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Pichlmeier S, Streb J, Rösel FA, Dobler H, Dudeck M, Fritz M. Subjective and objective assessments of executive functions are independently predictive of aggressive tendencies in patients with substance use disorder. Compr Psychiatry 2024; 132:152475. [PMID: 38531178 DOI: 10.1016/j.comppsych.2024.152475] [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: 11/21/2023] [Revised: 02/14/2024] [Accepted: 03/16/2024] [Indexed: 03/28/2024] Open
Abstract
BACKGROUND AND AIMS Impairments in executive functions have been found to influence violent behavior. Executive functions are crucial in the treatment of patients with substance use disorders because substance use generally impairs cognitive processes and is therefore detrimental for executive functions thereby reducing control of behavior and thus of consumption impulses. We studied correlations between subjective, i.e. self-report, and objective, i.e. behavior-based, assessment of executive functions and the predictive validity of these measures for aggression in patients with substance use disorder. METHODS The study included 64 patients with a diagnosed substance use disorder who were convicted according to the German Criminal Code for crimes they committed in the context of their disorder and were therefore in treatment in forensic psychiatric departments in Germany. Multiple self-report and behavior-based instruments were used to assess executive functions, appetitive and facilitative aggression as well as clinical and sociodemographic variables. RESULTS Participants showed impaired executive functions, and measures of executive functions predicted aggressive tendencies and violent offenses. Despite ecological validity of the findings, the subjective and objective assessments of executive functions did not correlate with each other, which corroborates studies in other clinical settings. CONCLUSIONS We discuss that this finding may be due to the conceptual differences between subjective and objective measures. Therefore, self-report and behavior-based measures should not be used as proxies of each other but as complementary measures that are useful for comprehensive diagnostics of cognitive impairments and assessment of risks for violent behavior.
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Affiliation(s)
- Sebastian Pichlmeier
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Ulm, Germany.
| | - Judith Streb
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Franziska Anna Rösel
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Hannah Dobler
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Manuela Dudeck
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Ulm, Germany
| | - Michael Fritz
- Department of Forensic Psychiatry and Psychotherapy, Ulm University, Ulm, Germany; School of Health and Social Sciences, AKAD University of Applied Sciences, Stuttgart, Germany
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Nathan R, Lewis E. Assessment of coexisting psychosis and substance misuse: complexities, challenges and causality. BJPSYCH ADVANCES 2020. [DOI: 10.1192/bja.2020.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
SUMMARYSubstance misuse worsens the prognosis for people suffering psychosis and places them at risk of being denied appropriate mental health service interventions. To increase the chances of its success, the plan of management for patients with coexisting psychosis and substance misuse should be based on a valid formulation of their problems, which in turn is dependent on the clinician having (a) a thorough understanding of the bidirectional and changing ways that substance use and mental illness symptoms can interact, (b) an awareness of their own biased implicit assumptions about causality in explaining these interactions and (c) a framework for assessment and formulation. This article addresses these three areas with reference to the evidence base and to clinical experience in a way that guides mental health clinicians in the assessment of patients with coexisting psychosis and substance misuse.
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Exploring the prevalence of substance-induced neurocognitive disorder among polysubstance users, adding subjective and objective evidence of cognitive impairment. Psychiatry Res 2020; 288:112944. [PMID: 32339804 DOI: 10.1016/j.psychres.2020.112944] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2019] [Revised: 03/23/2020] [Accepted: 03/24/2020] [Indexed: 12/17/2022]
Abstract
UNLABELLED The objective of this study was to explore the prevalence of substance-induced neurocognitive disorder (NCD) in a sample of polysubstance users, adding both objective- and subjective cognitive impairment. METHOD We collected cross-sectional data from 33 community-based residential facilities in Mexico City. Montreal Cognitive Assessment was used for measurement of objective cognitive impairment, and a DSM-5-based interview for subjective impairment. Years and days of recent use of alcohol, marijuana, cocaine and inhalants were collected for regression analyses. RESULTS 753 participants were analyzed; from these, 50.5% show objective impairment, 71% and 58.5% self-reported any cognitive deficit and cognitive decline, respectively. Between 21.8%-36.5% would qualify for NCD when integrating both objective- and subjective impairment (deficit or decline). Significant weak associations were found between objective impairment and subjective deficits in all cognitive domains except social cognition. Regression models adding both objective- and subjective measures explained more variation in the years of alcohol, inhalant and cocaine use, and in recent marijuana use, than the objective measure alone, but associations were inconsistent. CONCLUSION Though significant in proportion, the prevalence of NCD in this population can only be partially related to substance use. Further integrative approaches are needed to refine the epidemiology of this disorder.
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Bruijnen CJWH, Dijkstra BAG, Walvoort SJW, Markus W, VanDerNagel JEL, Kessels RPC, DE Jong CAJ. Prevalence of cognitive impairment in patients with substance use disorder. Drug Alcohol Rev 2019; 38:435-442. [PMID: 30916448 PMCID: PMC6593747 DOI: 10.1111/dar.12922] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2018] [Revised: 02/14/2019] [Accepted: 02/18/2019] [Indexed: 02/01/2023]
Abstract
INTRODUCTION AND AIMS Cognitive impairments in substance use disorder predict treatment outcome and are assumed to differ between substances. They often go undetected, thus the current study focuses on the prevalence of and differences in cognitive functioning across substances by means of a cognitive screen at the early stage of addiction treatment. DESIGN AND METHODS The Montreal Cognitive Assessment was administered to outpatients seeking treatment for substance use disorder. Patient characteristics (age, years of regular use, polysubstance use, severity of dependence/abuse, depression, anxiety and stress) were also taken into account. RESULTS A total of 656 patients were included (n = 391 used alcohol, n = 123 used cannabis, n = 100 used stimulants and n = 26 used opioids). The prevalence of cognitive impairments was 31%. Patients using alcohol had a lower total- and memory domain score than those using cannabis. Patients using opioids scored lower on visuospatial abilities than those using cannabis or stimulants. Younger patients scored higher than older patients. No effect was found for the other investigated characteristics. DISCUSSION AND CONCLUSIONS Given the high prevalence of cognitive impairments, standard screening at an early stage of treatment is important to determine the course of treatment and maximise treatment outcome. Caution is needed in interpreting results about opioids due to an underrepresentation of this patient group, and more research is needed on the effect of age on Montreal Cognitive Assessment performance.
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Affiliation(s)
- Carolien J W H Bruijnen
- Centre of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands.,Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University, Nijmegen, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands
| | - Boukje A G Dijkstra
- Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University, Nijmegen, The Netherlands.,Novadic-Kentron, Addiction Care Centre, Vught, The Netherlands
| | - Serge J W Walvoort
- Centre of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands.,Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University, Nijmegen, The Netherlands
| | - Wiebren Markus
- Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University, Nijmegen, The Netherlands.,IrisZorg, Centre for Addiction Treatment, Arnhem, The Netherlands
| | - Joanne E L VanDerNagel
- Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University, Nijmegen, The Netherlands.,Tactus, Centre for Addiction and Intellectual Disability, Deventer, The Netherlands.,Aveleijn, Borne, The Netherlands
| | - Roy P C Kessels
- Centre of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands.,Donders Institute for Brain, Cognition and Behaviour, Radboud University, Nijmegen, The Netherlands.,Department of Medical Psychology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Cornelis A J DE Jong
- Nijmegen Institute for Scientist-Practitioners in Addiction, Radboud University, Nijmegen, The Netherlands.,Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands
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Bruijnen CJWH, Jansen M, Dijkstra BAG, Walvoort SJW, Lugtmeijer S, Markus W, De Jong CAJ, Kessels RPC. The Montreal Cognitive Assessment (MoCA) as a cognitive screen in addiction health care: A validation study for clinical practice. JOURNAL OF SUBSTANCE USE 2018. [DOI: 10.1080/14659891.2018.1497102] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Affiliation(s)
- Carolien J. W. H. Bruijnen
- Center of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University Nijmegen, Nijmegen, The Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - Mandy Jansen
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
| | - Boukje A. G. Dijkstra
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University Nijmegen, Nijmegen, The Netherlands
- Novadic-Kentron, Addiction Care Center, Vught, The Netherlands
| | - Serge J. W. Walvoort
- Center of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Selma Lugtmeijer
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
- Amsterdam Brain and Cognition (ABC) Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Wiebren Markus
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University Nijmegen, Nijmegen, The Netherlands
- IrisZorg, Center for Addiction Treatment, Arnhem, The Netherlands
| | - Cor A. J. De Jong
- Nijmegen Institute for Scientist-Practitioners in Addiction (NISPA), Radboud University Nijmegen, Nijmegen, The Netherlands
| | - Roy P. C. Kessels
- Center of Excellence for Korsakoff and Alcohol-Related Cognitive Disorders, Vincent van Gogh Institute for Psychiatry, Venray, The Netherlands
- Donders Institute for Brain, Cognition and Behavior, Radboud University, Nijmegen, The Netherlands
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
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