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Ferreira PM, Alves RJR, Zantut-Wittmann DE. Impact of the use of illicit and licit substances and anxiety disorders on the academic performance of medical students: a pilot study. BMC MEDICAL EDUCATION 2022; 22:684. [PMID: 36123725 PMCID: PMC9484241 DOI: 10.1186/s12909-022-03752-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Accepted: 09/13/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Medical students have a considerable prevalence of anxiety and substance use disorders. Our aim was to assess the presence of anxiety disorders and the use of alcohol and licit and illicit substances, and their influence on the academic performance of medical students. METHODS This is a cross-sectional, non-experimental pilot study, with quantitative analyses, in which 67 medical students at the Federal University of Rondonópolis, Mato Grosso, Brazil (UFR), were evaluated through the application of non-invasive anxiety assessment instruments, screening for involvement with tobacco, alcohol and other substances, related to school performance coefficient, between June 2019 and March 2020. RESULTS Worse academic performance was associated with frequent use of tobacco and its derivatives (p = 0.0022), marijuana (p = 0.0020), hypnotics and sedatives (p = 0.0138). Also, the performance was negatively correlated with the use of tobacco (p = 0.0004), alcoholic beverages (p = 0.0261), cannabis (p = 0.0075), sedatives (p = 0.0116) and trait anxiety (p = 0.0036). Greater trait anxiety intensity was associated with previous use of tobacco (p = 0.0276), marijuana (p = 0.0466), amphetamines/ecstasy (p = 0.0151), and hypnotics/sedatives (p = 0.0103). State anxiety was positively correlated with heavy alcohol use (p = 0.0434). Higher state anxiety intensity was related to needing intervention due to the use of amphetamines/ecstasy (p = 0.00379). Students from the intermediate classes of the course (3rd and 4th years) had a higher frequency and intensity of use of tobacco and its derivatives (p = 0.0133), amphetamines or ecstasy (p = 0.0006), and inhalants (p = 0.0256). CONCLUSIONS Worse academic performance in medical students was correlated with licit and illicit substances use and anxiety disorders. Mid-course students had a higher frequency and intensity of substance use.
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Affiliation(s)
- Pedro Marques Ferreira
- Medicine Course, Faculty of Health Sciences, Federal University of Rondonópolis, Rondonópolis, Brazil
| | - Rauni Jandé Roama Alves
- Psychology Course, Institute of Human and Natural Sciences, Federal University of Rondonópolis, Rondonópolis, Brazil
| | - Denise Engelbrecht Zantut-Wittmann
- Division of Endocrinology, Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas, CampinasCampinas, Brazil.
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Comprehensive analyses of RNA-seq and genome-wide data point to enrichment of neuronal cell type subsets in neuropsychiatric disorders. Mol Psychiatry 2022; 27:947-955. [PMID: 34719691 PMCID: PMC9054675 DOI: 10.1038/s41380-021-01324-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2021] [Revised: 08/24/2021] [Accepted: 09/24/2021] [Indexed: 01/09/2023]
Abstract
Neurological and psychiatric disorders, including substance use disorders, share a range of symptoms, which could be the result of shared genetic background. Many genetic loci have been identified for these disorders using genome-wide association studies, but conclusive evidence about cell types wherein these loci are active is lacking. We aimed to uncover implicated brain cell types in neuropsychiatric traits and to assess consistency in results across RNA datasets and methods. We therefore comprehensively employed cell type enrichment methods by integrating single-cell transcriptomic data from mouse brain regions with an unprecedented dataset of 42 human genome-wide association study results of neuropsychiatric, substance use and behavioral/quantitative brain-related traits (n = 12,544,007 individuals). Single-cell transcriptomic datasets from the Karolinska Institute and 10x Genomics were used. Cell type enrichment was determined using Linkage Disequilibrium Score Regression, Multi-marker Analysis of GenoMic Annotation, and Data-driven Expression Prioritized Integration for Complex Traits. We found the largest degree of consistency across methods for implication of pyramidal cells in schizophrenia and cognitive performance. For other phenotypes, such as bipolar disorder, two methods implicated the same cell types, i.e., medium spiny neurons and pyramidal cells. For autism spectrum disorders and anorexia nervosa, no consistency in implicated cell types was observed across methods. We found no evidence for astrocytes being consistently implicated in neuropsychiatric traits. In conclusion, we provide comprehensive evidence for a subset of neuronal cell types being consistently implicated in several, but not all psychiatric disorders, while non-neuronal cell types seem less implicated.
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Hou J, Ndasauka Y, Jiang Y, Ye Z, Wang Y, Yang L, Li X, Zhang Y, Pang L, Kong Y, Xu F, Zhang X. Excessive use of WeChat, social interaction and locus of control among college students in China. PLoS One 2017; 12:e0183633. [PMID: 28817710 PMCID: PMC5560757 DOI: 10.1371/journal.pone.0183633] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 08/02/2017] [Indexed: 11/19/2022] Open
Abstract
In China, the number of college students using mobile phone based messaging and social networking applications like WeChat is increasing rapidly. However, there has been minimal research into the addictive nature of these applications and the psychological characteristics associate with their excessive use. There is also no published scale available for assessing excessive use of WeChat and similar applications. In the current study, we collected data from 1,245 college students in China (715 females) and developed the WeChat Excessive Use Scale (WEUS). We then assessed the relationship between excessive use of WeChat and excessive use of a social networking application-Weibo, problematic use of mobile phones, external locus of control, and social interaction skills. Our 10-item scale featured three factors, namely- "mood modification," "salience" and ''conflict"- critical factors in assessing different forms of addiction. The WEUS was found to be a reliable instrument in assessing excessive use of WeChat as it showed good internal consistency and correlated with other measures of problematic use social networking and mobile phone addiction. Our results showed that excessive users of WeChat are more likely to excessively use Weibo than they are to problematically use mobile phones. Our study also showed that greater excessive use of WeChat is associated with higher external locus of control and greater online social interaction skills. These results reveal that WeChat has unique and strong appeal among college students in China. Further, practitioners should consider dealing with malleable factors like locus of control and real life social skills in treating people with problematic messaging and social networking.
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Affiliation(s)
- Juan Hou
- Department of Philosophy, Anhui University, Hefei, Anhui, China
| | - Yamikani Ndasauka
- School of Humanities and Social Science, University of Science and Technology of China, Hefei, Anhui, China
- Department of Philosophy, University of Malawi; Chancellor College, Zomba, Malawi
| | - Yingying Jiang
- School of Humanities and Social Science, University of Science and Technology of China, Hefei, Anhui, China
| | - Zi Ye
- School of Humanities and Social Science, University of Science and Technology of China, Hefei, Anhui, China
| | - Ying Wang
- CAS Key Laboratory of Brain Function and Disease, and School of Life Science, University of Science and Technology of China, Hefei, Anhui, China
| | - Lizhuang Yang
- CAS Key Laboratory of Brain Function and Disease, and School of Life Science, University of Science and Technology of China, Hefei, Anhui, China
| | - Xiaoming Li
- CAS Key Laboratory of Brain Function and Disease, and School of Life Science, University of Science and Technology of China, Hefei, Anhui, China
| | - Yongjun Zhang
- Center for Biomedical Engineering, University of Science & Technology of China, Hefei, Anhui, China
| | | | - Yan Kong
- School of Humanities and Social Science, University of Science and Technology of China, Hefei, Anhui, China
| | - Fei Xu
- School of Humanities and Social Science, University of Science and Technology of China, Hefei, Anhui, China
| | - Xiaochu Zhang
- School of Humanities and Social Science, University of Science and Technology of China, Hefei, Anhui, China
- CAS Key Laboratory of Brain Function and Disease, and School of Life Science, University of Science and Technology of China, Hefei, Anhui, China
- Center for Biomedical Engineering, University of Science & Technology of China, Hefei, Anhui, China
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Dauber H, Braun B, Pfeiffer-Gerschel T, Kraus L, Pogarell O. Co-occurring Mental Disorders in Substance Abuse Treatment: the Current Health Care Situation in Germany. Int J Ment Health Addict 2017; 16:66-80. [PMID: 29491767 PMCID: PMC5814539 DOI: 10.1007/s11469-017-9784-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Aim of this study was to investigate the current health care situation for patients with co-occurring mental disorders in addiction treatment. Therefore, data from the German Substance Abuse Treatment System (N = 194,406) was analysed with regard to the prevalence of comorbid mental disorders, treatment characteristics and outcomes of patients with comorbid psychiatric diagnosis. In outpatient setting, the prevalence of comorbid diagnoses was considerably lower (4.6%) than in inpatient setting (50.7%), but mood and anxiety disorders were the most prevalent additional diagnoses in both settings. In the treatment of patients with these comorbid disorders, we found higher rates of complementary internal and external (psychiatric) treatment, more co-operations and referrals after treatment, and positive treatment process outcomes. Findings indicate that the knowledge of an additional diagnosis influences the health care provision of affected patients and can therefore be seen as the essential precondition for providing adequate and comprehensive treatment. This highlights the importance of a sufficient consideration and diagnostic assessment of mental disorders in addiction treatment to further improve the health care situation of comorbid patients.
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Affiliation(s)
- Hanna Dauber
- 1IFT Institut für Therapieforschung, Parzivalstr. 25, 80804 Munich, Germany.,2Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Nußbaumstr. 7, 80336 Munich, Germany
| | - Barbara Braun
- 1IFT Institut für Therapieforschung, Parzivalstr. 25, 80804 Munich, Germany
| | | | - Ludwig Kraus
- 1IFT Institut für Therapieforschung, Parzivalstr. 25, 80804 Munich, Germany.,3Centre for Social Research on Alcohol and Drugs (SoRAD), Stockholm University, 10691 Stockholm, Sweden
| | - Oliver Pogarell
- 2Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Nußbaumstr. 7, 80336 Munich, Germany
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Huỳnh C, Tremblay J, Fleury MJ. Typologies of Individuals Attending an Addiction Rehabilitation Center Based on Diagnosis of Mental Disorders. J Subst Abuse Treat 2016; 71:68-78. [DOI: 10.1016/j.jsat.2016.09.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Revised: 09/08/2016] [Accepted: 09/14/2016] [Indexed: 10/21/2022]
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Gidhagen Y, Philips B, Holmqvist R. Outcome of psychological treatment of patients with substance use disorders in routine care. JOURNAL OF SUBSTANCE USE 2016. [DOI: 10.1080/14659891.2016.1200149] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Yoshimi NT, Campos LM, Simão MO, Torresan RC, Torres AR. Social anxiety symptoms in alcohol-dependent outpatients: prevalence, severity and predictors. JORNAL BRASILEIRO DE PSIQUIATRIA 2016. [DOI: 10.1590/0047-2085000000112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Objectives High rates of comorbidity between social anxiety disorder (SAD) and alcohol use disorders have been reported, but the predictors of this comorbidity are poorly known and most studies involve primary SAD samples. The aims were to estimate the prevalence and severity of SAD symptoms among alcohol-dependent patients and to investigate sociodemographic and clinical factors associated with SAD comorbidity, including suicidal behaviors. Methods A cross-sectional study with 53 adults who were in treatment for alcohol dependence at a Brazilian public university outpatient service. Assessment instruments Social Phobia Inventory (SPIN), Short Alcohol Dependence Data and Beck Depression Inventory. Bivariate analyses between the categorical outcome (Probable SAD: SPIN ≥ 19) and explanatory variables were conducted. Correlates of SPIN total and subscales scores (dimensional outcomes) were also investigated. Results The diagnosis and treatment of alcohol dependence occurred, on average, 30 years after the onset of alcohol use and 39.6% of the 53 patients (37 men and 16 women) reported alleviation of social anxiety symptoms with alcohol use. Twenty-four (45.3%) patients presented probable SAD. These patients differed from non-SAD alcohol-dependent individuals by having lower income and higher frequency of depression, suicidal ideation, suicide plans and attempts. The SPIN subscales mostly associated with suicidal behaviors were social inadequacy and social inferiority. Conclusions SAD symptoms are common among help-seeking alcohol-dependent individuals and should be directly investigated and treated, since depression and suicidality are associated with this comorbidity. Prospective studies are needed to assess the impact of SAD treatment on the clinical course of alcohol dependence.
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The Prevalence, Mental Health and Criminal Characteristics of Potential Problem Gamblers in a Substance Using Treatment Seeking Population. Int J Ment Health Addict 2015. [DOI: 10.1007/s11469-015-9604-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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Foulds JA, Mulder RT, Newton-Howes G, Adamson SJ, Boden JM, Sellman JD. Personality Predictors of Drinking Outcomes in Depressed Alcohol-Dependent Patients. Alcohol Alcohol 2015; 51:296-301. [DOI: 10.1093/alcalc/agv122] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2015] [Accepted: 10/09/2015] [Indexed: 11/14/2022] Open
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Dharmawardene V, Menkes DB. Substance use disorders in New Zealand adults with severe mental illness: descriptive study of an acute inpatient population. Australas Psychiatry 2015; 23:236-40. [PMID: 26014623 DOI: 10.1177/1039856215586147] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To elucidate patterns of substance misuse, across diagnoses and demographic variables, in patients with severe mental illness. METHOD We studied 141 adults admitted to an acute psychiatric unit in Hamilton, New Zealand. Semi-structured interviews, including the Alcohol Use Disorders Identification Test (AUDIT) and Cannabis Use Disorders Identification Test - Revised (CUDIT-R), were used to assess substance use. RESULTS Seventy-six participants were of European origin (56%), 59 were Maori (42%). Tobacco smoking was noted in 81% overall, with a higher frequency (93%) among Maori. A majority of patients had alcohol use disorder, with greater prevalence in bipolar and schizoaffective disorder compared to schizophrenia. By contrast, cannabis use disorder was strikingly associated with schizophrenia. Younger patients and Maori were disproportionately affected by both alcohol and cannabis use. CONCLUSIONS Substance misuse in New Zealand patients with severe mental illness is common, particularly among younger patients and Maori, and differentially distributed across diagnoses.
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Affiliation(s)
- Vajira Dharmawardene
- Consultant Psychiatrist, Department of Psychiatry, Teaching Hospital, Anuradhapura, Sri Lanka
| | - David B Menkes
- Associate Professor of Psychiatry, Waikato Clinical Campus, University of Auckland, Hamilton, New Zealand
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Urbanoski K, Kenaszchuk C, Veldhuizen S, Rush B. The Clustering of Psychopathology Among Adults Seeking Treatment for Alcohol and Drug Addiction. J Subst Abuse Treat 2015; 49:21-6. [DOI: 10.1016/j.jsat.2014.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Revised: 06/27/2014] [Accepted: 07/09/2014] [Indexed: 10/25/2022]
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12
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McLachlan A, Levy M, McClintock K, Tauroa R. A Literature Review: Addressing Indigenous Parental Substance Use and Child Welfare in Aotearoa: A Whānau Ora Framework. J Ethn Subst Abuse 2014; 14:96-109. [DOI: 10.1080/15332640.2014.947460] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Roncero C, Vega P, Martínez-Raga J, Barral C, Basurte-Villamor I, Rodríguez-Cintas L, Mesías B, Grau-López L, Casas M, Szerman N. Professionals' perceptions about healthcare resources for co-occuring disorders in Spain. Int J Ment Health Syst 2014; 8:35. [PMID: 25206926 PMCID: PMC4158069 DOI: 10.1186/1752-4458-8-35] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Accepted: 08/17/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Since provision of integrated services for patients with dual pathology or dual disorders (coexistence of an addictive disorder and other psychiatric disorders) constitutes an important challenge, this study compared the perceptions of health-care professionals with the existing, current state of specific resources for patients with dual pathology in Spain. METHODS Epidemiological, observational, cross-sectional, multicenter study with a large, representative sample of health care professionals attending patients with dual pathology in treatment resources throughout Spain. Participants completed a specifically designed ad-hoc on-line questionnaire about their perceptions on the existence of available resources and treatment needs for patients with dual pathology. To compare professionals' perceptions with existing available resources, the same on-line questionnaire was also completed by commissioners and managers responsible for national and regional healthcare plans on drug abuse. RESULTS A total of 659 professionals, mostly psychologists (43.40%) or psychiatrists (32.93%) agreed to participate in the study. The highest degree of concordance between the perceptions of professional and the actual situation was found regarding the existence of mental health and addiction networks (either separately or unified) (74.48%), followed by specific workshops (73.08%) and sub-acute inpatient units (67.38%), specific hospitalization units (66.26%), detoxification units (63.15%) and outpatient programs (60.73%). We detected a lower degree of agreement regarding specific occupational rehabilitation centers (59.34%) day hospitals (58.93%), day centers (57.88%), outpatient intermediate resources (48.87%), psychiatric acute admission units (46.54%) and therapeutic communities (43.77%). In addition, on average, health care professionals underestimated the number of resources present in their respective communities. CONCLUSIONS Relevant differences exist between the perceptions of professional and existing available resources for dual pathology patients in Spain, thus supporting the need of additional efforts and strategies to establish a registry and clearly inform about available resources for patients with dual diagnosis.
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Affiliation(s)
- Carlos Roncero
- Sociedad Española de Patología Dual. Londres, 17 28028 Madrid, EU Spain ; Department of Psychiatry, Outpatient Drug Clinic, Vall d'Hebron University Hospital - Public Health Agency, Barcelona (ASPB), CIBERSAM. Passeig de la Vall d'Hebrón, 119-129, 08035 Barcelona, EU Spain ; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, EU Spain
| | - Pablo Vega
- Sociedad Española de Patología Dual. Londres, 17 28028 Madrid, EU Spain ; Instituto de Adicciones, C/ Juan Esplandiú, 11-13, 28007 Madrid, EU Spain
| | - Jose Martínez-Raga
- Sociedad Española de Patología Dual. Londres, 17 28028 Madrid, EU Spain ; Unidad Docente de Psiquiatría y Psicología Medica, Hospital Universitario Dr. Peset y Universidad de Valencia, & Universidad CEU-UCH, 46017 Valencia, EU Spain
| | - Carmen Barral
- Sociedad Española de Patología Dual. Londres, 17 28028 Madrid, EU Spain ; Department of Psychiatry, Outpatient Drug Clinic, Vall d'Hebron University Hospital - Public Health Agency, Barcelona (ASPB), CIBERSAM. Passeig de la Vall d'Hebrón, 119-129, 08035 Barcelona, EU Spain ; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, EU Spain
| | - Ignacio Basurte-Villamor
- Sociedad Española de Patología Dual. Londres, 17 28028 Madrid, EU Spain ; Department of Psychiatry, Hospital Universitario Gregorio Marañón, Calle Doctor Esquerdo, 46, 28007, EU Madrid, Spain
| | - Laia Rodríguez-Cintas
- Sociedad Española de Patología Dual. Londres, 17 28028 Madrid, EU Spain ; Department of Psychiatry, Outpatient Drug Clinic, Vall d'Hebron University Hospital - Public Health Agency, Barcelona (ASPB), CIBERSAM. Passeig de la Vall d'Hebrón, 119-129, 08035 Barcelona, EU Spain
| | - Beatriz Mesías
- Sociedad Española de Patología Dual. Londres, 17 28028 Madrid, EU Spain ; Instituto de Adicciones, C/ Juan Esplandiú, 11-13, 28007 Madrid, EU Spain
| | - Lara Grau-López
- Sociedad Española de Patología Dual. Londres, 17 28028 Madrid, EU Spain ; Department of Psychiatry, Outpatient Drug Clinic, Vall d'Hebron University Hospital - Public Health Agency, Barcelona (ASPB), CIBERSAM. Passeig de la Vall d'Hebrón, 119-129, 08035 Barcelona, EU Spain ; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, EU Spain
| | - Miguel Casas
- Sociedad Española de Patología Dual. Londres, 17 28028 Madrid, EU Spain ; Department of Psychiatry, Outpatient Drug Clinic, Vall d'Hebron University Hospital - Public Health Agency, Barcelona (ASPB), CIBERSAM. Passeig de la Vall d'Hebrón, 119-129, 08035 Barcelona, EU Spain ; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Plaça Cívica, 08193 Bellaterra (Cerdanyola del Vallès), Barcelona, EU Spain
| | - Nestor Szerman
- Sociedad Española de Patología Dual. Londres, 17 28028 Madrid, EU Spain ; Department of Psychiatry, Hospital Universitario Gregorio Marañón, Calle Doctor Esquerdo, 46, 28007, EU Madrid, Spain
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Glover M, Fraser T, Bullen C, Wallace-Bell M, McRobbie H, Hadwen G. Transition to a smoke-free culture within mental health and drug and alcohol services: A survey of key stakeholders. Int J Ment Health Nurs 2014; 23:183-91. [PMID: 23859185 DOI: 10.1111/inm.12035] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Tobacco smoking is common among people with mental illnesses, and they carry a higher burden of smoking-related illnesses. Despite this, smoke-free policies and systems for supporting cessation have proved difficult to introduce in mental health and drug and alcohol services (MHDAS). This paper examines the barriers to becoming smoke free within New Zealand services. Key informants, including staff, smoke-free coordinators, and cessation specialists were interviewed. Of the 142 invited informants 61 agreed (42%) to participate in a telephone interview, and 56 provided useable data. Organizations had a permissive or transitioning smoking culture, or were smoke free, defined by smoke-free environments, smoke-free-promoting attitudes and behaviours of management and staff, and cessation support. Most organizations were on a continuum between permissive and transitional cultures. Only eight services had a fully smoke-free culture. MHDAS face many challenges in the transition to a smoke-free culture. They are not helped by exemptions in smoke-free policies for mental health services, staff smoking, negative staff attitudes to becoming smoke free, poor knowledge of nicotine dependence, smoking-related harm and comorbidities, and poor knowledge and skills regarding cessation-support options. Health inequalities will continue across both service and socioeconomic divides without a concerted effort to address smoking.
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Affiliation(s)
- Marewa Glover
- Centre for Tobacco Control Research, School of Population Health, University of Auckland, Auckland, New Zealand
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Szerman N, Vega P, Grau-López L, Barral C, Basurte-Villamor I, Mesías B, Rodríguez-Cintas L, Martínez-Raga J, Casas M, Roncero C. Dual diagnosis resource needs in Spain: a national survey of professionals. J Dual Diagn 2014; 10:84-90. [PMID: 25392250 DOI: 10.1080/15504263.2014.906195] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVE Since provision of integrated services for patients with dual pathology or dual disorders (coexistence of an addictive disorder and another mental health disorder) is an important challenge in mental health, this study assessed health care professionals' perceptions and knowledge of the current state of specific resources for patients with dual pathology in Spain. METHODS We conducted a national survey of health care professionals seeing patients with dual pathology in treatment facilities throughout Spain. Participants completed a specific online questionnaire about the needs of and available resources for patients with dual pathology. RESULTS A total of 659 professionals, mostly psychologists (n = 286, 43.4%) or psychiatrists (n = 217, 32.9%), participated in the study. Nearly all participants who responded to these items reported that specific resources for dual pathology were needed (n = 592/635, 93.2%); 76.7% (n = 487) identified intermediate resources, 68.8% (n = 437) acute detoxification units, and 64.6% (n = 410) medium-stay rehabilitation units as particularly necessary. In the opinion of 54.0% of respondents (n = 343), integrated mental health and addiction treatment services were available. Of the participants who answered these items, only a small proportion (n = 162/605, 26.8%) reported that there were appropriate outpatient programs for dual pathology, 30.4% (n = 184/605) specific hospitalization units, 16.9% (n = 99/587) subacute inpatient units, 34.2% (n = 201/587) outpatient intermediate resources, 15.5% (n = 91/587) day hospitals, and 21.5% (n = 126/587) day centers. Conversely, 62.5% (n = 378/587) of participants reported a greater presence of specific detoxification/withdrawal units, 47.3% (n = 286/587) psychiatric acute admission units, and 41.9% (n = 246/587) therapeutic communities. In the professionals' opinion, the presence of specialty programs was low; 11.6% of respondents (n = 68/587) reported that vocational programs and 16.7% (n = 98/587) reported that occupational rehabilitation programs were available. Employee turnover was common: 51.9% of respondents (n = 314/605) stated that employee turnover was occasional to frequent. CONCLUSIONS According to the professionals surveyed, specific health care resources for the management of dual pathology are currently insufficient, underlining the need for additional efforts and strategies for treating individuals with comorbid disorders.
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Affiliation(s)
- Nestor Szerman
- a Departament of Psychiatry Hospital Universitario Gregorio Marañon , Madrid , Spain
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Cowlishaw S, Merkouris S, Chapman A, Radermacher H. Pathological and problem gambling in substance use treatment: a systematic review and meta-analysis. J Subst Abuse Treat 2013; 46:98-105. [PMID: 24074847 DOI: 10.1016/j.jsat.2013.08.019] [Citation(s) in RCA: 72] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Revised: 08/06/2013] [Accepted: 08/14/2013] [Indexed: 10/26/2022]
Abstract
Pathological and problem gambling refer to a class of disorders, including those meeting criteria for a psychiatric diagnosis (i.e., pathological gambling), and others comprising a spectrum of severity defined by significant personal and social harm (i.e., problem gambling), that may be common in substance use treatment but are frequently unrecognized. This paper presents a systematic review and meta-analysis of available evidence indicating the prevalence of such gambling disorders in substance use treatment. It provides weighted mean estimates from across studies of clinical samples of substance users, and suggests around 14% of patients that demonstrate comorbid pathological gambling. Around 23% suffer conditions along the broader spectrum of problem gambling. The review also highlights important limitations of existing evidence, including scant data on current versus lifetime comorbidity, as well as reliance on convenience samples and self-administered measures of gambling problems. Notwithstanding a concomitant need for caution when applying these results, the findings suggest a strong need to identify and manage gambling comorbidity in substance use treatment. Strategies for identification of gambling disorders, and therapies that may provide useful adjunctive interventions in substance use treatment are discussed.
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Affiliation(s)
- Sean Cowlishaw
- Division of Health Research, Faculty of Health & Medicine, Lancaster University, United Kingdom; Centre for Gambling Research, ANU College of Arts and Social Sciences, School of Sociology, the Australian National University, Australia.
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Psychosocial characteristics and poly-drug use of pregnant women enrolled in methadone maintenance treatment. Neurotoxicol Teratol 2013; 38:46-52. [DOI: 10.1016/j.ntt.2013.04.006] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 04/17/2013] [Accepted: 04/17/2013] [Indexed: 01/06/2023]
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Langås AM, Malt UF, Opjordsmoen S. Substance use disorders and comorbid mental disorders in first-time admitted patients from a catchment area. Eur Addict Res 2012; 18:16-25. [PMID: 22042311 DOI: 10.1159/000332234] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 08/27/2011] [Indexed: 11/19/2022]
Abstract
AIM To describe lifetime mental disorders in patients with substance use disorders (SUD) admitted for the first time to specialized treatment for psychiatric or addiction problems from a catchment area. METHODS Special efforts were made to include all eligible patients and secure completion of thorough assessments, including the Psychiatric Research Interview for Substance and Mental Disorders (PRISM) and the Structured Clinical Interview for DSM-IV axis II personality disorders (SCID-II). The strength of this study lies in its rigorous patient recruitment and assessment methods. RESULTS Of 61 patients, 53 had alcohol use disorder (AUD). Of these, 28 had AUD only, and 25 had an additional drug use disorder (DUD). 89% had comorbid axis I (85%) or axis II (46%) disorders. The most prevalent axis I disorders were major depressive disorder (71%), social phobia (31%) and posttraumatic stress disorder (18%). Among those with comorbid psychiatric disorders (n = 54), 25 (41% of the sample) had disorders considered to be independent of their substance use only, 4 patients (7%) had substance-induced disorders only, and 23 patients (38%) had both independent and substance-induced disorders. CONCLUSION Comorbid mental disorders were remarkably prevalent in these SUD patients who were admitted for the first time.
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Langås AM, Malt UF, Opjordsmoen S. Comorbid mental disorders in substance users from a single catchment area--a clinical study. BMC Psychiatry 2011; 11:25. [PMID: 21314980 PMCID: PMC3042931 DOI: 10.1186/1471-244x-11-25] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2010] [Accepted: 02/12/2011] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The optimal treatment of patients with substance use disorders (SUDs) requires an awareness of their comorbid mental disorders and vice versa. The prevalence of comorbidity in first-time-admitted SUD patients has been insufficiently studied. Diagnosing comorbidity in substance users is complicated by symptom overlap, symptom fluctuations, and the limitations of the assessment methods. The aim of this study was to diagnose all mental disorders in substance users living in a single catchment area, without any history of treatment for addiction or psychiatric disorders, admitted consecutively to the specialist health services. The prevalence of substance-induced versus substance-independent disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), in SUD patients will be described. METHODS First-time consecutively admitted patients from a single catchment area, aged 16 years or older, admitted to addiction clinics or departments of psychiatry as outpatients or inpatients will be screened for substance-related problems using the Alcohol Use Disorder Identification Test and the Drug Use Disorder Identification Test. All patients with scores above the cutoff value will be asked to participate in the study. The patients included will be diagnosed for SUD and other axis I disorders by a psychiatrist using the Psychiatric Research Interview for Substance and Mental Disorders. This interview was designed for the diagnosis of primary and substance-induced disorders in substance users. Personality disorders will be assessed according to the Structured Clinical Interview for DSM-IV axis II disorders. The Symptom Checklist-90-Revised, the Inventory of Depressive Symptoms, the Montgomery Asberg Depression Rating Scale, the Young Mania Rating Scale, and the Angst Hypomania Check List will be used for additional diagnostic assessments. The sociodemographic data will be recorded with the Stanley Foundation's Network Entry Questionnaire. Biochemical assessments will reveal somatic diseases that may contribute to the patient's symptoms. DISCUSSION This study is unique because the material represents a complete sample of first-time-admitted treatment seekers with SUD from a single catchment area. Earlier studies have not focused on first-time-admitted patients, so chronically ill patients, may have been overrepresented in those samples. This study will contribute new knowledge about mental disorders in first-time-admitted SUD patients.
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Affiliation(s)
| | - Ulrik F Malt
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway,Oslo University Hospital, Oslo, Norway,Norwegian Research Network on Mood Disorders (NORMOOD), Oslo, Norway
| | - Stein Opjordsmoen
- University of Oslo, Institute of Clinical Medicine, Oslo, Norway,Oslo University Hospital, Oslo, Norway
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Schulte SJ, Meier PS, Stirling J, Berry M. Unrecognised dual diagnosis – a risk factor for dropout of addiction treatment. ACTA ACUST UNITED AC 2010. [DOI: 10.1080/17523281003705199] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Jiménez-Murcia S, Granero Pérez R, Fernández-Aranda F, Alvarez Moya E, Aymamí MN, Gómez-Peña M, Bueno B, Santamaría JJ, Moragas L, Penelo E, Jaurrieta N, Alonso MP, Segalàs C, Real E, Labad J, Bove F, Vallejo J, Menchón JM. Comorbidity in pathological gambling: clinical variables, personality and treatment response. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2010; 2:178-89. [PMID: 23034347 DOI: 10.1016/s1888-9891(09)73236-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2009] [Accepted: 09/28/2009] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Pathological gambling shows high comorbidity rates, especially with substance use disorders, although affective, anxiety and other impulse control disorders, as well as personality disorders, are also frequently associated. OBJECTIVES To explore comorbidity in pathological gambling with other mental disorders in a consecutive sample of patients attending a unit specialized in pathological gambling, and specifically the relationship between substance-related disorders, on the one hand, and personality and clinical variables in pathological gamblers, on the other. METHOD A total of 498 patients with a DSM-IV-TR diagnosis of Pathological Gambling (11.8% women) were assessed with a semi-structured clinical interview and several clinical and personality scales. RESULTS Higher comorbidity with affective disorders was found in women (30.5%), while higher comorbidity with substance-related disorders was found in men (11.2%). A positive association was also detected between a history of psychiatric disorders and current comorbidity with substance-use disorders, as well as between alcohol abuse and age. Finally, some personality traits such as low reward dependence (OR=0.964) and high impulsivity (OR=1.02) predicted other substance abuse (not alcohol). High selftranscendence scores predicted both alcohol and other substance abuse (OR=1.06). CONCLUSIONS Our results suggest a high prevalence of comorbid disorders in pathologic gambling, mainly with affective and substance-related disorders. The results of the present study, conducted in a broad sample of consecutively admitted pathologic gamblers, may contribute to understanding of this complex disorder and treatment improvement.
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Affiliation(s)
- S Jiménez-Murcia
- Servicio de Psiquiatría, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España; Ciber Fisiopatologia de la Obesidad y Nutrición (CIBERObn), Instituto de Salud Carlos III, Barcelona, España.
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Abstract
If you were asked: 'What are the most important things we know about addiction?' what would you say? This paper brings together a body of knowledge across multiple domains and arranged as a list of 10 things known about addiction, as a response to such a question. The 10 things are: (1) addiction is fundamentally about compulsive behaviour; (2) compulsive drug seeking is initiated outside of consciousness; (3) addiction is about 50% heritable and complexity abounds; (4) most people with addictions who present for help have other psychiatric problems as well; (5) addiction is a chronic relapsing disorder in the majority of people who present for help; (6) different psychotherapies appear to produce similar treatment outcomes; (7) 'come back when you're motivated' is no longer an acceptable therapeutic response; (8) the more individualized and broad-based the treatment a person with addiction receives, the better the outcome; (9) epiphanies are hard to manufacture; and (10) change takes time. The paper concludes with a call for unity between warring factions in the field to use the knowledge already known more effectively for the betterment of tangata whaiora (patients) suffering from addictive disorders.
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Affiliation(s)
- Doug Sellman
- Psychiatry and Addiction Medicine, National Addiction Centre (NAC), Christchurch, New Zealand.
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Social anxiety impacts willingness to participate in addiction treatment. Addict Behav 2009; 34:474-6. [PMID: 19195794 DOI: 10.1016/j.addbeh.2008.12.011] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2008] [Revised: 12/19/2008] [Accepted: 12/31/2008] [Indexed: 11/22/2022]
Abstract
Individuals with social anxiety have difficulty participating in group settings. Although it makes intuitive sense that social anxiety could present a challenge in addiction treatment settings, which often involve small groups and encouragement to participate in self-help groups like Alcoholics Anonymous (AA) and Narcotics Anonymous (NA), to our knowledge no study has yet assessed the impact of shyness on the treatment experience. Assessment surveys were given to 110 individuals seeking intensive outpatient substance abuse treatment at three community treatment programs. Established cut-offs for presence of clinically-significant social anxiety indicated a prevalence of 37%. Controlling for depression and worry, social anxiety was a unique predictor of endorsement that shyness interfered with willingness to talk to a therapist, speak up in group therapy, attend AA/NA, and ask somebody to be a sponsor. Socially anxious substance abusers were 4-8 times more likely to endorse that shyness interfered with addiction treatment activities. These findings have clinical and research implications.
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Jiménez-Murcia S, Granero Pérez R, Fernández-Aranda F, Álvarez Moya E, Aymamí M, Gómez-Peña M, Bueno B, Santamaría J, Moragas L, Penelo E, Jaurrieta N, Alonso M, Segalàs C, Real E, Labad J, Bove F, Vallejo J, Menchón J. Comorbidity of Pathological Gambling: clinical variables, personality and response to treatment. ACTA ACUST UNITED AC 2009. [DOI: 10.1016/s2173-5050(09)70050-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
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Herrera Rivera W, Mari JDJ, Andreoli SB, Quintana MI, Ferraz MPDT. Prevalence of mental disorder and associated factors in civilian Guatemalans with disabilities caused by the internal armed conflict. Int J Soc Psychiatry 2008; 54:414-24. [PMID: 18786903 DOI: 10.1177/0020764008090445] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The 34-year-long, Guatemalan war left at least 1,841 persons disabled in the country. The aim of this study was to describe the prevalence of mental disorders in individuals who acquired their disability as a result of the war, and to identify probable risk factors. METHOD A cross-sectional study was conducted of a group of 99 civilians with a disability in Guatemala. Participants were selected from four civilian organizations serving disabled persons in the municipality of Nebaj, Quiche. The diagnostic instrument was the computerized version of the Composite International Diagnostic Instrument 2.1 (CIDI 2.1). Data were collected from 2002 to 2004. RESULTS Of the 99 disabled persons who completed the interview, 44 had some type of lifetime psychiatric disorder. Post-traumatic stress disorder (PTSD) was the most prevalent, with 34.34% (34 cases), followed by dysthymia, with 10.10% (10 cases), and depression, with 6.06% (6 cases). CONCLUSION The traumatic events experienced during the conflict caused long-term psychological sequelae in people who were disabled as a result of the war. Increased exposure to traumatic events, being married, physical disability, illiteracy and advanced age were identified as probable risk factors for mental disorders .
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Affiliation(s)
- Walter Herrera Rivera
- Department of Psychiatry, Paulista School of Medicine, Universidade Federal de São Paulo, Brazil.
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Adamson SJ, Sellman JD, Robertson PJ. Social phobia in an outpatient alcohol and drug treatment sample. Aust N Z J Psychiatry 2008; 42:134-40. [PMID: 18197508 DOI: 10.1080/00048670701787511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To examine characteristics of patients with social phobia (SP) in alcohol and drug treatment settings and to identify features distinguishing this group from patients with and without other psychiatric conditions. METHOD A random sample of 105 patients completing an initial assessment at two outpatient alcohol and drug treatment services were assessed and agreed to a 9 month follow-up interview, completed by n=102 (97%). At baseline the Composite International Diagnostic Interview (CIDI) was administered. Current diagnoses at baseline were used to separate the sample into those with SP (n=33), other current psychiatric disorders (OPD, n=40), and those with no current psychiatric diagnosis other than a substance use disorder (NPD, n=29). The novel methodology used in this study compared the SP group first to the NPD group to see if SP was associated with a different presentation, and then compared the SP group to the OPD group to see if any identified differences were associated with SP per se or psychopathology generally. The three groups were compared on demographic, current clinical, and past treatment utilization variables at baseline, while follow-up data were used to compare the groups on treatment outcome and treatment utilization. RESULTS The SP group did not differ from either group in a systematic way. What differences did emerge tended to show a difference between OPD and NPD, with SP intermediate between the two, or that SP and OPD together were different from NPD. CONCLUSIONS Despite the relatively small sample size, these findings suggest that in substance use disorder treatment settings, patients with coexisting SP do not represent a distinctly high-needs or at-risk group in the broader context of patient populations, for which coexisting psychiatric diagnoses are the norm rather than the exception.
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Affiliation(s)
- Simon J Adamson
- National Addiction Centre, Terrace House, Department of Psychological Medicine, Christchurch School of Medicine and Health Science, Christchurch, New Zealand.
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