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Grote V, Wagner T, Riedl D, Kautzky-Willer A, Fischer MJ, Scheibenbogen O, Musalek M. Female Patients Show a Larger Reduction in Suicidal Ideation in Inpatient Addiction Treatment Than Male Patients: Results of a Single-Center Observational Study. Subst Abuse Rehabil 2024; 15:31-42. [PMID: 38567036 PMCID: PMC10986415 DOI: 10.2147/sar.s454436] [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: 01/09/2024] [Accepted: 03/16/2024] [Indexed: 04/04/2024] Open
Abstract
Background Substance use disorders (SUD) are prevalent disorders worldwide. Among other associated health problems, patients with SUD are at an increased risk of dying of suicide, with females displaying an even higher risk than males. Therefore, the aim of this study was to conduct a gender-sensitive evaluation of changes in suicidal ideation during multimodal inpatient treatment at a hospital facility specialized in treating addiction. Methods A total of 694 patients (68.2% male) completed routine assessment including suicidal ideation, abstinence confidence, impulsivity, emotion regulation, self-efficacy and autonomy and joy both before (T1) and at the end (T2) of treatment. Mean changes were evaluated with repeated measures MANOVAs. Results Before treatment, a total of n=127 (18.3%) of the respondents reported suicidal ideation, which was reduced to n=72 (10.4%) by the end of treatment. Among female patients, the change in reported suicidal ideation compared from T1 to T2 (21.7% vs 7.7%) was significantly higher than among male patients (T1: 16.7%%, T2: 11.6%; p=0.040). Generally, females reported worse symptoms scores and slightly higher numbers of suicidal thoughts at baseline (effect sizes ranging from η²=.008 - 0.044). While both genders significantly profited from the treatment, female patients generally showed larger improvements than male. Discussion Our study underscores the beneficial effect of addiction-specialized inpatient treatment on suicidal ideation. Additionally, we found a substantial gender effect: while female patients generally were more distressed before treatment, they also reported higher symptom reduction during the treatment. This result highlights the need to perform more gender-sensitive research and develop more gender-sensitive treatment programs.
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Affiliation(s)
- Vincent Grote
- Ludwig Boltzmann Institute for Rehabilitation Research, Ludwig Boltzmann Gesellschaft, Vienna, Austria
| | - Tim Wagner
- Ludwig Boltzmann Institute for Rehabilitation Research, Ludwig Boltzmann Gesellschaft, Vienna, Austria
- Anton Proksch Institute, Vienna, Austria
| | - David Riedl
- Ludwig Boltzmann Institute for Rehabilitation Research, Ludwig Boltzmann Gesellschaft, Vienna, Austria
- University Hospital of Psychiatry II, Medical University of Innsbruck, Innsbruck, Austria
| | | | - Michael J Fischer
- Ludwig Boltzmann Institute for Rehabilitation Research, Ludwig Boltzmann Gesellschaft, Vienna, Austria
- Vamed Rehabilitation Center Kitzbühel, Kitzbühel, Austria
- Clinic for Rehabilitation Medicine, Hannover Medical School MHH, Hannover, Germany
| | | | - Michael Musalek
- Department of General Psychiatry, Sigmund Freud University, Vienna, Austria
- Institute for Social Aesthetics and Mental Health, Sigmund Freud University, Vienna, Austria
- Institute for Social Aesthetics and Mental Health, Sigmund Freud University, Berlin, Germany
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Shin J, Yang S, Park DH, Ryu SH, Ha JH, Kim JW, Jeon HJ. Predictors of Psychiatric Outpatient Adherence after an Emergency Room Visit for a Suicide Attempt. Psychiatry Investig 2020; 17:896-901. [PMID: 32894928 PMCID: PMC7538252 DOI: 10.30773/pi.2020.0130] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 06/25/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE This study aimed to investigate the potential correlation between baseline characteristics of individuals visiting an emergency room for a suicide attempt and subsequent psychiatric outpatient treatment adherence. METHODS Medical records of 525 subjects, who visited an emergency room at a university-affiliated hospital for a suicide attempt between January 2017 and December 2018 were retrospectively reviewed. Potential associations between baseline characteristics and psychiatric outpatient visitation were statistically analyzed. RESULTS 107 out of 525 individuals (20.4%) who attempted suicide visited an outpatient clinic after the initial emergency room visit. Several factors (e.g., sober during suicide attempt, college degree, practicing religion, psychiatric treatment history) were significantly related to better psychiatric outpatient follow-up. CONCLUSION Several demographic and clinical factors predicted outpatient adherence following a suicide attempt. Therefore, additional attention should be given to suicide attempters who are at the risk of non-adherence by practitioners in the emergency room.
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Affiliation(s)
- Jin Shin
- Department of Psychiatry, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Seungbeom Yang
- Department of Psychiatry, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Doo-Heum Park
- Department of Psychiatry, Konkuk University Medical Center, Seoul, Republic of Korea.,Department of Psychiatry, School of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Seung-Ho Ryu
- Department of Psychiatry, Konkuk University Medical Center, Seoul, Republic of Korea.,Department of Psychiatry, School of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Jee Hyun Ha
- Department of Psychiatry, Konkuk University Medical Center, Seoul, Republic of Korea.,Department of Psychiatry, School of Medicine, Konkuk University, Seoul, Republic of Korea
| | - Jong Won Kim
- Department of Emergency Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Hong Jun Jeon
- Department of Psychiatry, Konkuk University Medical Center, Seoul, Republic of Korea
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Yuodelis-Flores C, Ries RK. Addiction and Suicide: A Review. FOCUS (AMERICAN PSYCHIATRIC PUBLISHING) 2019; 17:193-199. [PMID: 32021589 PMCID: PMC6526997 DOI: 10.1176/appi.focus.17203] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
(Reprinted with permission from The American Journal on Addictions 24: 98-104, 2015).
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Evren C, Karabulut V, Alniak I, Evren B, Carkci OH, Yilmaz Cengel H, Ozkara Menekseoglu P, Cetin T, Bozkurt M, Umut G. Emotion dysregulation and internalizing symptoms affect relationships between ADHD symptoms and borderline personality features among male patients with substance use disorders. PSYCHIAT CLIN PSYCH 2019. [DOI: 10.1080/24750573.2019.1595271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Cuneyt Evren
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Vahap Karabulut
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Izgi Alniak
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Bilge Evren
- Department of Psychiatry, Baltalimani State Hospital for Muskuloskeletal Disorders, Istanbul, Turkey
| | - Ozlem Helin Carkci
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Hanife Yilmaz Cengel
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Pelin Ozkara Menekseoglu
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Turan Cetin
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Muge Bozkurt
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
| | - Gokhan Umut
- Research, Treatment and Training Center for Alcohol and Substance Dependence (AMATEM), Bakirkoy Training and Research Hospital for Psychiatry Neurology and Neurosurgery, Istanbul, Turkey
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Parmar A, Kaloiya G. Comorbidity of Personality Disorder among Substance Use Disorder Patients: A Narrative Review. Indian J Psychol Med 2018; 40:517-527. [PMID: 30533947 PMCID: PMC6241194 DOI: 10.4103/ijpsym.ijpsym_164_18] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Comorbidity of personality disorders (PDs) and substance use disorders (SUDs) is common in clinical practice. Borderline PD and antisocial PD are particularly found to be associated with SUDs. Our review suggests that the overall prevalence of PD ranges from 10% to 14.8% in the normal population and from 34.8% to 73.0% in patients treated for addictions. Even though the types of PD seen in patients with drug and alcohol use disorder are similar, the prevalence of any PD is higher among patients with drug use disorder than alcohol use disorder. The higher comorbidity between these two conditions has been explained by a primary personality pathology followed by a secondary development of a SUD. The comorbidity with PD positively correlates with the severity of the SUD. Comorbid PD among patients with SUDs is a predictor of poor prognosis in terms of poorer treatment response and outcome. Psychotherapy is the mainstay of treatment in comorbid condition with dialectical behavioral therapy, dynamic deconstructive psychotherapy, and dual-focused schema therapy having the most evidence base. Pharmacotherapy is primarily indicated for the acute crisis management or for the treatment of other comorbid conditions such as psychosis and depression. However, the evidence is insufficient as of now to suggest one treatment over the other. Further research is required to identify more efficacious treatment approaches for this comorbidity.
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Affiliation(s)
- Arpit Parmar
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India
| | - Gaurishanker Kaloiya
- Department of Psychiatry and NDDTC, All India Institute of Medical Sciences, New Delhi, India
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Hoertel N, Faiz H, Airagnes G, Blanco C, Pascal De Raykeer R, Franco S, Ducoutumany G, Lemogne C, Limosin F. A comprehensive model of predictors of suicide attempt in heavy drinkers: Results from a national 3-year longitudinal study. Drug Alcohol Depend 2018; 186:44-52. [PMID: 29547760 DOI: 10.1016/j.drugalcdep.2018.01.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Revised: 11/04/2017] [Accepted: 01/05/2018] [Indexed: 10/17/2022]
Abstract
BACKGROUND Heavy drinkers are at high risk for suicide attempt and suicide. Multiple factors, when examined in isolation, have been implicated in the risk of suicide attempt in this population. In this report, we present a comprehensive model of the 3-year risk of suicide attempt in heavy drinkers using a longitudinal nationally representative study, the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; wave 1, 2001-2002; wave 2, 2004-2005). METHODS We used structural equation modeling to simultaneously examine effects of four broad groups of clinical factors previously identified as potential predictors of attempted suicides: 1) alcohol use disorder severity, 2) severity of comorbidity, 3) sociodemographic characteristics and 4) help-seeking for alcohol problems. Heavy drinking was defined as drinking 5 or more drinks in a day more than once a week in the month prior to Wave 1. RESULTS About 1.5% of the 1573 heavy drinker participants (i.e., 5.1% of the NESARC sample) attempted suicide during the 3-year follow-up period. After adjusting for all other factors, several factors independently predicted attempted suicides: the alcohol use disorder liability factor measured by DSM-IV-TR criteria for alcohol abuse and dependence and two dimensions of psychopathology, the general psychopathology factor accounting for the shared effects of all comorbid psychiatric disorders and the externalizing dimension accounting for the shared effects of comorbid substance use disorders. No other factor predicted this risk in addition. CONCLUSION This model may help identify individuals with heavy drinking at high risk of suicide and develop more effective suicide prevention strategies.
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Affiliation(s)
- Nicolas Hoertel
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin-Celton Hospital, Department of Psychiatry, 92130, Issy-les-Moulineaux, France; INSERM UMR 894, Psychiatry and Neurosciences Center, France; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France.
| | - Hadi Faiz
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin-Celton Hospital, Department of Psychiatry, 92130, Issy-les-Moulineaux, France; INSERM UMR 894, Psychiatry and Neurosciences Center, France
| | - Guillaume Airagnes
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin-Celton Hospital, Department of Psychiatry, 92130, Issy-les-Moulineaux, France; Inserm, UMS 011, Population-based Epidemiological Cohorts, Villejuif, France; Inserm UMR 1168, VIMA, Villejuif, France
| | - Carlos Blanco
- Division of Epidemiology, Services, and Prevention Research, National Institute on Drug Abuse, Bethesda, MD, USA
| | - Rachel Pascal De Raykeer
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin-Celton Hospital, Department of Psychiatry, 92130, Issy-les-Moulineaux, France; INSERM UMR 894, Psychiatry and Neurosciences Center, France
| | - Silvia Franco
- New York State Psychiatric Institute, Department of Psychiatry, College of Physicians and Surgeons of Columbia University, New York, NY, USA
| | - Géraldine Ducoutumany
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin-Celton Hospital, Department of Psychiatry, 92130, Issy-les-Moulineaux, France
| | - Cédric Lemogne
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin-Celton Hospital, Department of Psychiatry, 92130, Issy-les-Moulineaux, France; INSERM UMR 894, Psychiatry and Neurosciences Center, France; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France
| | - Frédéric Limosin
- Assistance Publique-Hôpitaux de Paris (APHP), Corentin-Celton Hospital, Department of Psychiatry, 92130, Issy-les-Moulineaux, France; INSERM UMR 894, Psychiatry and Neurosciences Center, France; Paris Descartes University, PRES Sorbonne Paris Cité, Paris, France
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7
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Newton-Howes G, Foulds J. Personality Disorder and Alcohol Use Disorder: An Overview. Psychopathology 2018; 51:130-136. [PMID: 29466805 DOI: 10.1159/000486602] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2017] [Accepted: 12/26/2017] [Indexed: 12/15/2022]
Abstract
BACKGROUND Clinically, personality disorder (PD) commonly coexists with alcohol use disorder (AUD), although within mainstream mental health services both of these mental disorders are routinely overlooked. Despite a rich literature examining the interactions between AUD and personality functioning, personality traits, and PD, there remains conflicting evidence as to the degree of association and impact of one on the other. METHODS A narrative review and a synthesis of the literature were done. RESULTS The lifetime prevalence of AUD approaches 50% in some PD populations. The rates of PD in AUD populations are less clear but likely similar. Personality influences outcomes in AUD regardless of whether a categorical personality diagnosis or dimensional trait domain approach is taken. There are, however, no good data to inform clinicians on the impact of AUD on the outcomes of PD. Understanding the extent of this impact is complicated by the multiple tools used for diagnosis (of both PD and AUD) and the statistical methods used. Overall, caution is required in interpreting the data due to the quality of the current literature; however, comorbidity between the two disorders is likely significant and the impact of PD on AUD outcomes is sufficient to require consideration. CONCLUSIONS From a research perspective, better agreement on both diagnoses and outcomes is urgently needed to improve the overall quality of the evidence. Clinically, despite the limitations in the literature, it is unacceptable for PD services to ignore AUD and for AUD services not to screen for PD. Both are likely to have an impact on health and functioning and should be considered in routine reviews. A better conceptualization of the putative mechanisms of this interaction, as well as an understanding of the neurobiology and reasons for the impact on treatment outcomes, will help to move the field forward.
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Affiliation(s)
- Giles Newton-Howes
- Department of Psychological Medicine, University of Otago, Wellington, New Zealand
| | - James Foulds
- Department of Psychological Medicine, University of Otago, Christchurch, New Zealand
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Shorey RC, Elmquist J, Wolford-Clevenger C, Gawrysiak MJ, Anderson S, Stuart GL. The relationship between dispositional mindfulness, borderline personality features, and suicidal ideation in a sample of women in residential substance use treatment. Psychiatry Res 2016; 238:122-128. [PMID: 27086221 PMCID: PMC4834542 DOI: 10.1016/j.psychres.2016.02.040] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 12/28/2015] [Accepted: 02/16/2016] [Indexed: 11/27/2022]
Abstract
Borderline personality disorder (BPD), which is characterized by unstable moods, behavior, and relationships, is also associated with heightened suicidal ideation. Prior research has demonstrated that BPD and suicidal ideation are prevalent among women in substance use treatment. Efforts to treat substance use in this population are made difficult due to the severity of BPD, and it is possible that mindfulness-based interventions specific to substance use could be an effective approach for this population. However, basic research is needed on the relationship between dispositional mindfulness, BPD, and suicidal ideation among women in treatment for substance use to support their associations, which was the purpose of the present study. Pre-existing medical records were reviewed from a residential substance use treatment center. A total of 81 female patients were included in the current study. Patients completed self-report measures of mindfulness, BPD, suicidal ideation, substance use, and impression management at treatment intake. Findings demonstrated dispositional mindfulness to be negatively associated with BPD features and suicidal ideation. With the exception of self-harm, this negative relationship was found even after controlling for age, substance use, and impression management. Future research should examine whether mindfulness-based interventions are an effective treatment for comorbid substance use and BPD.
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Affiliation(s)
- Ryan C Shorey
- Ohio University, Department of Psychology, Athens, OH, USA.
| | - JoAnna Elmquist
- University of Tennessee, Knoxville, Department of Psychology, Knoxville, TN, USA
| | | | | | | | - Gregory L Stuart
- University of Tennessee, Knoxville, Department of Psychology, Knoxville, TN, USA
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Shustov D, Tuchina O, Fedotov I, Novikov S. Self-destructive alcoholic personality. КОНСУЛЬТАТИВНАЯ ПСИХОЛОГИЯ И ПСИХОТЕРАПИЯ 2016. [DOI: 10.17759/cpp.2016240306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
The article presents the findings of а study investigating a relationship between personality types developing under the influence of negative parental messages (injunctions) and different types of self-destructive behaviors in alcohol-dependent patients. The study was carried out in 2009—2012 in Ryazan in a sample of 190 outpatient male clients who received psychotherapy for alcohol-dependence. The authors assumed that the choice of self-destructive behaviors was linked to the alcohol-dependent patients’ personality organization and depended on а combination of different injunctions with the main self-destructive injunction — “Don’t be”. The authors describe parental injunctions, which contributed to the devel- opment of “the alcoholic personality”. The main contributing injunctions were “Don’t be” which formed the basis for self-destructiveness, and “Don’t think”, which reinforced alcohol abuse as a maladaptive coping strategy. The other injunctions, when combined with “Don’t be”, were mediating personality type de- velopment and the related groups of self-destructiveness. The authors identified statistically significant correlations between the most frequent personality types and specific groups of self-destructive behavior in alcohol-dependent patients: thus, borderline personality organization was linked to suicidal behavior, dissocial personality organization — to antisocial behaviors, and narcissistic — to self- destructiveness in the professional sphere.
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Affiliation(s)
| | - O.D. Tuchina
- Moscow Research and Practical Centre for Narcology of the Department of Public Health
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Yuodelis-Flores C, Ries RK. Addiction and suicide: A review. Am J Addict 2015; 24:98-104. [PMID: 25644860 DOI: 10.1111/ajad.12185] [Citation(s) in RCA: 170] [Impact Index Per Article: 18.9] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Revised: 10/30/2014] [Accepted: 11/16/2014] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Addiction specialists frequently find themselves faced with suicidal behavior in their addictions patients. Although many addiction treatment programs will not accept clients with recent suicidal behavior, up to 40% of patients seeking treatment for substance dependence report a history of suicide attempt(s).(1-3) Risk factors for suicide have been studied in the general population and among people with mental illness, less is known about risk factors in those with substance use disorders and co-occurring disorders. METHODS Studies, psychological autopsies and recent reviews on risk factors for suicide and suicide attempts in patients with alcohol and drug use disorders and the relationship with co-occurring mental illness were examined. RESULTS AND CONCLUSIONS Suicidal behavior is a significant problem for people with co-occurring disorders seeking addiction treatment. Several predisposing and precipitating risk factors such as marital and interpersonal relationship disruption, occupational and financial stressors, recent heavy substance use and intoxication as well as a history of previous suicide attempts and sexual abuse combine in an additive fashion with personality traits and mental illnesses to intensify risk for suicidal behavior in addiction patients. Major depression, bipolar disorder, borderline personality disorder and post-traumatic stress disorder are especially associated with suicidal behavior in people with addictive disorders. DISCUSSION AND SCIENTIFIC SIGNIFICANCE Treatment implications of these findings are discussed. Addiction treatment providers should routinely gather information about client's suicidal histories, thoughts, and plans in order to assess risk and develop treatment plans for suicidality at various points in treatment.
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Affiliation(s)
| | - Richard K Ries
- University of Washington, Department of Psychiatry and Behavioral Sciences, Seattle, Washington
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Prakash O, Sharma N, Singh AR, Sengar KS, Chaudhury S, Ranjan JK. Personality disorder, emotional intelligence, and locus of control of patients with alcohol dependence. Ind Psychiatry J 2015; 24:40-7. [PMID: 26257482 PMCID: PMC4525430 DOI: 10.4103/0972-6748.160931] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIM To assess personality disorder (PD), emotional intelligence (EI), and locus of control of alcohol dependent (AD) patients and its comparison with normal controls. MATERIALS AND METHODS Based on purposive sampling technique, 33 AD patients were selected from the De-Addiction Ward of Ranchi Institute of Neuro-Psychiatry and Allied Sciences (RINPAS) and 33 matched normal subjects were selected from Ranchi and nearby places. Both the groups were matched on various sociodemographic parameters, that is, age, gender, and socioeconomic level. All participants were assessed with Millon Clinical Multiaxial Inventory-III, Mangal EI Inventory, and Locus of Control scale. Obtained responses were scored by using standard scoring procedures and subsequently statistically analyzed by using Chi-square test. RESULTS AD patients have more comorbid pathological personality traits and disorders in comparison to their normal counterparts. Depressive, narcissistic, and paranoid PDs were prominent among AD group; followed by schizotypal, antisocial, negativistic, dependent, schizoid, sadistic, masochistic, and borderline PD. In comparison to normal participants, AD patients were significantly deficient in almost all the areas of EI and their locus of control was externally oriented. CONCLUSION Patients with AD have significantly higher PDs, low EI, and an external orientation on the locus of control. Identification and management of these comorbid conditions are likely to improve the management and outcome of AD.
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Affiliation(s)
- Om Prakash
- Clinical Psychologist, Government Medical College and Hospital, Sector 32, Chandigarh, India
| | - Neelu Sharma
- Department of Clinical Psychology, RINPAS, Kanke, Ranchi, Jharkhand, India
| | - Amool R Singh
- Department of Clinical Psychology, RINPAS, Kanke, Ranchi, Jharkhand, India
| | - K S Sengar
- Department of Clinical Psychology, RINPAS, Kanke, Ranchi, Jharkhand, India
| | - Suprakash Chaudhury
- Department of Psychiatry, Pravara Institute of Medical Sciences (Deemed University), Rural Medical College, Ahmed Nagar, Maharashtra, India
| | - Jay Kumar Ranjan
- Department of Psychology, RBR NES PG College, Jaspur Nagar, Chhattisgarh, India
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Dalbudak E, Evren C, Aldemir S, Evren B. The severity of Internet addiction risk and its relationship with the severity of borderline personality features, childhood traumas, dissociative experiences, depression and anxiety symptoms among Turkish university students. Psychiatry Res 2014; 219:577-82. [PMID: 25023365 DOI: 10.1016/j.psychres.2014.02.032] [Citation(s) in RCA: 81] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 02/17/2014] [Accepted: 02/24/2014] [Indexed: 01/30/2023]
Abstract
The aim of this study was to investigate the relationship of Internet addiction (IA) risk with the severity of borderline personality features, childhood traumas, dissociative experiences, depression and anxiety symptoms among Turkish university students. A total of 271 Turkish university students participated in this study. The students were assessed through the Internet Addiction Scale (IAS), the Borderline Personality Inventory (BPI), the Dissociative Experiences Scale (DES), the Childhood Trauma Questionnaire (CTQ-28), the Beck Depression Inventory (BDI) and the Beck Anxiety Inventory (BAI). The rates of students were 19.9% (n=54) in the high IA risk group, 38.7% (n=105) in the mild IA risk group and 41.3% (n=112) in the group without IA risk. Correlation analyses revealed that the severity of IA risk was related with BPI, DES, emotional abuse, CTQ-28, depression and anxiety scores. Univariate covariance analysis (ANCOVA) indicated that the severity of borderline personality features, emotional abuse, depression and anxiety symptoms were the predictors of IAS score, while gender had no effect on IAS score. Among childhood trauma types, emotional abuse seems to be the main predictor of IA risk severity. Borderline personality features predicted the severity of IA risk together with emotional abuse, depression and anxiety symptoms among Turkish university students.
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Affiliation(s)
- Ercan Dalbudak
- Department of Psychiatry, Faculty of Medicine, Turgut Ozal University, Ankara, Turkey.
| | - Cuneyt Evren
- Bakirkoy Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Alcohol and Drug Research, Treatment and Training Center (AMATEM), Istanbul, Turkey
| | - Secil Aldemir
- Department of Psychiatry, Faculty of Medicine, Turgut Ozal University, Ankara, Turkey
| | - Bilge Evren
- Department of Psychiatry, Baltalimani State Hospital for Muskuloskeletal Disorders, Istanbul, Turkey
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Teraishi T, Hori H, Sasayama D, Matsuo J, Ogawa S, Ishida I, Nagashima A, Kinoshita Y, Ota M, Hattori K, Kunugi H. Relationship between lifetime suicide attempts and schizotypal traits in patients with schizophrenia. PLoS One 2014; 9:e107739. [PMID: 25226584 PMCID: PMC4166669 DOI: 10.1371/journal.pone.0107739] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2014] [Accepted: 08/14/2014] [Indexed: 11/18/2022] Open
Abstract
Patients with schizophrenia are at increased risk for suicide. Various risk factors for suicide have been reported in schizophrenia; however, few studies have examined the association between personality traits and suicidal behavior. We administered the Schizotypal Personality Questionnaire (SPQ) to 87 Japanese patients with schizophrenia (49 males; mean age 38.1±10.6 years) with and without a history of suicide attempts (SA and nSA groups, respectively), and 322 controls (158 males; mean age 40.8±13.9 years). As expected, an analysis of covariance (ANCOVA) controlling for age and sex showed that all SPQ indices (total SPQ score and all three factors, i.e., cognitive-perceptual, interpersonal, and disorganized) were significantly higher in patients with schizophrenia (SA+nSA groups), than controls (p<0.001 for all comparisons). Furthermore, there were significant differences in the total score and the interpersonal and disorganized factors between the SA and nSA groups (nSA<SA, p<0.01 for all comparisons). Receiver operating characteristic analysis showed that a total SPQ score of 33.5 was the optimal cut-off value to discriminate the SA group from the nSA group (χ2[1] = 10.6, p = 0.002, odds ratio: 4.7, 95% confidence interval: 1.8–12.1, sensitivity: 0.70, specificity: 0.67). These results suggest that high schizotypy is associated with lifetime suicide attempts, and that the total SPQ score might be useful to assess the risk of suicide attempt in patients with schizophrenia.
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Affiliation(s)
- Toshiya Teraishi
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hiroaki Hori
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Daimei Sasayama
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Junko Matsuo
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Shintaro Ogawa
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Ikki Ishida
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Anna Nagashima
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Yukiko Kinoshita
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Miho Ota
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Kotaro Hattori
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
| | - Hiroshi Kunugi
- Department of Mental Disorder Research, National Institute of Neuroscience, National Center of Neurology and Psychiatry, Tokyo, Japan
- * E-mail:
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Kienast T, Stoffers J, Bermpohl F, Lieb K. Borderline personality disorder and comorbid addiction: epidemiology and treatment. DEUTSCHES ARZTEBLATT INTERNATIONAL 2014; 111:280-6. [PMID: 24791755 PMCID: PMC4010862 DOI: 10.3238/arztebl.2014.0280] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Revised: 02/13/2014] [Accepted: 02/13/2014] [Indexed: 11/27/2022]
Abstract
BACKGROUND Borderline personality disorder (BPD) affects 2.7% of adults. About 78% of adults with BPD also develop a substance-related disorder or addiction at some time in their lives. These persons are more impulsive and clinically less stable than BPD patients without substance dependency. They display suicidal behavior to a greater extent, drop out of treatment more often, and have shorter abstinence phases. The combination of borderline personality disorder with addiction requires a special therapeutic approach. METHOD This review is based on a selective literature search about the treatment of patients with BPD and addiction, with particular attention to Cochrane Reviews and randomized controlled trials (RCT). RESULTS The available evidence is scant. In two RCTs, Dialectical Behavior Therapy for Substance Use Disorders (DBT-SUD) was found to improve patients' overall functional level (standardized mean difference, 1.07-1.78) and to increase the number of abstinence days (effect strength [ES], 1.03) and negative urine samples (ES, 0.75). Dual focus schema therapy (DFST) was evaluated in three RCTs. Because of methodological problems, however, no useful quantitative comparison across trials is possible. In one RCT, dynamic deconstructive psychotherapy (DDP) was found to have only a moderate, statistically insignificant effect. Only a single study provides data about potentially helpful drug therapy over the intermediate term. CONCLUSION Patients with borderline personality disorder and comorbid addiction should be treated as early as possible for both conditions in a thematically hierarchical manner. There is no evidence for any restriction on drug therapy to prevent recurrent addiction in these patients. The psychotherapeutic techniques that can be used (despite the currently inadequate evidence base) include DBT-SUD, DFST, and DDP. These patients need qualified expert counseling in choosing a suitable type of psychotherapy. Specific treatment is available in only a few places, and the relevant treatment networks in Germany are just beginning to be constructed.
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Affiliation(s)
- Thorsten Kienast
- Department of Psychological Medicine, Max-Grundig-Clinic, Bühl/Baden, Department of Psychiatry and Psychotherapy at the Charité Campus Mitte, Berlin, Department of Psychiatry and Psychotherapy, University Hospital of Freiburg, Department of Psychiatry and Psychotherapy, University Medical Center Mainz
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15
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Levola J, Kaskela T, Holopainen A, Sabariego C, Tourunen J, Cieza A, Pitkänen T. Psychosocial difficulties in alcohol dependence: a systematic review of activity limitations and participation restrictions. Disabil Rehabil 2013; 36:1227-39. [DOI: 10.3109/09638288.2013.837104] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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16
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Tschiesner R, Schweigkofler H, Favaretto E, Prossliner J, Lun S, Schwitzer J. [About epidemiology of suicidal behavior: an investigation in the health-service district of Brixen]. NEUROPSYCHIATRIE : KLINIK, DIAGNOSTIK, THERAPIE UND REHABILITATION : ORGAN DER GESELLSCHAFT OSTERREICHISCHER NERVENARZTE UND PSYCHIATER 2012; 26:121-128. [PMID: 23055306 DOI: 10.1007/s40211-012-0024-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2011] [Accepted: 02/02/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE Aim of this investigation is to find out how many parasuicids as well as suicides are commited and which epidemiological characteristics (sex, age, substance addictions, relationships, job, life-events and suicide attempts in past) show people who commit suicide, and people who commiting parasuicide. After that we try to find variables predicting a suicide or variables what show a vulnerability to commit suicide. METHODS Clinicans assess patients who commit parasuicide by the WHO-Parasuicide-Monitoring-Questionnaire and suicide victims by interview with the bereaved. Afterwards, data are assimilated and aggregated. RESULTS In this period a mean of 37 (SD = 7.78) parasuicides and 6.32 (SD = 3.79) suicides happened yearly. The sample shows different characteristics in age, sex, life-events in the run-up to the action, job situation and parasuicide(s) in past. No differences were found between relationship and substance abuse/addiction and regarding both types of suicidal behavior. CONCLUSION The incidence concerning suicide is slightly lower; the incidence with regard to parasuicide is lower than in other samples. Demographic variables show that people commiting suicide differ from those who commit parasuicide.
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Affiliation(s)
- Reinhard Tschiesner
- Fakultät für Bildungswissenschaften Brixen, Freie Universität Bozen, Regensburger Allee 16, Bozen, Italien
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17
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Chachamovich E, Ding Y, Turecki G. Levels of aggressiveness are higher among alcohol-related suicides: results from a psychological autopsy study. Alcohol 2012; 46:529-36. [PMID: 22579734 DOI: 10.1016/j.alcohol.2012.03.007] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2011] [Revised: 03/13/2012] [Accepted: 03/29/2012] [Indexed: 01/09/2023]
Abstract
Suicide is one of the major causes of deaths worldwide. Several studies have showed that alcohol use disorders (AUD) are associated with suicide ideation, suicide attempts, and suicide completion. The majority of the theoretical conceptualization and the bulk of evidence on suicidal behavior and AUD are based on investigations of nonfatal cases because data on nonfatal suicidal behaviors are more readily available. This study aims to explore demographic, clinical, and behavioral dimensions in a large sample of alcohol-related suicides compared to an age-gender matched sample of non-AUD suicides to identify specific factors associated with AUD suicides. We conducted a psychological autopsy study with 158 pairs of AUD and non-AUD suicides. Findings showed that AUD suicides have lower educational level, more biological children and were more likely to be heavy smokers (OR=3.32). Cases were more likely to have family history of alcohol (OR=1.73) and drug abuse (OR=3.61). Subjects had similar prevalences of depressive disorders, anxiety disorders or psychotic disorders. AUD suicides were more likely to meet criteria for current cocaine abuse/dependence (OR=6.64). With respect to personality disorders, AUD suicides presented higher prevalence of Antisocial Personality Disorder (OR=4.68), and were less likely to meet criteria for Avoidant (OR=0.26) and Obsessive-Compulsive Personality Disorders (OR=0.35). Impulsivity scores were higher in AUD suicides (p=0.18), as well as aggression scores (p<0.001). Results form the conditional logistic regression models showed that cocaine abuse/dependence (OR=4.20) and Antisocial Personality Disorder (OR=6.24) were associated with AUD suicide. After controlling for impulsive-aggressive behaviors, levels of aggression were the only psychopathological feature statistically different between AUD and non-AUD suicides (OR=1.28). In conclusion, higher levels of aggressive behaviors are a specific characteristic of AUD suicides. Apart from substance-related diagnoses, AUD and non-AUD suicides have comparable Axis I psychiatric diagnoses and familial transmission of suicidal behavior.
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Affiliation(s)
- Eduardo Chachamovich
- McGill Group for Suicide Studies, Department of Psychiatry, McGill University, 6875 LaSalle Blvd, Montreal, Quebec, Canada H4H 1R3.
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Evren C, Cınar O, Evren B. Relationship of alexithymia and dissociation with severity of borderline personality features in male substance-dependent inpatients. Compr Psychiatry 2012; 53:854-9. [PMID: 22225788 DOI: 10.1016/j.comppsych.2011.11.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2011] [Revised: 11/13/2011] [Accepted: 11/28/2011] [Indexed: 11/24/2022] Open
Abstract
The aim of this study was to evaluate possible interactions between severity of borderline personality features (BPFs), dissociative experiences, and alexithymia among substance-dependent men while controlling for their current age, depression, and anxiety. Participants were 200 substance-dependent men consecutively admitted to a dependency treatment unit. The Borderline Personality Inventory, the Toronto Alexithymia Scale, the Dissociative Experiences Scale, the Beck Depression Inventory, and the Spielberger State-Trait Anxiety Inventory were administered to all participants. Severity of negative affect, alexithymia, dissociative experiences, and BPF were correlated with each other. Being younger, severity of dissociative experiences, difficulty in identifying feelings, depression, and trait anxiety predicted the severity of BPF in linear regression analysis. These findings suggest that alexithymia and dissociative experiences may be a way of coping with depression and chronic anxiety, but they also seem to be related to the severity of BPF independent of the negative affect and from each other.
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Affiliation(s)
- Cuneyt Evren
- Bakirkoy State Hospital for Mental Health and Neurological Disorders, Alcohol and Drug Research, Treatment and Training Center, Istanbul, Turkey.
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19
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Qin P. The impact of psychiatric illness on suicide: differences by diagnosis of disorders and by sex and age of subjects. J Psychiatr Res 2011; 45:1445-52. [PMID: 21722920 DOI: 10.1016/j.jpsychires.2011.06.002] [Citation(s) in RCA: 84] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 05/01/2011] [Accepted: 06/01/2011] [Indexed: 10/16/2022]
Abstract
People with a psychiatric illness are at high risk for suicide; however, variation of the risk by patients' sex and age and by specific diagnosis needs to be explored in a more detail. This large population study systematically assesses suicide incidence rate ratio (IRR) and population attributable risk (PAR) associated with various psychiatric disorders by comparing 21,169 suicides in Denmark over a 17-year period with sex-age-time-matched population controls. The study shows that suicide risk is significantly increased for persons with a hospitalized psychiatric disorder and the associated risk varies significantly by diagnosis and by sex and age of subjects. Further adjustment for personal socioeconomic differences eliminates the IRRs associated with various disorders only to a limited extend. Recurrent depression and borderline personality disorder increase suicide risk the strongest while dementia increases the risk the least for both males and females. The influence of various disorders generally weakens with increasing age; however, there are important exceptions. Schizophrenia affects people aged ≤35 years the strongest in terms of both IRR and PAR. Recurrent depression increases suicide risk particularly strong in all age groups and the associated PAR increases steadily with age. Borderline personality disorder has a strong effect in young people, especially those ≤35 years. Alcohol use disorder accounts the highest PAR of suicides in males of 36-60 years old. For the elderly above 60 years old, reaction to stress and adjustment disorder increases the risk for suicide the most in both sexes. These findings suggest that approaches to psychiatric suicide prevention should be varied according to diagnosis and sex and age of subjects.
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Affiliation(s)
- Ping Qin
- National Centre for Register-Based Research, Aarhus University, Taasingegade 1, DK-8000 Aarhus C, Denmark.
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20
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Zikos E, Gill KJ, Charney DA. Personality disorders among alcoholic outpatients: prevalence and course in treatment. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2010; 55:65-73. [PMID: 20181301 DOI: 10.1177/070674371005500202] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
OBJECTIVE To determine the prevalence of concurrent personality disorders (PDs) among alcoholic men and women seeking outpatient treatment, and to examine their effect on the course of alcohol treatment. METHOD Patients with alcohol use disorders (n = 165) were assessed by clinical and semi-structured interviews, as well as self-report scales, to measure levels of psychological distress, impulsivity, social functioning, and addiction severity at treatment intake. PD diagnoses were assessed using the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Personality Disorder (SCID-II). Course in treatment was monitored prospectively for 12 weeks. RESULTS Using the results of the SCID-II (n = 138), the sample was divided into 3 groups-that is, no PD 41% (n = 57), Cluster B PD 32% (n = 44), and other PD 27% (n = 37). The 3 groups did not differ in their alcohol use severity at intake. However, the Cluster B PD group achieved alcohol milestones at a younger age. Subjects with a PD had more severe psychological and social problems at intake. The Cluster B PD group showed significantly higher levels of impulsivity at intake, greater likelihood of early treatment dropout, and quicker times to first slip and to relapse. CONCLUSIONS This study supports the high prevalence of concurrent PDs, particularly Cluster B PDs, among treatment-seeking alcoholics. The relation between observed high levels of impulsivity and worse course in early alcohol treatment among people with a Cluster B PD merits further investigation.
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Affiliation(s)
- Eugenia Zikos
- Department of Psychiatry, McGill University Health Centre, 1025 Pine Avenue West, Montreal, Quebec.
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Charney DA, Zikos E, Gill KJ. Early recovery from alcohol dependence: Factors that promote or impede abstinence. J Subst Abuse Treat 2010; 38:42-50. [DOI: 10.1016/j.jsat.2009.06.002] [Citation(s) in RCA: 93] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2008] [Revised: 04/20/2009] [Accepted: 06/22/2009] [Indexed: 11/26/2022]
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Preuss U, Johann M, Fehr C, Koller G, Wodarz N, Hesselbrock V, Wong W, Soyka M. Personality Disorders in Alcohol-Dependent Individuals: Relationship with Alcohol Dependence Severity. Eur Addict Res 2009; 15:188-95. [PMID: 19622885 PMCID: PMC2790737 DOI: 10.1159/000228929] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The rate of axis II disorders in alcohol-dependent individuals is suggested to be high. The aim of this investigation is to assess the rate of DSM-IV axis II diagnoses in alcohol-dependent inpatients and their correlation with clinical characteristics of alcohol dependence (AD). 1,079 inpatients with DSM-IV AD from three inpatient addiction treatment centers ('qualified detoxification', open psychiatric university hospital wards) were included. Characteristics of AD were obtained using standardized structured interviews. Diagnoses of DSM-IV personality disorders (PDs) were generated with SCID-II-PQ and SCID-II interviews. Alcoholism severity was measured using the number of DSM-IV criteria endorsed and age at first drinking. Approximately 60% of the sample had at least one PD. However, rates of Axis II disorders differed significantly across centers. The most frequent PDs were obsessive-compulsive, borderline, narcissistic and paranoid PD. Diagnosis of any PD was related to a more severe clinical profile of AD. Regression analyses revealed that obsessive-compulsive PD was related to the number of DSM-IV criteria endorsed while antisocial PD was related to early age at first drinking. The majority of alcohol-dependent individuals had one or more comorbid axis II disorders. Univariate and multivariate analyses indicate that different PDs are related to age at first dinking and alcoholism severity.
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Affiliation(s)
- U.W. Preuss
- Department of Psychiatry, Psychotherapy and Psychosomatics, Martin Luther University of Halle-Wittenberg, Halle, Germany,*Ulrich W. Preuss, MD, Department of Psychiatry, Psychotherapy and Psychosomatics, Martin Luther University of Halle-Wittenberg, Julius-Kühn-Strasse 7, DE–06097 Halle/Saale (Germany), Tel. +49 345 557 4595, Fax +49 345 557 3500, E-Mail
| | - M. Johann
- Department of Psychiatry, University of Regensburg, Regensburg, Germany
| | - C. Fehr
- Department of Psychiatry, Johannes Gutenberg University, Mainz, Germany
| | - G. Koller
- Department of Psychiatry, Ludwig Maximilians University, Munich, Germany
| | - N. Wodarz
- Department of Psychiatry, University of Regensburg, Regensburg, Germany
| | - V. Hesselbrock
- Department of Psychiatry, University of Connecticut School of Medicine, Farmington, Conn., USA
| | - W.M. Wong
- AWO Psychiatry Centre, Halle, Germany
| | - M. Soyka
- Department of Psychiatry, Ludwig Maximilians University, Munich, Germany
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Conner KR, McCloskey MS, Duberstein PR. Psychiatric Risk Factors for Suicide in the Alcohol-dependent Patient. Psychiatr Ann 2008. [DOI: 10.3928/00485713-20081101-04] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Bakken K, Vaglum P. Predictors of suicide attempters in substance-dependent patients: a six-year prospective follow-up. Clin Pract Epidemiol Ment Health 2007; 3:20. [PMID: 17927822 PMCID: PMC2098764 DOI: 10.1186/1745-0179-3-20] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2007] [Accepted: 10/10/2007] [Indexed: 11/16/2022]
Abstract
Background This is a six-year prospective follow-up of a former cross sectional study of suicide attempters in a sample of treatment-seeking substance-dependent patients. The aims were to explore the frequency of patients with new suicide attempts (SA) during the six-year observation period, and to explore the predictive value of lifetime Axis I and II disorders, measured at index admission, on SA in the observation period, when age, gender and substance-use variables, measured both at admission and at follow-up, were controlled for. Methods A consecutive sample of 156 alcohol-dependent and 131 poly-substance-dependent inpatients and outpatients in two Norwegian counties were assessed at index admission (T1) with the Composite International Diagnostic Interview (Axis I disorders), Mon's Clinical Multiaxial Inventory (Axis II disorders) and Hopkins Symptom Checklist-25 (mental distress). At follow-up six years later (T2), 56% (160/287 subjects, 29% women) were assessed using the HSCL-25 and measures of harmful substance use (Alcohol Use Disorders Identification Test and Drug Use Disorders Identification Test). Results The prevalence of patients with SA between T1 and T2 was 19% (30/160), with no difference between sexes or between patient type (alcohol-dependent versus poly-substance-dependent). Sober patients also attempted suicide. At the index admission, lifetime eating disorders, agoraphobia with and without panic disorder, and major depression were significantly and independently associated with SA. Prospectively, only lifetime dysthymia increased the risk of SA during the following six years, whereas lifetime generalized anxiety disorder reduced the risk of SA. Individually, neither the numbers of Axis I and Axis II disorders nor the sum of these disorders were independently related to SA in the observation period. Substance use measured at T1 did not predict SA in the follow-up period, nor did harmful use of substances at follow-up or in the preceding year. Conclusion A high prevalence of SA was found six years later, both in patients still abusing substances and in sober patients. To prevent SA, treatment of both affective disorders and substance abuse is important.
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Affiliation(s)
- Kjell Bakken
- Centre for Addiction Issues, Department for Substance Abuse, Innlandet Hospital Trust, Norway.
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Palomo T, Kostrzewa RM, Beninger RJ, Archer T. Genetic variation and shared biological susceptibility underlying comorbidity in neuropsychiatry. Neurotox Res 2007; 12:29-42. [PMID: 17513198 DOI: 10.1007/bf03033899] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Genetic factors underlying alcoholism, substance abuse, antisocial and violent behaviour, psychosis, schizophrenia and psychopathy are emerging to implicate dopaminergic and cannabinoid, but also monoaminergic and glutamatergic systems through the maze of promoter genes and polymorphisms. Candidate gene association studies suggest the involvement of a range of genes in different disorders of CNS structure and function. Indices of comorbidity both complicate the array of gene-involvement and provide a substrate of hazardous interactivity. The putative role of the serotonin transporter gene in affective-dissociative spectrum disorders presents both plausible genetic variation and complication of comorbidity The position of genetic variation is further complicated through ethnic, contextual and social factors that provide geometric progressions in the comordity already underlying diagnostic obstacles. The concept of shared biological susceptibility to two or more disorder conditions of comorbidity seems a recurring observation, e.g., bipolar disorder with alcoholism or schizophrenia with alcohol/substance abuse or diabetes with schizopsychotic disorder. Several lines of evidence seem to suggest that the factors influencing variation in one set of symptoms and those affecting one or more disorders are observed to a marked extent which ought to facilitate the search for susceptibility genes in comorbid brain disorders. Identification of regional genetic factors is awaited for a more compelling outline that ought eventually to lead to greater efficacy of symptom-disorder arrangements and an augmentation of current pharmacological treatment therapies.
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Affiliation(s)
- Tomas Palomo
- Psychiatry Service, 12 de Octubre, University Hospital, Madrid 28041, Spain
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van den Bosch LM, Verheul R. Patients with addiction and personality disorder: Treatment outcomes and clinical implications. Curr Opin Psychiatry 2007; 20:67-71. [PMID: 17143086 DOI: 10.1097/yco.0b013e328011740c] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW The present review examines the outcomes of treatments focusing on substance abuse, on personality disorders, and on both the foci simultaneously. Clinical guidelines for the treatment of dually diagnosed patients are described. RECENT FINDINGS Recent studies continued the tradition of examining the importance of factors such as the chronicity of substance abuse and the impact of sex with regard to the prognosis of the treatment of substance abuse and the development of effective treatment programs. Overall, the multifaceted and risky nature of dual problems is stressed, and as a logical consequence, an early detection of dual problems is promoted. Several studies show the risk of suicidal and harmful behavior associated with this population, even when the treatment for substance abuse has been successful. For the first time, the issue of dropout is studied from the client's perspective. SUMMARY Knowledge about the effectiveness of dually focused treatments is emerging. Results show that the treatment of dually diagnosed patients with severe problems needs to include both the foci because it leads to enormous gains for the patients when personality disorders are also addressed. Yet, integrated treatment programs are lacking and research is still too limited.
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