Hospital of Xi’an Jiaotong University, 277 Yanta West Road, Xi’an, 710061 China
| | - Bang An
- grid.440299.2Department of Psychiatry, Xianyang Central Hospital, 78 Renmin East Road, Xianyang, 712099 China
| | - Bin Yan
- grid.452438.c0000 0004 1760 8119Clinical Research Center for Psychiatric Medicine of Shaanxi Province, The First Affiliated Hospital of Xi’an Jiaotong University, 277 Yanta West Road, Xi’an, 710061 China
| | - Qingyan Ma
- grid.452438.c0000 0004 1760 8119Department of Psychiatry, The First Affiliated Hospital of Xi’an Jiaotong University, 277 Yanta West Road, Xi’an, 710061 China
| | - Binglong Wen
- grid.452438.c0000 0004 1760 8119Department of Psychiatry, The First Affiliated Hospital of Xi’an Jiaotong University, 277 Yanta West Road, Xi’an, 710061 China
| | - Shanshan Zhao
- grid.440299.2Department of Psychiatry, Xianyang Central Hospital, 78 Renmin East Road, Xianyang, 712099 China
| | - Chengge Gao
- grid.452438.c0000 0004 1760 8119Department of Psychiatry, The First Affiliated Hospital of Xi’an Jiaotong University, 277 Yanta West Road, Xi’an, 710061 China
| | - Xiancang Ma
- grid.452438.c0000 0004 1760 8119Department of Psychiatry, The First Affiliated Hospital of Xi’an Jiaotong University, 277 Yanta West Road, Xi’an, 710061 China
| | - Lili Zhang
- grid.452427.20000 0004 6831 978XDepartment of Sleep Medicine, Hebei Mental Health Center, 572 Dongfeng East Road, Baoding, 050899 China
| | - Bin Li
- grid.452427.20000 0004 6831 978XDepartment of Sleep Medicine, Hebei Mental Health Center, 572 Dongfeng East Road, Baoding, 050899 China
| | - Ping Zhang
- grid.452427.20000 0004 6831 978XDepartment of Sleep Medicine, Hebei Mental Health Center, 572 Dongfeng East Road, Baoding, 050899 China
| | - Jian Wang
- grid.452427.20000 0004 6831 978XDepartment of Sleep Medicine, Hebei Mental Health Center, 572 Dongfeng East Road, Baoding, 050899 China
| | - Hong Yu
- University at Buffalo-Psychiatry, Erie County Medical Center, 462 Grider Street, Buffalo, New York, USA.
| | - Wei Wang
- Department of Psychiatry, The First Affiliated Hospital of Xi'an Jiaotong University, 277 Yanta West Road, Xi'an, 710061, China.
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Hendricks TM, Griepentrog GJ, Hodge DO, Mohney BG. Psychosocial and mental health disorders among a population-based, case-control cohort of patients with congenital upper eyelid ptosis. Br J Ophthalmol 2023; 107:12-16. [PMID: 34281901 PMCID: PMC9311484 DOI: 10.1136/bjophthalmol-2021-319276] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 07/05/2021] [Indexed: 12/24/2022]
Abstract
BACKGROUND/AIM Recent studies have demonstrated adverse psychosocial and mental health disorders among children with ocular disorders. The mental health burden of children with simple congenital ptosis, however, is unknown. The purpose of this study was to compare the psychosocial and mental health findings of children with simple congenital ptosis with controls. METHODS The medical records of all children (<19 years) diagnosed with simple congenital ptosis from 1 January 1965 through 31 December 2004 while residing in Olmsted County, Minnesota were retrospectively reviewed for psychosocial and mental health morbidity. One-to-one randomly selected age-matched and gender-matched controls from the same population were similarly reviewed. RESULTS 81 children with ptosis were diagnosed at a mean age of 3.2 years (range, 1 month-16 years), 35 (43.2%) of whom were girls. An adverse psychosocial development was diagnosed in 41 (50.6%) patients with simple congenital ptosis monitored to a mean age of 21.4 years, compared with 26 (32.5%) controls (p=0.02). A mental illness was diagnosed in 31 (38.3%) patients with ptosis compared with 16 (20%) controls (p=0.01). Children with ptosis were 2.5 times more likely than controls to develop a mental illness and 2.1 times more likely to develop a psychosocial maladjustment. Patients with ptosis were also significantly more likely to have more mental health disorders (p=0.02) and a longer duration of psychotropic medication use (p=0.005). CONCLUSIONS Children diagnosed with simple congenital ptosis in this population had significantly greater psychosocial and mental health morbidity compared with controls. Children with ptosis may benefit from early psychosocial intervention.
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Affiliation(s)
- Tina M Hendricks
- Department of Ophthalmology and Visual Sciences, University of Iowa, Iowa City, Iowa, USA
| | - Gregory J Griepentrog
- Department of Ophthalmology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - David O Hodge
- Division of Biostatistics, Mayo Clinic, Jacksonville, Florida, USA
| | - Brian G Mohney
- Department of Ophthalmology, Mayo Clinic, Rochester, Minnesota, USA
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Geuijen P, Schellekens A, Schene A, Atsma F. Substance use disorder and alcohol consumption patterns among Dutch physicians: a nationwide register-based study. Addict Sci Clin Pract 2023; 18:4. [PMID: 36639645 PMCID: PMC9837897 DOI: 10.1186/s13722-022-00356-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2022] [Accepted: 12/09/2022] [Indexed: 01/15/2023] Open
Abstract
PURPOSE Problematic substance use and Substance Use Disorders (SUD) are common in all layers of the population. Several studies suggest higher prevalence rates of problematic substance use among physicians compared to the general population, which is harmful for themselves and potentially impairs quality of care. However, nationwide comparison with a highly educated reference group is lacking. Using nationwide register data, this study compared the prevalence of clinical SUD diagnoses and alcohol consumption patterns between physicians and a highly educated reference population. METHODS A retrospective study was performed using registry data from 2011 up to and including 2019, provided by Statistics Netherlands. From the data, a highly educated reference group was selected and those with an active medical doctor registration were identified as "physicians". Clinical SUD diagnoses were identified by DSM-IV codes in mental healthcare registries. Benchmark analyses were performed, without statistical testing, to compare the prevalence of SUD diagnoses and alcohol consumption patterns between physicians and the reference population. RESULTS Clinical SUD diagnoses were found among 0.3% of the physicians and 0.5% of the reference population, with higher proportions of sedative use disorder among physician patients. Among drinkers, the prevalence rates of heavy and excessive drinking were respectively 4.0% and 4.3% for physicians and 7.7% and 6.4% for the reference population. CONCLUSION Prevalence rates of SUD diagnoses were fairly comparable between physicians and the highly educated reference population, but physicians displayed more favorable alcohol consumption patterns. The use of sedatives by physicians might deserve attention, given the relatively higher prevalence of sedative use disorder among physicians. Overall, we observed relatively low prevalence rates of SUD diagnoses and problematic alcohol use, which may reflect a treatment gap and social desirable answers.
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Affiliation(s)
- Pauline Geuijen
- grid.10417.330000 0004 0444 9382Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Psychiatry, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC Nijmegen, The Netherlands ,grid.491352.8Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
| | - Arnt Schellekens
- grid.10417.330000 0004 0444 9382Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Psychiatry, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC Nijmegen, The Netherlands ,grid.491352.8Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Nijmegen, The Netherlands
| | - Aart Schene
- grid.10417.330000 0004 0444 9382Donders Institute for Brain, Cognition and Behaviour, Centre for Neuroscience, Department of Psychiatry, Radboud University Medical Center, Reinier Postlaan 4, 6525 GC Nijmegen, The Netherlands
| | - Femke Atsma
- grid.10417.330000 0004 0444 9382Scientific Center for Quality of Healthcare (IQ Healthcare), Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
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Green J, Bagge ASL, Olausson S, Andiné P, Wallinius M, Karlén MH. Implementing clinical guidelines for co-occurring substance use and major mental disorders in Swedish forensic psychiatry: An exploratory, qualitative interview study with mental health care staff. J Subst Abuse Treat 2023; 144:108899. [PMID: 36270196 DOI: 10.1016/j.jsat.2022.108899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 07/04/2022] [Accepted: 10/10/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Patients with substance use disorders (SUD) and co-occurring mental disorders (COD) within forensic psychiatric care often suffer poor treatment outcomes and high rates of criminal recidivism, substance use, and psychiatric problems. This study aimed to describe the conditions for, and mental health care staff's experiences with, implementing integrated SUD-focused clinical guidelines, including assessment and treatment for patients with COD at a high-security forensic mental health services (FMHS) facility in Sweden. METHODS Study staff conducted nineteen semi-structured interviews with health care staff experienced in administering the new SUD assessment and treatment. The study conducted a thematic analysis to describe the health care staff's experiences with these guidelines and suggestions for improvement. RESULTS Most participants reported appreciation for the implementation of clinical guidelines with an SUD focus, an area they considered to have previously been neglected, but also noted the need for more practical guidance in the administration of the assessments. Participants reported the dual roles of caregiver and warden as difficult to reconcile and a similar, hindering division was also present in the health care staff's attitudes toward SUD. Participants' reports also described an imbalance prior to the implementation, whereby SUD was rarely assessed but treatment was still initiated. One year after the implementation, an imbalance still existed, but in reverse: SUD was more frequently assessed, but treatment was difficult to initiate. CONCLUSIONS Despite indications of some ambivalence among staff regarding the necessity of the assessment and treatment guidelines, many participants considered it helpful to have a structured way to assess and treat SUD in this patient group. The imbalance between frequent assessment and infrequent treatment may have been due to difficulties transitioning patients across the "gap" between assessment and treatment. To bridge this gap, mental health services should make efforts to increase patients' insight concerning their SUD, flexibility in the administration of treatment, and the motivational skills of the health care staff working with this patient group. Participants considered important for enhancing treatment quality a shared knowledge base regarding SUD, and increased collaboration between different professions and between in- and outpatient services.
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Affiliation(s)
- J Green
- Centre for Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Psychology, University of Gothenburg, Gothenburg, Sweden.
| | - A S Lindqvist Bagge
- Centre for Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - S Olausson
- Department of Psychology, University of Gothenburg, Gothenburg, Sweden
| | - P Andiné
- Centre for Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Forensic Psychiatry, National Board of Forensic Medicine, Gothenburg, Sweden; Forensic Psychiatric Clinic, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - M Wallinius
- Centre for Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Child and Adolescent Psychiatry, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Research Department, Regional Forensic Psychiatric Clinic, Växjö, Sweden
| | - M Hildebrand Karlén
- Centre for Ethics, Law and Mental Health, Department of Psychiatry and Neurochemistry, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Psychology, University of Gothenburg, Gothenburg, Sweden; Department of Forensic Psychiatry, National Board of Forensic Medicine, Gothenburg, Sweden
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Bruzios KE, Shaffer PM, Byrne T, Pinals DA, Trojano M, Pressman K, Smelson D. Examining Perceived Coercion in Drug Treatment Courts. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2023; 67:53-65. [PMID: 35670193 DOI: 10.1177/0306624x221102838] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
While perceptions of voluntary consent have been studied among participants in Mental Health Courts (MHC), little is known about coercion among participants in Drug Treatment Courts (DTC), the most common type of specialty court. The purpose of the present study was to examine perceptions of coercion at enrollment among participants (N = 85) in two Massachusetts DTCs. Results indicated that, on average, participants reported low levels of perceived coercion (M = 1.67, SD = 1.23), which suggests that most individuals did not perceive their decision to enroll in DTC to be coercive. However, further research is needed to delineate whether clinical or procedural variations exist within DTCs, if levels of perceived coercion predict DTC participant outcomes, and if subpopulations experience higher or lower levels of coercion.
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Affiliation(s)
- Kathryn E Bruzios
- University of Massachusetts Medical School, Worcester, USA
- VA Bedford Healthcare System, Bedford, MA, USA
| | - Paige M Shaffer
- University of Massachusetts Medical School, Worcester, USA
- VA Bedford Healthcare System, Bedford, MA, USA
| | - Thomas Byrne
- VA Bedford Healthcare System, Bedford, MA, USA
- Boston University School of School of Social Work, MA, USA
| | - Debra A Pinals
- University of Massachusetts Medical School, Worcester, USA
| | - Max Trojano
- Pennsylvania State University College of Medicine, Hershey, USA
| | | | - David Smelson
- University of Massachusetts Medical School, Worcester, USA
- VA Bedford Healthcare System, Bedford, MA, USA
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Casanovas F, Fonseca F, Mané A. Substance use Specificities in Women with Psychosis: A Critical Review. Curr Neuropharmacol 2023; 21:1953-1963. [PMID: 36453494 PMCID: PMC10514534 DOI: 10.2174/1570159x21666221129113942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/28/2022] [Accepted: 09/03/2022] [Indexed: 12/05/2022] Open
Abstract
BACKGROUND Women with schizophrenia or other psychotic disorders differ from male patients in many respects, including psychopathology, prognosis, disease course, and substance use comorbidities. Most studies performed to date to investigate the association between drug use and psychosis have not evaluated gender differences, although this has started to change in recent years. METHODS We briefly summarize the available evidence on gender differences in drug use and substance use disorders (SUD) in psychotic patients during the early phases of the psychotic illness and during the course of schizophrenia. RESULTS Substance use and SUD are both less prevalent in women, both in the general population and at all phases of the psychotic spectrum. Some studies suggest that SUD may be under diagnosed in female patients, in part due to their more vulnerable profile. Substance use, especially cannabis, may more negatively impact females, especially on the disease course and prognosis. The available data suggest that it may be more difficult to treat SUD in female patients with schizophrenia, which could negatively impact prognosis. CONCLUSION Women with concomitant psychotic illness and SUD comprise a highly vulnerable subgroup. This should be considered when selecting the treatment approach, especially in the early phases of the illness, to ensure better outcomes.
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Affiliation(s)
- Francesc Casanovas
- Institut de Neuropsiquiatria i Adiccions (INAD), Parc de Salut Mar, Barcelona, Spain
| | - Francina Fonseca
- Institut de Neuropsiquiatria i Adiccions (INAD), Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Medicine and Life Sciences (MELIS), Universitat Pompeu Fabra, Barcelona, Spain
| | - Anna Mané
- Institut de Neuropsiquiatria i Adiccions (INAD), Parc de Salut Mar, Barcelona, Spain
- Hospital del Mar Medical Research Institute (IMIM), Barcelona, Spain
- Department of Medicine and Life Sciences (MELIS), Universitat Pompeu Fabra, Barcelona, Spain
- Centro de Investigación Biomédica en Red, Área de Salud Mental (CIBERSAM), Madrid, Spain
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Yoshimura A, Matsushita S, Kimura M, Yoneda JI, Maesato H, Yokoyama A, Higuchi S. Influence of ADHD, especially attention-deficit characteristics, on the course of alcohol-dependent individuals. BMC Psychiatry 2022; 22:803. [PMID: 36536366 PMCID: PMC9762023 DOI: 10.1186/s12888-022-04455-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND While several studies have revealed that neurodevelopmental disorders have a high probability of overlapping with substance use disorders, the effects of neurodevelopmental disorders on the courses of substance use disorders have hardly been examined. METHODS This study targeted 637 alcohol-dependent individuals who received inpatient treatment and whose drinking situations were followed for 12 months after hospital discharge using mailed questionnaires. The comorbidity of psychiatric disorders and the characteristics associated with the neurodevelopmental disorders were assessed using several measurements at the time of hospital admission. The effects of neurodevelopmental disorders on the drinking courses of the subjects were then estimated. RESULTS The presence of a current depressive episode or any anxiety disorder significantly lowered the abstinence rates during the follow-up period (p = 0.0195 and p = 0.0214, respectively). ADHD traits as assessed using the ADHD Self-report Scale (ASRS) predicted a significantly poorer abstinence rate (p = 0.0296). Similarly, attention-deficit characteristics assessed objectively through interviews predicted a significantly lower abstinence rate (p = 0.0346), and a sensitivity analysis enhanced these results (p = 0.0019). When the drinking patterns were classified into three groups, the subjects with attention-deficit characteristics had a significantly higher rate of "Recurrence" and lower rates of "Abstinence" and "Controlled drinking" (p = 0.013). In a multivariate proportional hazards analysis, the ASRS score was significantly correlated with the re-drinking risk (p = 0.003). CONCLUSION ADHD traits had significant effects on not only abstinence rates, but also on drinking pattern. The presence of ADHD traits, especially attention-deficit characteristics, influenced the drinking courses of alcohol-dependent individuals after hospital treatment.
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Affiliation(s)
- Atsushi Yoshimura
- National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan. .,Division of Psychiatry, Tohoku Medical and Pharmaceutical University, Sendai, Japan.
| | - Sachio Matsushita
- grid.415575.7National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Mitsuru Kimura
- grid.415575.7National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Jun-ichi Yoneda
- grid.415575.7National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Hitoshi Maesato
- grid.415575.7National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Akira Yokoyama
- grid.415575.7National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
| | - Susumu Higuchi
- grid.415575.7National Hospital Organization, Kurihama Medical and Addiction Center, Yokosuka, Japan
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72
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Bonfiglio NS, Portoghese I, Renati R, Mascia ML, Penna MP. Polysubstance Use Patterns among Outpatients Undergoing Substance Use Disorder Treatment: A Latent Class Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:16759. [PMID: 36554643 PMCID: PMC9779802 DOI: 10.3390/ijerph192416759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 12/05/2022] [Accepted: 12/12/2022] [Indexed: 06/17/2023]
Abstract
Substance Use Disorders (SUDs) pose significant challenges to both individuals and society at large. The primary focus of existing research with clinical SUD populations has been on individual substances, but research is required to better understand the profiles of individuals who use different substances simultaneously. The purpose of the current study was, therefore, to identify patterns of use among subjects (n = 1025) who reported using multiple substances by adopting a Latent Class Analysis (LCA) methodology. The Addiction Severity Index (ASI-lite) was included as a measure of substance misuse, we performed LCA to identify patterns of substance use through the administration of the ASI-Lite. Responses were collected from the following substances: alcohol, cannabis/cannabinoids, opioids and heroin, and cocaine. Results identified two latent classes: (1) alcohol use dominant, and (2) poly-abuser use dominants. Class 1 represented 60.0% of the sample and refers to individuals with the dominant use of alcohol, of those a higher proportion (47%) reported low-frequency use (1 to 7 days per month) and 26% reported a frequency of use of 24 to 30 days per month. Furthermore, 18% used alcohol in combination with cocaine. Class 2 represents 40.0% of the sample. This class is characterized by low-frequency and high-frequency users of several substances. The results obtained highlight the importance of deepening the study of the concomitant use of substances in individuals with SUDs to better understand the health risk of the combined use of two or more substances.
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Affiliation(s)
- Natale Salvatore Bonfiglio
- Department of Pedagogy, Psychology, Philosophy, University of Cagliari, 09126 Cagliari, Italy
- Noah SRL, 27100 Pavia, Italy
| | - Igor Portoghese
- Department of Medical Sciences and Public Health, University of Cagliari, 09124 Cagliari, Italy
| | - Roberta Renati
- Department of Pedagogy, Psychology, Philosophy, University of Cagliari, 09126 Cagliari, Italy
- Noah SRL, 27100 Pavia, Italy
| | - Maria Lidia Mascia
- Department of Pedagogy, Psychology, Philosophy, University of Cagliari, 09126 Cagliari, Italy
| | - Maria Pietronilla Penna
- Department of Pedagogy, Psychology, Philosophy, University of Cagliari, 09126 Cagliari, Italy
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The influence of social media affordances on drug dealer posting behavior across multiple social networking sites (SNS). COMPUTERS IN HUMAN BEHAVIOR REPORTS 2022. [DOI: 10.1016/j.chbr.2022.100235] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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74
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Past, Present, and Future Labor Market Participation Among Patients Admitted to Hospital With Concurrent Substance Use and Mental Health Disorder, and What We Can Learn From It. J Occup Environ Med 2022; 64:1041-1045. [PMID: 36472565 DOI: 10.1097/jom.0000000000002633] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
OBJECTIVE The aim of the study is to investigate the labor market participation of patients with concurrent substance use and mental health disorder before treatment, as well as the strength of the barriers to re-enter the labor market. METHODS The study population is composed of individuals with concurrent substance use and mental health disorder at a psychiatric unit in 1996, 2001, 2006, 2011, and 2016. The number of self-supported years 20 years back in time, as well as present and subsequent employment, was calculated. RESULTS From 1996 to 2016, there was a decrease by 43.8% in self-supported years before treatment and by 36.4% in the fraction of patients working at the time of admission. CONCLUSIONS The results point to increasing difficulties with regard to labor market attachment among individuals with mental illnesses.
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75
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Huang H, Nissen N, Lim CT, Gören JL, Spottswood M, Huang H. Treating Bipolar Disorder in Primary Care: Diagnosis, Pharmacology, and Management. Int J Gen Med 2022; 15:8299-8314. [PMID: 36447648 PMCID: PMC9701507 DOI: 10.2147/ijgm.s386875] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 11/11/2022] [Indexed: 09/10/2023] Open
Abstract
Bipolar disorder is a chronic mental illness associated with early mortality, elevated risk of comorbid cardiovascular disease, enormous burden of disability, and large societal costs. Patients often seek treatment for symptoms of bipolar disorder in the primary care setting but are frequently misdiagnosed. This article provides primary care providers with an evidence-based approach to the screening, diagnosis, and pharmacological management of bipolar disorder. Guidance is also provided for helping patients connect with higher levels of specialty psychiatric care when clinically indicated.
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Affiliation(s)
- Heather Huang
- Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Nicholas Nissen
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
| | - Christopher T Lim
- Department of Psychiatry, Boston Medical Center, Boston University School of Medicine, Boston, MA, USA
| | - Jessica L Gören
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
- Department of Pharmacy, Cambridge Health Alliance, Cambridge, MA, USA
| | - Margaret Spottswood
- Community Health Centers of Burlington, Burlington, VT, USA
- Department of Psychiatry, University of Vermont College of Medicine, Burlington, VT, USA
| | - Hsiang Huang
- Department of Psychiatry, Cambridge Health Alliance, Harvard Medical School, Cambridge, MA, USA
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76
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Pogarell O, Koller G, Adorjan K. Drogeninduzierte Psychosen. SUCHTTHERAPIE 2022. [DOI: 10.1055/a-1912-0382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Substanzkonsumstörungen und Psychosen stehen häufig in einem
kausalen Zusammenhang. Dieser kann uni- oder bidirektional sein – oder
beide Störungen beruhen auf gemeinsamen ätiopathogenetischen
Faktoren. Substanzen wie Cannabinoide, Stimulanzien oder Halluzinogene scheinen
wichtige Ko-Faktoren für die Entwicklung einer (sekundären)
Psychose darzustellen. Der Beitrag gibt einen Überblick über die
Substanzgruppen, Diagnostik und Therapie.
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Icick R, Shadrin A, Holen B, Karadag N, Lin A, Hindley G, O'Connell K, Frei O, Bahrami S, Høegh MC, Cheng W, Fan CC, Djurovic S, Dale AM, Lagerberg TV, Smeland OB, Andreassen OA. Genetic overlap between mood instability and alcohol-related phenotypes suggests shared biological underpinnings. Neuropsychopharmacology 2022; 47:1883-1891. [PMID: 35953530 PMCID: PMC9485134 DOI: 10.1038/s41386-022-01401-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2022] [Revised: 06/20/2022] [Accepted: 07/16/2022] [Indexed: 11/09/2022]
Abstract
Alcohol use disorder (AUD) is a pervasive and devastating mental illness with high comorbidity rates with other mental disorders. Understanding the genetic architecture of this comorbidity could be improved by focusing on intermediate traits that show positive genetic correlation with the disorders. Thus, we aimed to characterize the shared vs. unique polygenicity of AUD, alcohol consumption (AC) and mood instability (MOOD) -beyond genetic correlation, and boost discovery for jointly-associated loci. Summary statistics for MOOD (a binary measure of the tendency to report frequent mood swings), AC (number of standard drinks over a typical consumption week) and AUD GWASs (Ns > 200,000) were analyzed to characterize the cross-phenotype associations between MOOD and AC, MOOD and AUD and AC and AUD. To do so, we used a newly established pipeline that combines (i) the bivariate causal mixture model (MiXeR) to quantify polygenic overlap and (ii) the conjunctional false discovery rate (conjFDR) to discover specific jointly associated genomic loci, which were mapped to genes and biological functions. MOOD was highly polygenic (10.4k single nucleotide polymorphisms, SNPs, SD = 2k) compared to AC (4.9k SNPs, SD = 0.6k) and AUD (4.3k SNPs, SD = 2k). The polygenic overlap of MOOD and AC was twice that of MOOD and AUD (98% vs. 49%), with opposite genetic correlation (-0.2 vs. 0.23), as confirmed in independent samples. MOOD&AUD associated SNPs were significantly enriched for brain genes, conversely to MOOD&AC. Among 38 jointly associated loci, fifteen were novel for MOOD, AC and AUD. MOOD, AC and AUD were also strongly associated at the phenotypic level. Overall, using multilevel polygenic quantification, joint loci discovery and functional annotation methods, we evidenced that the polygenic overlap between MOOD and AC/AUD implicated partly shared biological underpinnings, yet, clearly distinct functional patterns between MOOD&AC and MOOD&AUD, suggesting new mechanisms for the comorbidity of AUD with mood disorders.
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Affiliation(s)
- Romain Icick
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway.
- Université de Paris Cité, INSERM UMR-S1144, F-75006, Paris, France.
| | - Alexey Shadrin
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Børge Holen
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Naz Karadag
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Aihua Lin
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Guy Hindley
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Kevin O'Connell
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Oleksandr Frei
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
- Center for Bioinformatics, Department of Informatics, University of Oslo, PO box 1080, Blindern, 0316, Oslo, Norway
| | - Shahram Bahrami
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Margrethe Collier Høegh
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Weiqiu Cheng
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Chun C Fan
- Department of Radiology, University of California, San Diego, La Jolla, CA, 92093, USA
- Multimodal Imaging Laboratory, University of California San Diego, La Jolla, CA, 92093, USA
- Department of Cognitive Science, University of California, San Diego, La Jolla, CA, USA
| | - Srdjan Djurovic
- Department of Medical Genetics, Oslo University Hospital, Oslo, Norway
- NORMENT Centre, Department of Clinical Science, University of Bergen, Bergen, Norway
- KG Jebsen Centre for Neurodevelopmental disorders, University of Oslo, Oslo, Norway
| | - Anders M Dale
- Department of Radiology, University of California, San Diego, La Jolla, CA, 92093, USA
- Multimodal Imaging Laboratory, University of California San Diego, La Jolla, CA, 92093, USA
- Department of Psychiatry, University of California, San Diego, La Jolla, CA, USA
- Department of Neurosciences, University of California San Diego, La Jolla, CA, 92093, USA
| | - Trine Vik Lagerberg
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Olav B Smeland
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
| | - Ole A Andreassen
- NORMENT Centre, Institute of Clinical Medicine, University of Oslo and Division of Mental Health and Addiction, Oslo University Hospital, 0407, Oslo, Norway
- KG Jebsen Centre for Neurodevelopmental disorders, University of Oslo, Oslo, Norway
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Ummels SA, Seldenrijk A, Bos EH, de Graaf R, Batelaan NM, Ten Have M. The bidirectional relationship between anxiety disorders and alcohol use disorders in adults: Findings from a longitudinal population-based study. J Affect Disord 2022; 314:126-132. [PMID: 35780968 DOI: 10.1016/j.jad.2022.06.091] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 06/21/2022] [Accepted: 06/27/2022] [Indexed: 10/17/2022]
Abstract
BACKGROUND Anxiety disorders (AD) and alcohol use disorder (AUD) frequently co-occur, but the temporal order of the association is unclear. We have determined the association between AD and the presence and first-onset of AUD, and vice versa. METHODS Data were used from n = 6.646 participants and four measurement waves (baseline, 3-, 6- and 9-years) of the Netherlands Mental Health Survey and Incidence Study 2 (NEMESIS-2), a cohort study of the Dutch general population aged 18-64 years. AD and AUD were assessed with the Composite International Diagnostic Interview 3.0. Multilevel logistic autoregressive models were controlled for previous-wave AD or AUD, sociodemographics (Model 1), smoking and clinical factors (Model 2). RESULTS People with AUD had a higher risk of present (OR = 1.65, 95 % CI 1.11-2.43; Model 2) and first-onset (OR = 2.03, 95 % CI 1.17-3.51; Model 2) AD in 3-years follow-up intervals than people without AUD. Vice versa, people with AD also had a higher sociodemographics-adjusted risk of present and first-onset AUD over 3-years follow-up intervals, but these associations attenuated into insignificance after adjustment for smoking and clinical variables. Limitations For statistical power reasons we were not able to analyze 9-year follow-up data or distinguish between AD and AUD types. CONCLUSIONS Our results indicate a bidirectional relationship between AD and AUD; especially those with severe AD (medication use, comorbid depression) are at risk of developing AUD. Health care professionals should focus on prevention of AD in AUD patients and prevention of AUD in patients with (more severe) AD. Further research should investigate the mechanisms underlying the observed associations.
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Affiliation(s)
| | - Adrie Seldenrijk
- GGZ inGeest Mental Health Care, Amsterdam, the Netherlands; Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
| | - Elisabeth H Bos
- Department of Developmental Psychology, Behavioral and Social Sciences, University of Groningen, Groningen, the Netherlands
| | - Ron de Graaf
- Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
| | - Neeltje M Batelaan
- GGZ inGeest Mental Health Care, Amsterdam, the Netherlands; Amsterdam Public Health, Mental Health Program, Amsterdam, the Netherlands
| | - Margreet Ten Have
- Netherlands Institute of Mental Health and Addiction, Utrecht, the Netherlands
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Reynolds CF, Jeste DV, Sachdev PS, Blazer DG. Mental health care for older adults: recent advances and new directions in clinical practice and research. World Psychiatry 2022; 21:336-363. [PMID: 36073714 PMCID: PMC9453913 DOI: 10.1002/wps.20996] [Citation(s) in RCA: 51] [Impact Index Per Article: 25.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
The world's population is aging, bringing about an ever-greater burden of mental disorders in older adults. Given multimorbidities, the mental health care of these people and their family caregivers is labor-intensive. At the same time, ageism is a big problem for older people, with and without mental disorders. Positive elements of aging, such as resilience, wisdom and prosocial behaviors, need to be highlighted and promoted, both to combat stigma and to help protect and improve mental health in older adults. The positive psychiatry of aging is not an oxymoron, but a scientific construct strongly informed by research evidence. We champion a broader concept of geriatric psychiatry - one that encompasses health as well as illness. In the present paper, we address these issues in the context of four disorders that are the greatest source of years lived with disability: neurocognitive disorders, major depression, schizophrenia, and substance use disorders. We emphasize the need for implementation of multidisciplinary team care, with comprehensive assessment, clinical management, intensive outreach, and coordination of mental, physical and social health services. We also underscore the need for further research into moderators and mediators of treatment response variability. Because optimal care of older adults with mental disorders is both patient-focused and family-centered, we call for further research into enhancing the well-being of family caregivers. To optimize both the safety and efficacy of pharmacotherapy, further attention to metabolic, cardiovascular and neurological tolerability is much needed, together with further development and testing of medications that reduce the risk for suicide. At the same time, we also address positive aging and normal cognitive aging, both as an antidote to ageism and as a catalyst for change in the way we think about aging per se and late-life mental disorders more specifically. It is in this context that we provide directions for future clinical care and research.
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Affiliation(s)
| | - Dilip V. Jeste
- Department of PsychiatryUniversity of California San DiegoLa JollaCAUSA
| | | | - Dan G. Blazer
- Department of Psychiatry and Behavioral SciencesDuke UniversityDurhamNCUSA
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Lespine LF, Bramness JG, Pignon B, Vaiva G, Thomas P, Roelandt JL, Benradia I, Amad A, Geoffroy PA, Rolland B. Gender-related associations between psychiatric disorders and alcohol use disorder: Findings from the french "Mental health in the general population" survey. Arch Womens Ment Health 2022; 25:895-902. [PMID: 36083520 DOI: 10.1007/s00737-022-01253-5] [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: 03/28/2022] [Accepted: 08/03/2022] [Indexed: 11/26/2022]
Abstract
Women with alcohol use disorder (AUD) might be particularly vulnerable to psychiatric comorbidities. However, population surveys have yielded disparate findings. We used data from the French Mental Health in the General Population survey to investigate gender-related risks of psychiatric comorbidities associated with AUD. A cross-sectional survey based on face-to-face interviews, including the Mini International Neuropsychiatric Interview, was conducted among 38,717 subjects. Logistic regression models were used to assess risks of psychiatric comorbidities associated with AUD. After adjustment for socio-demographics and other psychiatric disorders, both women and men with AUD were at higher risk of comorbid depressive disorder (odds ratio [OR] = 2.6, 95% confidence interval [CI]: 2.0-3.4 in women, and OR = 2.0, 95% CI: 1.7-2.4 in men), bipolar I disorder (2.5; 1.4-4.4 in women vs. 2.6; 1.9-3.4 in men), and psychotic disorder (1.6; 1.01-2.5 in women vs. 1.8; 1.4-2.3 in men). Women with AUD exhibited an increased risk of comorbid panic disorder (OR = 1.6, 95% CI: 1.1-2.2) while the increased risk of post-traumatic stress disorder (PTSD) was significant in men only (OR = 2.6, 95% CI: 1.6-4.2). The increased risk of comorbid substance use disorder (SUD) was more elevated in women, compared to men (12.9; 8.1-18.1 vs. 4.8; 4.0-5.8 in men). Most of psychiatric conditions were over-represented in both women and men with AUD, relative to controls. Gender-specific findings were that women with AUD had an increased risk of comorbid SUD or panic disorder, while men had a significantly higher risk of comorbid PTSD.
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Affiliation(s)
- Louis-Ferdinand Lespine
- Service Universitaire d'Addictologie de Lyon (SUAL), Hospices Civils de Lyon, Centre Hospitalier Le Vinatier, 95 Bd Pinel, 69500, Bron, France.
- UCBL1, INSERM, U1028, CNRS, UMR5292, CRNL, PSYR2, Lyon, France.
| | - Jørgen G Bramness
- Institute of Clinical Medicine, UiT-The Arctic University of Norway, Tromsø, Norway
- Norwegian National Advisory Unit On Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Brumunddal, Norway
- Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
| | - Baptiste Pignon
- DMU IMPACT, Univ Paris Est Creteil, INSERM, IMRB, AP-HP, Hôpitaux Universitaires « H. Mondor», Fondation FondaMental, Créteil, France
| | - Guillaume Vaiva
- Lille Neuroscience & Cognition (LilNCog), Université Lille, Inserm, CHU Lille, U1172, 59000, Lille, France
| | - Pierre Thomas
- Centre National de Ressources & Résilience Pour Les Psychotraumatismes (Cn2r Lille Paris), 59000, Lille, France
| | - Jean-Luc Roelandt
- Centre Collaborateur de L'Organisation Mondiale de La Santé Pour La Recherche Et La Formation en Santé Mentale, EPSM Lille Métropole, 211 rue Roger Salengro, 59 260, Hellemmes, France
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France
| | - Imane Benradia
- Centre Collaborateur de L'Organisation Mondiale de La Santé Pour La Recherche Et La Formation en Santé Mentale, EPSM Lille Métropole, 211 rue Roger Salengro, 59 260, Hellemmes, France
- ECEVE, UMRS 1123, Université Paris Diderot, Sorbonne Paris Cité, INSERM, Paris, France
| | - Ali Amad
- Centre National de Ressources & Résilience Pour Les Psychotraumatismes (Cn2r Lille Paris), 59000, Lille, France
| | - Pierre-Alexis Geoffroy
- Service de Psychiatrie Et dAddictologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Universitaire Bichat, Paris, France
- Université de Paris, Inserm, 75019, NeuroDiderot, Paris, France
| | - Benjamin Rolland
- Service Universitaire d'Addictologie de Lyon (SUAL), Hospices Civils de Lyon, Centre Hospitalier Le Vinatier, 95 Bd Pinel, 69500, Bron, France
- UCBL1, INSERM, U1028, CNRS, UMR5292, CRNL, PSYR2, Lyon, France
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Crowe M, Inder M, Thwaites B. The experience of mood disorder and substance use: An integrative review. J Psychiatr Ment Health Nurs 2022; 30:295-308. [PMID: 36177991 DOI: 10.1111/jpm.12876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 09/04/2022] [Accepted: 09/27/2022] [Indexed: 11/29/2022]
Abstract
WHAT IS KNOWN ON THE SUBJECT?: People with mood disorders often use substances. There are several clinician-driven hypotheses explaining the relationship. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The paper draws together the existing research on the perceptions of those with lived experience of mood disorders on the reasons for using substances. The participants in the studies identified using substances to manage their mood when treatment to manage their mood was not effective or acceptable, and as an escape from trauma and hardship. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses need an understanding of why people with mood disorders may use substances and the impact of this on their treatment. Mental health nurses need to provide trauma-informed care that emphasizes harm reduction for those who have mood disorders and substance use. ABSTRACT: Introduction Substance use is highly prevalent among people with mood disorders. Effective treatment for these people requires a better understanding of the relationship between both mood and substance use from the perspectives of those with lived experience. Question What are the reasons those with lived experience of mood disorders give for substance use? Method An integrative review was conducted. The Joanna Briggs Institute suite of critical appraisal tools was used to evaluate the quality of individual studies. Data relevant to the review question were extracted, and the results were synthesized into themes. Results Eighteen papers met the eligibility criteria. Three themes were identified across the included studies: Managing my mood, More Effective than prescribed medication, and Escape from trauma and hardship. Discussion This integrative review identified that people with a mood disorder who use substances described choosing to take substances to manage their mood, as an alternative to prescribed medications, and to cope with trauma and social hardships. Implications for Practice Mental health nurses need to provide care that recognizes why people use substances. They need to understand these reasons to provide a harm reduction and trauma-informed model of care. Evidence-based non-pharmacological interventions for mood disorders need to be available as an alternative to medications or as a supplement.
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Affiliation(s)
- Marie Crowe
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Maree Inder
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
| | - Bridgette Thwaites
- Department of Psychological Medicine, University of Otago, Christchurch, Christchurch, New Zealand
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82
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Ryan ED, Chang YM, Oliver M, Bradley KA, Hallgren KA. An Alcohol Symptom Checklist identifies high rates of alcohol use disorder in primary care patients who screen positive for depression and high-risk drinking. BMC Health Serv Res 2022; 22:1123. [PMID: 36064354 PMCID: PMC9446862 DOI: 10.1186/s12913-022-08408-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 08/02/2022] [Indexed: 11/12/2022] Open
Abstract
Background Although alcohol use disorder can complicate depression management, there is no standard process for assessing AUD symptoms (i.e., AUD diagnostic criteria) in primary care for patients who screen positive for depression. This study characterizes the association between depressive symptoms and high-risk drinking reported by primary care patients on screening measures in routine care. Then, using data from a novel clinical program, this study characterizes the association between depressive symptoms and AUD symptoms reported by primary care patients with high-risk drinking via an Alcohol Symptom Checklist. Methods In this cross-sectional study, electronic health record data were obtained from patients who visited 33 Kaiser Permanente Washington primary care clinics between 03/2018 and 02/2020 and completed depression (PHQ-2) and alcohol consumption (AUDIT-C) screening measures as part of routine care (N = 369,943). Patients who reported high-risk drinking (AUDIT-C scores 7–12) also completed an Alcohol Symptom Checklist where they reported the presence or absence of 11 AUD criteria as defined by the DSM-5 (N = 8,184). Generalized linear models estimated and compared the prevalence of high-risk drinking (AUDIT-C scores 7–12) and probable AUD (2–11 AUD symptoms on Alcohol Symptom Checklists) for patients with and without positive depression screens. Results Patients who screened positive for depression had a 131% higher prevalence of high-risk drinking than those who screened negative (5.2% vs. 2.2%; p < 0.001). Among patients with high-risk drinking, positive depression screens were associated with a significantly higher prevalence of probable AUD (69.8% vs. 48.0%; p < 0.001), with large differences in the prevalence of probable AUD observed with increasing PHQ-2 scores (e.g., probable AUD prevalence of 37.6%, 55.3% and 65.2%, for PHQ-2 scores of 0, 1, and 2, respectively). Although the overall prevalence of high-risk drinking was higher for male patients, similar patterns of association between depression screens, high-risk drinking, and AUD symptoms were observed for male and female patients. Conclusions Patients with positive depression screens are more likely to have high-risk drinking. Large percentages of patients with positive depression screens and high-risk drinking report symptoms consistent with AUD to healthcare providers when given the opportunity to do so using an Alcohol Symptom Checklist. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08408-1.
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Affiliation(s)
- Emma D Ryan
- University of Washington School of Medicine, 1959 NE Pacific St, Seattle, WA, 98195, USA.
| | - Yanni M Chang
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
| | - Malia Oliver
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA
| | - Katharine A Bradley
- Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.,Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA.,Department of Medicine, University of Washington, Seattle, WA, USA
| | - Kevin A Hallgren
- Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA.,Kaiser Permanente Washington Health Research Institute, Seattle, WA, USA.,Department of Health Systems and Population Health, University of Washington, Seattle, WA, USA
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83
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Roth KB, Sanchez E, Musci RJ. The differential relationship of common health comorbidities with acculturative experiences in United States Latinxs. SSM Popul Health 2022; 19:101179. [PMID: 35941995 PMCID: PMC9356214 DOI: 10.1016/j.ssmph.2022.101179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Revised: 07/08/2022] [Accepted: 07/18/2022] [Indexed: 11/26/2022] Open
Abstract
•A novel conceptualization of acculturation and related experiences is related to comorbidity.•Different patterns emerge in the relationship between acculturative experiences and health.•Toxic stress and social support may play differential roles in the risk for health comorbidities.
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Affiliation(s)
- Kimberly B. Roth
- Washington University in St. Louis, Brown School of Social Work, Center for Mental Health Services and Research, Campus Box 1196, One Brookings Drive, St. Louis, MO, 63130, USA
| | - Elizabeth Sanchez
- University of Chicago, Crown Family School of Social Work, Policy, and Practice, 969 E 60th St, Chicago, IL, 60637, USA
| | - Rashelle J. Musci
- Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, 624 N Broadway Suite 850, Baltimore, MD, 21205, USA
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84
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Grover S, Avasthi A, Chakravarty R, Dan A, Chakraborty K, Neogi R, Desouza A, Nayak O, Praharaj S, Menon V, Deep R, Bathla M, Subramanyam AA, Nebhinani N, Ghosh P, Lakdawala B, Bhattacharya R. Prevalence and association of comorbid substance dependence on the course and outcome of bipolar disorder: Findings from the bipolar disorder course and outcome study from India (BiD-CoIN study). Indian J Psychiatry 2022; 64:449-456. [PMID: 36458086 PMCID: PMC9707659 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_665_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 06/16/2022] [Accepted: 07/27/2022] [Indexed: 11/05/2022] Open
Abstract
AIM To evaluate the prevalence of substance use disorder (SUD) and its association with the course and outcome of bipolar disorder (BD). MATERIALS AND METHODS A total of 773 patients with BD were recruited from 14 centers in different parts of India, and they were evaluated for the prevalence of comorbid substance dependence, course and outcome, subjective cognitive functioning, and disability. RESULTS About one-fourth (22.9%) of the participants had one or more substance dependence. In terms of specific substance of abuse, 136 (17.6%) had nicotine dependence, 80 (10.3%) patients had alcohol dependence, 13 (1.7%) had cannabis dependence, and nine (1.2%) had opioid dependence. Compared to those without comorbid substance dependence, those with a dual diagnosis (i.e., using at least one substance in a dependent pattern) were less educated, more often males, more often currently single, more often employed, had a lower number of depressive episodes per year of illness, had a higher number of manic and mixed episodes per year of illness in the first 5 years of illness, had a higher level of disability, and more often had a history of hospitalization and a history of receiving electroconvulsive therapy (ECT); also, a higher proportion of them had manic predominant polarity, more often had recurrent mania course, and were more often receiving a combination of lithium and valproate. CONCLUSION About one-fourth of BD patients have comorbid SUDs, and presence of SUD has a negative impact on the course and outcome of BD.
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Affiliation(s)
- Sandeep Grover
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Ajit Avasthi
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Rahul Chakravarty
- Department of Psychiatry, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Amitava Dan
- Department of Psychiatry, Burdwan Medical College and Hospital, Burdwan, West Bengal, India
| | - Kaustav Chakraborty
- Department of Psychiatry, College of Medicine and J.N.M. Hospital WBUHS, Kalyani, Kolkata, West Bengal, India
| | - Rajarshi Neogi
- Department of Psychiatry, R. G. Kar Medical College and Hospital, Kolkata, West Bengal, India
| | - Avinash Desouza
- Department of Psychiatry, Lokmanya Tilak Municipal General Hospital (SION Hospital), Mumbai, Maharashtra, India
| | - Omkar Nayak
- Department of Psychiatry, Lokmanya Tilak Municipal General Hospital (SION Hospital), Mumbai, Maharashtra, India
| | - Samir Praharaj
- Department of Psychiatry, Kasturba Medical College, Manipal, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vikas Menon
- Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, India
| | - Raman Deep
- Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India
| | - Manish Bathla
- Department of Psychiatry, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala, Haryana, India
| | - Alka A Subramanyam
- Department of Psychiatry, Topiwala National Medical College (Nair Hospital), Mumbai, Maharashtra, India
| | - Naresh Nebhinani
- Department of Psychiatry, All India Institute of Medical Sciences, Jodhpur, Rajasthan, India
| | - Prosenjit Ghosh
- Department of Psychiatry, Silchar Medical College, Silchar, Assam, India
| | - Bhavesh Lakdawala
- Department of Psychiatry, Ahmedabad Municipal Corporation Medical Education Trust Medical College, Ahmedabad, Gujarat, India
| | - Ranjan Bhattacharya
- Department of Psychiatry, Murshidabad Medical College and Hospital, Murshidabad, West Bengal, India
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85
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Jegede O, Rhee TG, Stefanovics EA, Zhou B, Rosenheck RA. Rates and correlates of dual diagnosis among adults with psychiatric and substance use disorders in a nationally representative U.S sample. Psychiatry Res 2022; 315:114720. [PMID: 35834863 DOI: 10.1016/j.psychres.2022.114720] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 07/02/2022] [Accepted: 07/07/2022] [Indexed: 11/17/2022]
Abstract
Treatment needs of adults diagnosed with both psychiatric and substance use disorders (i.e., dual diagnosis) have not received detailed characterization in a nationally representative US sample. Data from the National Epidemiologic Survey on Alcohol and Related Conditions Wave III were used to compare socio-behavioral, diagnostic, and service use characteristics of dually diagnosed adults to those with psychiatric disorders or SUDs alone. Adults with dual diagnosis were estimated to constitute 25.8% of those with any psychiatric disorder; 36.5% of those with any SUD and 17.8% of the 75.8 million adults with either disorder. Among those with psychiatric disorders, the independent correlates of dual diagnosis reflected substantial social or psychopathological disadvantages (e.g., violent behavior, poor mental health-related quality of life [HRQOL], police trouble, homelessness, and incarceration). Similarly, among those with SUD all independent correlates of dual diagnosis also reflected social or psychopathological disadvantages including poor mental HRQOL, witnessing trauma in childhood, childhood sex abuse, drug use diagnoses, suicide attempt, medical problems, having more than one SUD diagnosis, child neglect, repeated adult traumas, and less social support. Provision of medical, psychiatric, addiction and especially diverse social services in an integrated and accessible setting appear necessary and deserve further study.
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Affiliation(s)
- Oluwole Jegede
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, United States; Connecticut Mental Health Center, 34 Park Street, New Haven CT 06519, United States.
| | - Taeho Greg Rhee
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, United States; U.S. Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Avenue, West Haven, CT, United States; Department of Public Health Sciences, University of Connecticut School of Medicine, 263 Farmington Avenue, Farmington, CT, United States
| | - Elina A Stefanovics
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, United States; U.S. Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Avenue, West Haven, CT, United States
| | - Bin Zhou
- Yale School of Public Health, New Haven, CT, United States
| | - Robert A Rosenheck
- Department of Psychiatry, Yale School of Medicine, 300 George Street, Suite 901, New Haven, CT 06511, United States; U.S. Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Avenue, West Haven, CT, United States
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86
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Schwartz EKC, Wolkowicz NR, De Aquino JP, MacLean RR, Sofuoglu M. Cocaine Use Disorder (CUD): Current Clinical Perspectives. Subst Abuse Rehabil 2022; 13:25-46. [PMID: 36093428 PMCID: PMC9451050 DOI: 10.2147/sar.s337338] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 08/22/2022] [Indexed: 11/29/2022] Open
Abstract
Cocaine use disorder (CUD) is a devastating disorder, impacting both individuals and society. Individuals with CUD face many barriers in accessing treatment for CUD, and most individuals with CUD never receive treatment. In this review, we provide an overview of CUD, including risk factors for CUD, common co-occurring disorders, acute and chronic effects of cocaine use, and currently available pharmacological and behavioral treatments. There are no FDA-approved pharmacological treatments for CUD. Future studies with larger sample sizes and testing treatment combinations are warranted. However, individuals with CUD and co-occurring disorders (eg, a mood or anxiety disorder) may benefit from medication treatments. There are behavioral interventions that have demonstrated efficacy in treating CUD – contingency management (CM) and cognitive-behavioral therapy for substance use disorders (CBT-SUD) in particular – however many barriers remain in delivering these treatments to patients. Following the discussion of current treatments, we highlight some promising emerging treatments, as well as offer a framework that can be used in building a treatment plan for individuals with CUD.
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Affiliation(s)
- Elizabeth K C Schwartz
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
- Correspondence: Elizabeth KC Schwartz, Tel +1-203-932-5711, Fax +1-203-937-3472, Email
| | - Noah R Wolkowicz
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Joao P De Aquino
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
| | - R Ross MacLean
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
| | - Mehmet Sofuoglu
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA
- Department of Psychiatry, VA Connecticut Healthcare System, West Haven, CT, USA
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87
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Simon N, Torrents R, Azorin JM. Comorbidities and the right dose: antipsychotics. Expert Opin Drug Metab Toxicol 2022; 18:507-518. [PMID: 35979611 DOI: 10.1080/17425255.2022.2113378] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION The effects of antipsychotic drugs are dose-dependent, which is particularly true for their efficacy, each antipsychotic having a specific dose-response curve. This may justify individualizing doses for these agents. AREAS COVERED We review the pharmacokinetic profiles of seven oral antipsychotics: haloperidol, risperidone, olanzapine, clozapine, quetiapine, ziprasidone, and aripiprazole. Their main indications are psychotic and affective disorders. They are prescribed in a very large population which may have comorbidities. Hence, we analyze the impact of the latter on the pharmacokinetic profiles of these antipsychotics, focusing on renal and hepatic impairment. Reviews and clinical trials were discussed based on a systematic literature search (PubMed) ranging from 1995 to 2022. EXPERT OPINION Factors liable to impact antipsychotic dosage are numerous and their subsequent effects often hard to predict, due to multi-level interactions and compensatory phenomena. In clinical practice, physicians must be aware of these potential effects, but base their decisions on monitoring antipsychotic plasma levels.
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Affiliation(s)
- Nicolas Simon
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Hôpital Sainte Marguerite, Service de Pharmacologie Clinique, CAP, Marseille, France
| | - Romain Torrents
- Aix Marseille Univ, INSERM, IRD, SESSTIM, Hôpital Sainte Marguerite, Service de Pharmacologie Clinique, CAP, Marseille, France
| | - Jean-Michel Azorin
- Department of Psychiatry, Sainte Marguerite Hospital. 13009 Marseille, France
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88
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Tretyak V, Kirsch DE, Le V, Fromme K, Strakowski SM, Lippard ET. Coping drinking motives, neural functional coupling during emotion processing, and alcohol use in young adults with bipolar disorder. Alcohol Clin Exp Res 2022; 46:1482-1496. [PMID: 35702929 PMCID: PMC9478569 DOI: 10.1111/acer.14885] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 06/01/2022] [Accepted: 06/06/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Rates of alcohol use disorders in individuals with bipolar disorder are 3 to 5 times greater than in the general population and exceed rates of alcohol use disorders reported in other affective and anxiety disorders. Despite this high rate of comorbidity, our understanding of the psychosocial and neural mechanisms that underlie the initiation of alcohol misuse in young adults with bipolar disorder remains limited. Prior work suggests that individuals with bipolar disorder may misuse alcohol as a coping mechanism, yet the neural correlates of coping drinking motives and associated alcohol use have not been previously investigated in this population. METHODS Forty-eight young adults (22 bipolar disorder type I, 26 typically developing; 71% women; average age ± standard deviation = 22 ± 2 years) completed the Drinking Motives and Daily Drinking Questionnaires, and a Continuous Performance Functional magnetic resonance imaging (fMRI) Task with Emotional and Neutral Distracters. We calculated the relative difference in anterior cingulate cortex (ACC) functional coupling with the anterior insula and amygdala in response to emotional distracters compared with neutral stimuli and investigated the relations with coping drinking motives and alcohol use. RESULTS Across all participants, coping drinking motives were associated with greater quantity of recent alcohol use. In individuals with bipolar disorder, greater ACC-anterior insula functional coupling was associated with greater coping drinking motives, and greater quantity and frequency of recent alcohol use. The relative difference in ACC-anterior insula functional coupling was not associated with coping drinking motives or alcohol use in the typically developing group. Greater ACC-anterior insula functional coupling in individuals with bipolar disorder was also associated with greater anxiety symptoms and recent perceived psychological stress. Exploratory analyses suggest that the relations between ACC-anterior insula functional coupling and coping drinking motives may be confounded by anticonvulsant use. CONCLUSION Results suggest that a difference in ACC-anterior insula functional coupling during emotion processing may underlie alcohol use as a maladaptive coping mechanism in young adults with bipolar disorder.
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Affiliation(s)
- Valeria Tretyak
- Department of Psychiatry and Behavioral Sciences,
University of Texas, Austin, TX, USA,Department of Psychology, University of Texas, Austin, TX,
USA,Waggoner Center for Alcohol and Addiction Research,
University of Texas, Austin, TX, USA
| | - Dylan E. Kirsch
- Department of Psychiatry and Behavioral Sciences,
University of Texas, Austin, TX, USA,Waggoner Center for Alcohol and Addiction Research,
University of Texas, Austin, TX, USA,Institute for Neuroscience, University of Texas, Austin,
TX, USA
| | - Vanessa Le
- Department of Psychiatry and Behavioral Sciences,
University of Texas, Austin, TX, USA
| | - Kim Fromme
- Department of Psychology, University of Texas, Austin, TX,
USA,Waggoner Center for Alcohol and Addiction Research,
University of Texas, Austin, TX, USA
| | - Stephen M. Strakowski
- Department of Psychiatry and Behavioral Sciences,
University of Texas, Austin, TX, USA,Department of Psychology, University of Texas, Austin, TX,
USA,Waggoner Center for Alcohol and Addiction Research,
University of Texas, Austin, TX, USA,Institute for Neuroscience, University of Texas, Austin,
TX, USA
| | - Elizabeth T.C. Lippard
- Department of Psychiatry and Behavioral Sciences,
University of Texas, Austin, TX, USA,Department of Psychology, University of Texas, Austin, TX,
USA,Waggoner Center for Alcohol and Addiction Research,
University of Texas, Austin, TX, USA,Institute for Neuroscience, University of Texas, Austin,
TX, USA,Institute of Early Life Adversity Research, University of
Texas, Austin, TX, USA
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89
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Marciuch A, Brenna IH, Weimand B, Solli KK, Tanum L, Røstad BK, Birkeland B. Patients' experiences of continued treatment with extended-release naltrexone: a Norwegian qualitative study. Addict Sci Clin Pract 2022; 17:36. [PMID: 35850782 PMCID: PMC9290197 DOI: 10.1186/s13722-022-00317-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Accepted: 06/29/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The opioid antagonist extended-release naltrexone (XR-NTX) in the treatment of opioid use disorder (OUD) is effective in terms of safety, abstinence from opioid use and retention in treatment. However, it is unclear how patients experience and adjust to losing the possibility of achieving an opioid effect. This qualitative study is the first to explore how people with opioid dependence experience XR-NTX treatment, focusing on the process of treatment over time. METHODS Using a purposive sampling strategy, semi-structured interviews were undertaken with 19 persons with opioid use disorder (15 men, four women, 22-55 years of age) participating in a clinical trial of XR-NTX in Norway. The interviewees had received at least three XR-NTX injections. Qualitative content analysis with an inductive approach was used. FINDINGS Participants described that XR-NTX treatment had many advantages. However they still faced multiple challenges, some of which they were not prepared for. Having to find a new foothold and adapt to no longer gaining an effect from opioids due to the antagonist medication was challenging. This was especially true for those struggling emotionally and transitioning into the harmful use of non-opioid substances. Additional support was considered crucial. Even so, the treatment led to an opportunity to participate in society and reclaim identity. Participants had strong goals for the future and described that XR-NTX enabled a more meaningful life. Expectations of a better life could however turn into broken hopes. Although participants were largely optimistic about the future, thinking about the end of treatment could cause apprehension. CONCLUSIONS XR-NTX treatment offers freedom from opioids and can facilitate the recovery process for people with OUD. However, our findings also highlight several challenges associated with XR-NTX treatment, emphasizing the importance of monitoring emotional difficulties and increase of non-opioid substances during treatment. As opioid abstinence in itself does not necessarily equal recovery, our findings underscore the importance of seeing XR-NTX as part of a comprehensive, individualized treatment approach. TRIAL REGISTRATION Clinicaltrials.gov # NCT03647774, first Registered: Aug 28, 2018.
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Affiliation(s)
- Anne Marciuch
- Department of Research and Development in Mental Health, Akershus University Hospital, PB. 1000, 1478, Loerenskog, HF, Norway.
- Department of Medicine, Faculty of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Ida Halvorsen Brenna
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
| | - Bente Weimand
- Department of Research and Development in Mental Health, Akershus University Hospital, PB. 1000, 1478, Loerenskog, HF, Norway
- Department of Health, Social and Welfare Studies, University of South-Eastern Norway, Drammen, Norway
| | - Kristin Klemmetsby Solli
- Department of Research and Development in Mental Health, Akershus University Hospital, PB. 1000, 1478, Loerenskog, HF, Norway
- Norwegian Centre for Addiction Research, University of Oslo, Oslo, Norway
- Vestfold Hospital Trust, Toensberg, Norway
| | - Lars Tanum
- Department of Research and Development in Mental Health, Akershus University Hospital, PB. 1000, 1478, Loerenskog, HF, Norway
- Faculty for Health Science, Oslo Metropolitan University, Oslo, Norway
| | - Bente K Røstad
- RIO-a Norwegian users' association in the field of alcohol and drugs, Oslo, Norway
| | - Bente Birkeland
- Department of Psychosocial Health, University of Agder, Kristiansand, Norway
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90
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Larsen JL, Johansen KS, Mehlsen MY. What kind of science for dual diagnosis? A pragmatic examination of the enactive approach to psychiatry. Front Psychol 2022; 13:825701. [PMID: 35923725 PMCID: PMC9339962 DOI: 10.3389/fpsyg.2022.825701] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Accepted: 06/28/2022] [Indexed: 11/25/2022] Open
Abstract
The recommended treatment for dual diagnosis - the co-occurrence of substance use and another mental disorder - requires seamless integration of the involved disciplines and services. However, no integrative framework exists for communicating about dual diagnosis cases across disciplinary or sectoral boundaries. We examine if Enactive Psychiatry may bridge this theoretical gap. We evaluate the enactive approach through a two-step pragmatic lens: Firstly, by taking a historical perspective to describe more accurately how the theoretical gap within the field of dual diagnosis initially developed. Secondly, by applying the Enactive Psychiatry approach to data from a longitudinal study on the trajectory of cannabis use in psychosis disorders. By applying the theory rather than simply presenting it, we position ourselves better to evaluate whether it may assist the purpose of achieving a more expedient pragmatic “grip” on the field of dual diagnosis. In our discussion, we suggest that this may very well be the case. Finally, we consider the enactive approach as one of a small handful of new theories of mental disorders that draw on systems thinking and ecological psychology, and discuss whether they have the potential for a wider progressive problemshift within psychiatry. The case in favor of such potential, we argue, is less strong unless the role of complexity, similar to that seen within the dual diagnosis field, may be demonstrated for other fields of clinical practice.
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Affiliation(s)
- Jonathan Led Larsen
- Sankt Hans Hospital, Roskilde, Denmark
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
- *Correspondence: Jonathan Led Larsen,
| | | | - Mimi Yung Mehlsen
- Department of Psychology and Behavioural Sciences, School of Business and Social Sciences, Aarhus University, Aarhus, Denmark
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Lewis MM, Naugle AE, DiBacco TA, Katte K, Smith CA, Blematl AR. Behavioral Measures of Experiential Avoidance: The Role of Context in Predicting Performance on Two Stressful Tasks. CURRENT PSYCHOLOGY 2022. [DOI: 10.1007/s12144-022-03447-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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92
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Ehlers CL, Schuckit MA, Hesselbrock V, Gilder DA, Wills D, Bucholz K. The clinical course of antisocial behaviors in men and women of three racial groups. J Psychiatr Res 2022; 151:319-327. [PMID: 35533515 PMCID: PMC9744109 DOI: 10.1016/j.jpsychires.2022.04.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 04/14/2022] [Accepted: 04/28/2022] [Indexed: 12/14/2022]
Abstract
AIMS To describe the clinical course and symptom profile of DSM-IV Antisocial Personality Disorder (ASPD) and the syndrome of Adult Antisocial Behavior Syndrome (AABS) and determine if they differ based on sex and race. METHODS Using questions from a validated semi-structured interview, data were gathered from 2 independent family studies in: 1) American Indians (AI), and 2) European Americans (EA), African Americans (AA) (total n = 7171) who reported antisocial symptoms. RESULTS Within these two samples 1148 (16%) individuals met ASPD criteria, 1932 (27%) met adult ASPD but not childhood conduct disorder (CD) (i.e., AABS). The clinical course of the antisocial behaviors studied did not differ based on race or sex; however, individual symptom counts, and age of onsets of those symptoms, were significantly different across the groups. Women reported fewer symptoms and at an older age (less fights, school suspensions/expulsions, arrests or jail time), than men but were more likely to run away from home. Those with ASPD vs. AABS had more symptoms overall including not experiencing remorse. AA and AI participants and those with ASPD, had more symptoms, and were more likely to be suspended/expelled from school and arrested at a younger age than EA. CONCLUSION In these select samples, the order and sequence of antisocial behaviors did not differ by race, AASB vs. ASPD, or sex; however individual symptom endorsement did, with men (vs. women), those with ASPD (vs. AABS), AI and AA (vs. EA) reporting more suspensions/expulsions from school and arrests. This suggests further study of the possible role of race and sex in the consequences associated with antisocial syndromes is warranted.
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Affiliation(s)
- Cindy L. Ehlers
- Department of Neurosciences, The Scripps Research Institute, La Jolla, CA
| | | | - Victor Hesselbrock
- Department of Psychiatry, University of Connecticut School of Medicine, Department of Psychiatry, Farmington, CT
| | - David A. Gilder
- Department of Neurosciences, The Scripps Research Institute, La Jolla, CA
| | - Derek Wills
- Department of Neurosciences, The Scripps Research Institute, La Jolla, CA
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93
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Analysing trends of psychiatric disorders, treatment and service use across time in adults with borderline intellectual impairment: A cross-sectional study of private households. J Psychiatr Res 2022; 151:339-346. [PMID: 35533517 DOI: 10.1016/j.jpsychires.2022.04.026] [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] [Received: 12/20/2021] [Revised: 04/08/2022] [Accepted: 04/20/2022] [Indexed: 11/24/2022]
Abstract
While there is evidence that mental health problems are more prevalent in people with borderline intellectual functioning (BIF) compared to the general population, it is not known to what extent this has varied or changed over time and whether there have been changes in access to services. This paper compares the prevalence rates of psychiatric disorders and monitors trends in treatment and services in this population compared to the general population. We conducted secondary analysis on the Adult Psychiatric Morbidity Surveys carried out in England in 2000, 2007 and 2014. The total sample analysed included 21,796 participants, with 12.8% of individuals identified with BIF (n = 2786). Regression models were used to examine trends in psychiatric disorders, treatment and service use across the three datasets. People with BIF had significantly higher odds of developing mood and anxiety disorders, psychosis, drug dependence and suicidal behaviour than the general population, increasing at each subsequent timepoint. They received significantly more pharmacological treatments than the general population but have had increasingly more access to general practitioners, community care and daycare services over time. This study shows increasing prevalence rates of several mental disorders in people with BIF. Access to day-care, community care and healthcare services has increased over time for this group but not formal psychiatric care. These changes over time underline some of the problems this population faces, emphasizing a need to recognize that this is a population often overlooked in research and clinical practice.
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94
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Puértolas-Gracia B, Barbaglia MG, Gotsens M, Parés-Badell O, Brugal MT, Torrens M, Treviño L, Rodríguez-Díaz C, Vázquez-Vázquez JM, Pascual A, Coromina-Gimferrer M, Jiménez-Dueñas M, Oliva I, González E, Mestre N, Bartroli M. Lifetime Dual Disorder Screening and Treatment Retention: A Pilot Cohort Study. J Clin Med 2022; 11:jcm11133760. [PMID: 35807045 PMCID: PMC9267195 DOI: 10.3390/jcm11133760] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Revised: 05/29/2022] [Accepted: 06/14/2022] [Indexed: 02/04/2023] Open
Abstract
The coexistence of a substance use disorder and another mental disorder in the same individual has been called dual disorder or dual diagnosis. This study aimed to examine the prevalence of lifetime dual disorder in individuals with alcohol or cocaine use disorder and their retention in treatment. We conducted a pilot cohort study of individuals (n = 1356) with alcohol or cocaine use disorder admitted to treatment in the public outpatient services of Barcelona (Spain) from January 2015 to August 2017 (followed-up until February 2018). Descriptive statistics, Kaplan−Meier survival curves and a multivariable Cox regression model were estimated. The lifetime prevalence of screening positive for dual disorder was 74%. At 1 year of follow-up, >75% of the cohort remained in treatment. On multivariable analysis, the factors associated with treatment dropout were a positive screening for lifetime dual disorder (HR = 1.26; 95% CI = 1.00−1.60), alcohol use (HR = 1.35; 95% CI = 1.04−1.77), polysubstance use (alcohol or cocaine and cannabis use) (HR = 1.60; 95% CI = 1.03−2.49) and living alone (HR = 1.34; 95% CI = 1.04−1.72). Lifetime dual disorder is a prevalent issue among individuals with alcohol or cocaine use disorders and could influence their dropout from treatment in public outpatient drug dependence care centres, along with alcohol use, polysubstance use and social conditions, such as living alone. We need a large-scale study with prolonged follow-up to confirm these preliminary results.
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Affiliation(s)
- Beatriz Puértolas-Gracia
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain;
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), 08002 Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain
| | - María Gabriela Barbaglia
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain;
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), 08002 Barcelona, Spain
- Biomedical Research Institute Sant Pau, IIB Sant Pau, Sant Antoni Mª Claret 167, 08025 Barcelona, Spain
- Red de Investigación en Atención Primaria en Adicciones (RIAPAd), 28029 Madrid, Spain
- Correspondence: ; Tel.: +34-93202-7702
| | - Mercè Gotsens
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Oleguer Parés-Badell
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - María Teresa Brugal
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Marta Torrens
- Institut Hospital del Mar d’Investigacions Mèdiques (IMIM), 08003 Barcelona, Spain;
- Red de Investigación en Atención Primaria en Adicciones (RIAPAd), 28029 Madrid, Spain
- Faculty of Medicine, Universitat Autònoma de Barcelona (UAB), 08193 Barcelona, Spain
- Faculty of Medicine, Universitat de Vic i Catalunya Central, Vic, 08500 Barcelona, Spain
| | - Lara Treviño
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Concepción Rodríguez-Díaz
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - José María Vázquez-Vázquez
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Alicia Pascual
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Marcela Coromina-Gimferrer
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Míriam Jiménez-Dueñas
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Israel Oliva
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Erick González
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Nicanor Mestre
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
| | - Montse Bartroli
- Agència de Salut Pública de Barcelona, 08023 Barcelona, Spain; (B.P.-G.); (M.G.); (O.P.-B.); (M.T.B.); (L.T.); (C.R.-D.); (J.M.V.-V.); (A.P.); (M.C.-G.); (M.J.-D.); (I.O.); (E.G.); (N.M.); (M.B.)
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), 08002 Barcelona, Spain
- Biomedical Research Institute Sant Pau, IIB Sant Pau, Sant Antoni Mª Claret 167, 08025 Barcelona, Spain
- Red de Investigación en Atención Primaria en Adicciones (RIAPAd), 28029 Madrid, Spain
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95
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Martinotti G, Chiappini S, Mosca A, Miuli A, Santovito MC, Pettorruso M, Skryabin V, Sensi SL, Giannantonio MD. Atypical antipsychotic drugs in dual disorders: current evidence and clinical guidelines. Curr Pharm Des 2022; 28:2241-2259. [PMID: 35747956 DOI: 10.2174/1381612828666220623092853] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 03/15/2022] [Indexed: 11/22/2022]
Abstract
BACKGROUND Concurrent disorder or dual diagnosis refers to a combination of substance use disorders and mental disorders that occur in the same patient simultaneously. These conditions pose significant clinical and healthcare impacts and are often underdiagnosed, undertreated, and complex to manage. OBJECTIVE We assessed the quality of current pharmacological recommendations for the management of dual diagnosis, particularly by evaluating the use of second-generation antipsychotics (SGA). METHOD A literature search was performed using the PubMed and Scopus databases for publications up to September 21, 2021, without any time restrictions. The following search strings were used: (aripiprazole OR brexpiprazole OR cariprazine OR paliperidone OR risperidone OR quetiapine OR clozapine OR olanzapine) AND (psychosis OR schizophrenia OR schizoaffective) AND ("substance use disorder" OR cocaine OR alcohol OR cannabis OR heroin OR "double diagnosis" OR "dual diagnosis")) NOT (animal OR rat OR mouse) NOT (review or meta-analysis). RESULTS The search produced a final set of 41 articles. Most patients were males and were affected by schizophrenia, with cannabis the most abused substance, followed by alcohol. Aripiprazole was the most used drug, either orally or by long-acting formulations, followed by risperidone with oral and long-acting formulations, clozapine, olanzapine, and quetiapine. CONCLUSION The findings highlight the use of SGA for the treatment of psychotic symptoms in comorbidity with substance use. Future studies on people with dual diagnosis and focused on long-term evaluations are warranted and need to investigate the efficacy of newly introduced molecules, such as partial D2 agonists and long-acting injectable antipsychotics.
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Affiliation(s)
- Giovanni Martinotti
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, 66100 Chieti-Pescara, Italy.,Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9AB, UK
| | - Stefania Chiappini
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, 66100 Chieti-Pescara, Italy.,Psychopharmacology, Drug Misuse and Novel Psychoactive Substances Research Unit, School of Life and Medical Sciences, University of Hertfordshire, Hertfordshire AL10 9AB, UK
| | - Alessio Mosca
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, 66100 Chieti-Pescara, Italy
| | - Andrea Miuli
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, 66100 Chieti-Pescara, Italy
| | - Maria Chiara Santovito
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, 66100 Chieti-Pescara, Italy
| | - Mauro Pettorruso
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, 66100 Chieti-Pescara, Italy
| | - Valentin Skryabin
- Moscow Research and Practical Center on Addictions of the Moscow Department of Healthcare, 37/1 Lyublinskaya street, Moscow, Russia
| | - Stefano L Sensi
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, 66100 Chieti-Pescara, Italy
| | - Massimo Di Giannantonio
- Department of Neurosciences, Imaging and Clinical Sciences, Università degli Studi G. D'Annunzio, 66100 Chieti-Pescara, Italy
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96
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Wray TB. Exploring Whether Addictions Counselors Recommend That Their Patients Use Websites, Smartphone Apps, or Other Digital Health Tools to Help Them in Their Recovery: Web-Based Survey. JMIR Form Res 2022; 6:e37008. [PMID: 35723917 PMCID: PMC9253968 DOI: 10.2196/37008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 04/29/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background
Hundreds of smartphone apps or websites claiming to help those with addictions are available, but few have been tested for efficacy in changing clinically relevant addictions outcomes. Although most of these products are designed for self-facilitation by users struggling with addictions, counselors and other addictions treatment providers will likely play a critical role in facilitating adoption by integrating their use into counseling or recommending them to their patients. Yet, few studies have explored the practices of addictions counselors in using or recommending addictions-focused digital health tools in their work.
Objective
The aim of this study was to understand whether addiction counselors are recommending that their patients use addictions-focused apps to help them in their recovery, and the factors that affect their desire to do so.
Methods
Licensed addiction counselors practicing in the United States (N=112) were recruited from professional and scientific organizations of alcohol or drug counselors to complete a web-based survey.
Results
In total, 74% (83/112) of counselors had recommended that their patients use a website or smartphone app to assist them in recovery, and those that had done so reported recommending an app with an average of 54% of their patients. The most commonly recommended app or website was SMARTRecovery.org (9%), I am Sober (8%), In the Rooms (7%), Insight Timer (4%), Calm (4%), Sober Tool (4%), Recovery Box (3%), and Sober Grid (3%). The most important reason that counselors recommended the websites or apps was that colleagues or patients told them they found it helpful (55%), followed by their workplaces recommending it (20%) and professional organizations recommending it (10%). Counselors’ intentions to recommend a hypothetical app were strongest for apps that had been tested in rigorous, scientific studies that showed they helped users stay sober or reduce their substance use; 94% (105/112) reported that they would “definitely” or “probably” use such an app.
Conclusions
Most addictions counselors surveyed are already recommending that their patients use apps or websites to help them in their recovery, despite the paucity of available products that have evidence supporting their efficacy for addictions outcomes. One way that product developers could increase adoption among addictions treatment providers is to make efficacy testing a priority and to disseminate results through professional organizations and clinics.
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Affiliation(s)
- Tyler B Wray
- Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States
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97
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Virtanen S, Kuja-Halkola R, Sidorchuk A, Fernández de la Cruz L, Rück C, Lundström S, Suvisaari J, Larsson H, Lichtenstein P, Mataix-Cols D, Latvala A. Association of Obsessive-Compulsive Disorder and Obsessive-Compulsive Symptoms With Substance Misuse in 2 Longitudinal Cohorts in Sweden. JAMA Netw Open 2022; 5:e2214779. [PMID: 35666504 PMCID: PMC9171556 DOI: 10.1001/jamanetworkopen.2022.14779] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
IMPORTANCE Neurobiological models have postulated shared neural mechanisms between obsessive-compulsive disorder (OCD) and substance use disorders, but results from clinical and epidemiological studies are conflicting or even suggest that OCD may be protective against substance misuse. OBJECTIVE To investigate whether OCD and obsessive-compulsive symptoms are associated with substance misuse and the extent to which shared genetic and/or environmental factors account for this association. DESIGN, SETTING, AND PARTICIPANTS In this cohort study, individuals in the general population of Sweden born between January 1, 1932, and December 31, 1997 (population cohort), were followed up through Swedish nationwide registers from January 1, 1997, to December 31, 2013. The second cohort included twin participants in the Child and Adolescent Twin Study in Sweden (CATSS) followed up from ages 18 to 24 years. Data were analyzed from March 1, 2021, to March 31, 2022. EXPOSURES Lifetime International Statistical Classification of Diseases and Related Health Problems, Tenth Revision, diagnosis of OCD in the National Patient Register (population cohort 1), and self-reported obsessive-compulsive symptoms at 18 years of age (CATSS cohort). MAIN OUTCOMES AND MEASURES Substance misuse was defined as registered substance use-related disorder, criminal conviction, or death (population cohort), and self-reported alcohol and drug dependence symptoms at 18 and 24 years of age (CATSS cohort). RESULTS The general population cohort included 6 304 188 individuals (48.9% women and 51.1% men; median baseline age, 30.5 [IQR, 15.0-46.4] years), of whom 27 342 had an OCD diagnosis. Obsessive-compulsive disorder was associated with an elevated risk of substance misuse (hazard ratio, 3.68 [95% CI, 3.52-3.85]). In the 9230 individuals in the CATSS cohort (5551 women [60.1%] and 3679 men [39.9%]), obsessive-compulsive symptoms at 18 years of age were associated with increased symptoms of alcohol dependence (concurrent [n = 9219], β = 0.18 [95% CI, 0.16-0.20]; longitudinal [n = 3381], β = 0.10 [95% CI, 0.06-0.14]) and drug dependence (concurrent [n = 749], β = 0.19 [95% CI, 0.11-0.27]; longitudinal [n = 452], β = 0.15 [95% CI, 0.04-0.25]). Comorbid anxiety and depression did not entirely explain the associations in either cohort. Using data from full siblings and maternal half-siblings (population cohort) and monozygotic and dizygotic twins (CATSS cohort) provided estimates of the relative contribution of genetic and environmental influences to the covariance between OCD and obsessive-compulsive symptoms and substance misuse or dependence. The associations were explained by genetic (56%-68%) and nonshared environmental (32%-44%) factors. CONCLUSIONS AND RELEVANCE The findings of this Swedish population-based cohort study challenge the notion that OCD is protective against developing substance misuse. The association of OCD and obsessive-compulsive symptoms with substance misuse was largely explained by shared genetics but was also compatible with partial environmental mediation.
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Affiliation(s)
- Suvi Virtanen
- Institute of Criminology and Legal Policy, University of Helsinki, Helsinki, Finland
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Ralf Kuja-Halkola
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - Anna Sidorchuk
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Lorena Fernández de la Cruz
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Christian Rück
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Sebastian Lundström
- Gillberg Neuropsychiatry Centre, University of Gothenburg, Gothenburg, Sweden
| | | | - Henrik Larsson
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
- School of Medical Sciences, Örebro University, Örebro, Sweden
| | - Paul Lichtenstein
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
| | - David Mataix-Cols
- Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Region Stockholm, Stockholm, Sweden
| | - Antti Latvala
- Institute of Criminology and Legal Policy, University of Helsinki, Helsinki, Finland
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
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98
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Nguyen MX, Reyes HL, Pence BW, Muessig KE, Hutton HE, Latkin CA, Dowdy D, Chander G, Lancaster KE, Frangakis C, Sripaipan T, Tran HV, Go VF. Effects of Two Alcohol Reduction Interventions on Depression and Anxiety Symptoms of ART Clients in Vietnam. AIDS Behav 2022; 26:1829-1840. [PMID: 34807321 PMCID: PMC10144180 DOI: 10.1007/s10461-021-03532-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/06/2021] [Indexed: 10/19/2022]
Abstract
Little is known about the potential mental health impacts of cognitive behavioral therapy and motivational interviewing interventions that focus on alcohol reduction among people with HIV (PWH). Our study aimed to assess the impact of two evidence-based alcohol reduction interventions on depression and anxiety symptoms of antiretroviral therapy (ART) clients with hazardous alcohol use. We conducted a secondary data analysis of data from a three-arm randomized controlled trial among ART clients in Thai Nguyen, Vietnam that evaluated the impacts of two alcohol reduction interventions in Vietnam. ART clients 18 years old or more with hazardous alcohol use (based on the Alcohol Use Disorders Identification Test-Consumption) were enrolled and randomized into one of three arms: Combined intervention, Brief intervention, and Standard of care (SOC). Symptoms of depression, measured with the Patient Health Questionnaire-9, and anxiety, measured with the Generalized Anxiety Disorder-7 scale, were assessed at baseline and 3, 6, and 12 months post-intervention. Generalized estimating equations were used to evaluate the effects of the interventions on depression and anxiety symptoms. The prevalence of depression and anxiety symptoms at baseline was 25.1% and 16.1%, respectively. Decreases in depression and anxiety symptoms were observed in all three arms from baseline to 12-month follow-up. There were no significant differences in depression and anxiety symptoms among participants receiving either intervention, relative to the SOC. Interventions with a dual focus on alcohol and mental health are needed to achieve more pronounced and sustainable improvements in depression and anxiety symptoms for PWH with hazardous alcohol use.
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Affiliation(s)
- M X Nguyen
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27516, USA.
| | - H L Reyes
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27516, USA
| | - B W Pence
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - K E Muessig
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27516, USA
| | - H E Hutton
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - C A Latkin
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - D Dowdy
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - G Chander
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
| | - K E Lancaster
- Department of Epidemiology, College of Public Health, Ohio State University, Columbus, OH, USA
| | - C Frangakis
- Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - T Sripaipan
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27516, USA
| | - H V Tran
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27516, USA
| | - V F Go
- Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Dr, Chapel Hill, NC, 27516, USA
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99
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Corrao MM, Nelson LA. Olanzapine/Samidorphan: A New Combination Treatment for Schizophrenia and Bipolar I Disorder Intended to Reduce Weight Gain. CNS Drugs 2022; 36:605-616. [PMID: 35644903 DOI: 10.1007/s40263-022-00923-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/13/2022] [Indexed: 11/03/2022]
Abstract
Olanzapine is a second-generation antipsychotic with established efficacy in several psychiatric disease states, but its use is limited because of weight gain and metabolic side effects. Samidorphan is a novel opioid antagonist that binds to mu-opioid, kappa-opioid, and delta-opioid receptors and is hypothesized to reduce cravings for high-calorie foods thus attenuating antipsychotic-induced weight gain. The combination product olanzapine/samidorphan was approved by the US Food and Drug Administration in June 2021 for the treatment of schizophrenia and bipolar I disorder; this article reviews the pharmacological properties of oral olanzapine/samidorphan and its clinical efficacy and tolerability with a focus on mitigation of olanzapine-induced weight gain in these patient populations. In clinical trials, the combination of olanzapine/samidorphan was associated with significantly less weight gain and smaller increases in waist circumference as compared with olanzapine monotherapy. Olanzapine/samidorphan demonstrated similar efficacy as olanzapine monotherapy and was well tolerated. Weight gain and metabolic side effects associated with olanzapine monotherapy can result in tolerability issues and potentially medication nonadherence. Olanzapine/samidorphan is an effective treatment for schizophrenia and bipolar I disorder with less weight gain than olanzapine monotherapy.
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Affiliation(s)
- Madeline M Corrao
- Division of Pharmacy Practice and Administration, School of Pharmacy, University of Missouri-Kansas City, 2464 Charlotte Street, Kansas City, MO, 64108, USA
| | - Leigh Anne Nelson
- Division of Pharmacy Practice and Administration, School of Pharmacy, University of Missouri-Kansas City, 2464 Charlotte Street, Kansas City, MO, 64108, USA.
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100
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Na PJ, Stefanovics EA, Rhee TG, Rosenheck RA. "Lives of despair" at risk for "deaths of despair": tracking an under-recognized, vulnerable population. Soc Psychiatry Psychiatr Epidemiol 2022; 57:1123-1134. [PMID: 35028698 PMCID: PMC8757395 DOI: 10.1007/s00127-022-02218-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 01/06/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The substantial and unexpected increase in "deaths of despair" in the US (e.g., deaths from drug overdose, suicide, and alcohol-related liver diseases) reported by economists Case and Deaton in 2015 raises questions about the number and characteristics of US adults potentially living "lives of despair" with these problems. METHODS We used data from the National Epidemiologic Survey on Alcohol and Related Conditions Wave III (NESARC-III) to examine population estimates and characteristics of adults with lifetime history of substance use disorder (SUD) and suicide attempt, or either condition alone, as compared to those with neither. RESULTS An estimated 7.2 million adults had both lifetime SUD and suicide attempt and 78.8 million had either. Those with both faced far more psychosocial adversities, familial adverse experiences and psychiatric disorders compared to those with the other two groups, and reported greater mental health service utilization. Multivariable analysis showed that psychiatric multimorbidity and violence were the strongest correlates of having both conditions as compared to neither while those with either condition fell in between. CONCLUSION A substantial number of US adults live with a lifetime SUD and suicide attempt with a multiplicity of additional socioeconomic, psychiatric and familial problems. While their utilization of mental health care service exceeds those with either or neither conditions, quality of life remained much poorer, suggesting that mental health treatment alone may not be enough to mitigate their sufferings, and a combination of both social policy support and quality mental health care may be needed.
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Affiliation(s)
- Peter J Na
- Department of Psychiatry, School of Medicine, Yale University, 300 George St, Suite 901, West Haven, New Haven, CT, 06511, USA.
| | - Elina A Stefanovics
- Department of Psychiatry, School of Medicine, Yale University, 300 George St, Suite 901, West Haven, New Haven, CT, 06511, USA
- VA New England Mental Illness, Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, New Haven, CT, USA
| | - Taeho Greg Rhee
- Department of Psychiatry, School of Medicine, Yale University, 300 George St, Suite 901, West Haven, New Haven, CT, 06511, USA
- VA New England Mental Illness, Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, New Haven, CT, USA
- Department of Public Health Sciences, School of Medicine, University of Connecticut, Farmington, CT, USA
| | - Robert A Rosenheck
- Department of Psychiatry, School of Medicine, Yale University, 300 George St, Suite 901, West Haven, New Haven, CT, 06511, USA
- VA New England Mental Illness, Research, Education and Clinical Center (MIRECC), VA Connecticut Healthcare System, New Haven, CT, USA
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