Risk factors for substance use disorders among inpatients with major affective disorders in Taiwan Chinese

Cancer incidence in people with affective disorder: nationwide cohort study in Taiwan, 1997-2010

BACKGROUND

Cancer is a serious public health problem worldwide, and its relationship with affective disorders is not clear. Aims To investigate alcohol- and tobacco-related cancer risk among patients with affective disorders in a large Taiwanese cohort.

METHOD

Records of newly admitted patients with affective disorders from January 1997 through December 2002 were retrieved from the Psychiatric Inpatient Medical Claims database in Taiwan. Cancers were stratified by site and grouped into tobacco- or alcohol-related cancers. Standardised incidence ratios (SIRs) were calculated to compare the risk of cancer between those with affective disorders and the general population.

RESULTS

Some 10 207 patients with bipolar disorder and 9826 with major depression were included. The risk of cancer was higher in patients with major depression (SIR = 2.01, 95% CI 1.85-2.19) than in those with bipolar disorder (SIR 1.39, 95% CI 1.26-1.53). The elevated cancer risk among individuals ever admitted to hospital for affective disorders was more pronounced in tobacco- and/or alcohol-related cancers.

CONCLUSIONS

Elevated cancer risk was found in patients who had received in-patient care for affective disorders. They require holistic approaches to lifestyle behaviours and associated cancer risks.

Benzodiazepine prescription among patients with severe mental illness and co-occurring alcohol abuse/dependence in Taiwan

OBJECTIVE

Because benzodiazepines (BZDs) may be abused, prescribing them is debatable. The purpose of this study was to investigate the prescription of BZDs to explore the current status of BZD use at discharge and at 4 months after discharge.

METHODS

From 1 January 2006 to 31 December 2006, prescribed doses for BZDs at discharge and at 4 months after discharge were recorded for all discharged inpatients with schizophrenia, bipolar I disorder, and major depressive disorder. Two‐way analysis of variance was used to analyze the effects of severe mental illness and co‐occurring alcohol abuse/dependence on BZD doses at discharge and at 4 months after discharge.

RESULTS

Patients with severe mental illness prescribed with significantly higher rates and higher doses of BZDs at discharge and at 4 months after discharge are more likely to have major depressive disorder and to have co‐occurring alcohol abuse/dependence problems. No significant interactions were found between severe mental illness and co‐occurring alcohol abuse/dependence.

CONCLUSIONS

These findings suggest that caution should be applied in prescribing BZDs to patients with severe mental illness, particularly those with major depressive disorder and co‐occurring alcohol abuse/dependence. Future studies require being conducted in many different mental health‐care systems in Taiwan to generalize the findings.

Time to rehospitalization in patients with major depression vs. those with schizophrenia or bipolar I disorder in a public psychiatric hospital

Compared rehospitalization rates in patients with schizophrenia or bipolar I disorder to patients with major depressive disorder remains unclear. This study aimed to compare the time to rehospitalization of the three groups. Other clinical variables were also examined. Rehospitalization status was monitored for all admitted inpatients with schizophrenia (n=637), bipolar I disorder (n=197), or major depressive disorder (n=191), from January 1, 2006 to December 31, 2006. Time to rehospitalization within 1 year after discharge was measured using the Kaplan-Meier method. Risk factors associated with rehospitalization were examined using the Cox proportional hazards regression model. The three groups were comparable for comorbid alcohol abuse/dependence, family history of severe psychiatric illness, years of education, and number of previous hospitalizations. No significant differences were noted among the three groups for the time to rehospitalization or the time to discontinuation. Age onset and number of previous admission were associated with risks of rehospitalization. This study suggests that the major depressive disorder, schizophrenia, and bipolar I disorder have comparable influences on time to rehospitalization and discontinuation from treatment and that earlier onset of illness and more previous hospitalizations are associated with higher risks of rehospitalization. Further prospective research is warranted.

Substance dependence and remission in schizophrenia: A comparison of schizophrenia and affective disorders

The present study examined psychiatric functioning, substance use and consequences, and motivation to change in people with schizophrenia and affective disorders and current or remitted cocaine dependence. Data were collected as part of a naturalistic, longitudinal study examining substance use, motivation to change, and the process of change in people with schizophrenia and affective disorders who were currently dependent or in remission from cocaine dependence. We examined the following questions: (1) Do those in remission show better psychiatric functioning than those who are currently dependent? (2) How do people with schizophrenia and current cocaine dependence differ in terms of substance use and consequences from people with schizophrenia in remission and people with affective disorders and current drug dependence? (3) What internal factors and external factors are associated with changes in substance use in schizophrenia and how do these compare to those in nonpsychotic affective disorders? Results indicated that people with schizophrenia and current dependence reported higher levels of positive and negative symptoms than those in remission. Remission status was related to less use of other drugs, fewer days of drug problems, less distress from drug problems, and more lifetime drug-related consequences. Those with current dependence reported more days of drinking and drinking to intoxication, as well as higher rates of current alcohol use disorders than the remitted group. When compared to those with affective disorders and cocaine dependence, those with schizophrenia and current dependence reported fewer days of problems associated with their drug use, less distress from drug problems, and fewer recent and lifetime consequences associated with their drug use. The schizophrenia dependent group generally showed the lowest readiness to change, fewest efforts being made to change, and lowest confidence in the ability to change. Implications of these findings are discussed.

Development of a comprehensive measure to assess clinical issues in dual diagnosis patients: The Substance Use Event Survey for Severe Mental Illness

This paper provides a description of The Substance Use Event Survey for Severe Mental Illness (SUESS), a brief (20-30 min) interview that assesses clinical issues and domains that are relevant patients with substance use disorders and severe mental illness. First, we discuss the need for a new clinical measure for dual diagnosis patients, as well as our process of creating domains and items and developing the content of the assessment. Second, we provide a first look at the performance of the SUESS in a large sample of dually diagnosed patients from several large scale studies, including how patients responded to the instrument and their ability to complete the items. Third, we present initial reliability data on the SUESS. Finally, we include some initial validity data, including comparison of the self-report of substance use questions to urinalysis results, and verification of the service use information from medical record review. The SUESS appears to be a useful assessment that is tolerated and understood by dual diagnosis patients, and shows good preliminary reliability and validity.