Risky use of alcohol, drugs and cigarettes in a psychosis unit: a 1 1/2 year follow-up of stability and changes after initial screening

Pathological gaming: a longitudinal study from the perspectives of mental health problems and social stress model

Debates about pathological gaming continues in the wake of the World Health Organization's (WHO) decision to establish a gaming disorder diagnosis. Questions persist whether gaming disorder is best conceived as a stand-alone psychiatric disorder, or whether it heralds or accompanies other, more established conditions, such as depression or ADHD. We tested these hypotheses in a sample of 3,034 youth from Singapore. Evidence suggests that pathological gaming is a somewhat unstable construct, often remitting spontaneously. Youth with preexisting ADHD or depression were more likely to develop later pathological gaming problems, while the inverse was not true, with neither early pathological gaming nor gaming time predictive of later mental health problems. Results suggest that, whenever there is any need to conduct robust evidence-based studies, more evidence should be collected before new disorders are recognized by means of "expert consensus".

The Psychometric Properties of the Drug Use Disorders Identification Test (DUDIT): A Review of Recent Research

This article reviews the reliability (internal consistency, interrater reliability), factor structure, and validity (i.e., sensitivity and specificity) of the 11-item Drug Use Disorders Identification Test (DUDIT). An extensive literature review was conducted using the Medline, Psychinfo and PubMed databases from January 2005 to October 2014. Search terms were "Drug Use Disorders Identification Test" and "DUDIT". All articles that addressed reliability, factor structure, sensitivity and specificity of the DUDIT were examined. Publications in which the DUDIT was used as a screening tool and/or studies that used the DUDIT to compare use and abuse/dependence of drugs in participants at baseline and at follow-up but had no data on its psychometric properties, were not included. In total, 18 usable publications were identified and included in the review. In general, the DUDIT yields satisfactory measures of reliability and validity for use as a clinical or research tool. Internal consistency reliability estimates (Cronbach's α) are generally >.90. Most studies also revealed favorable sensitivity (ranging from .85 to 1.00) and specificity (ranging from .75 to .92) in a variety of populations. Results on the factor structure, however, are somewhat equivocal. Future directions for research on the DUDIT are suggested.

Psychometric properties of the Turkish versions of the Drug Use Disorders Identification Test (DUDIT) and the Drug Abuse Screening Test (DAST-10) in the prison setting

The aim of this study was to evaluate psychometric properties of the Drug Use Disorders Identification Test (DUDIT) and the Drug Abuse Screening Test (DAST-10) in prisoners with (n = 124) or without (n = 78) drug use disorder. Participants were evaluated with the DUDIT, the DAST-10, and the Addiction Profile Index-Short (API-S). The DUDIT and the DAST-10 were found to be psychometrically sound drug abuse screening measures with high convergent validity when compared with each other (r = 0.86), and API-S (r = 0.88 and r = 0.84, respectively), and to have a Cronbach's α of 0.93 and 0.87, respectively. In addition, a single component accounted for 58.28% of total variance for DUDIT, whereas this was 47.10% for DAST-10. The DUDIT had sensitivity and specificity scores of 0.95 and 0.79, respectively, when using the optimal cut-off score of 10, whereas these scores were 0.88 and 0.74 for the DAST-10 when using the optimal cut-off score of 4. Additionally, both the DUDIT and the DAST-10 showed good discriminant validity as they differentiated prisoners with drug use disorder from those without. Findings support the Turkish versions of both the DUDIT and the DAST-10 as reliable and valid drug abuse screening instruments that measure unidimensional constructs.

Health-related quality of life and metabolic risk in patients with psychosis

Improved Health-related quality of life (HRQoL) is an alternative treatment goal for individuals with psychosis, who have up to two times greater prevalence of type 2 diabetes, hypertension and obesity than the general population.

AIM

to compare HRQoL in patients with psychosis, especially schizophrenia, with a reference sample and explore the relationship between HRQoL and metabolic risk factors in these patients.

METHODS

a prospective cohort study was carried out in specialized psychiatric outpatient departments in Sweden. The patients were invited consecutively. A prospective population-based study of public health in the south-east of Sweden served as reference group. Patients were assessed with psychiatric questionnaires that included Global Assessment of Functioning (GAF). Health-related quality of life was assessed using the questionnaire EQ5D, both for patients and the population, and several other health status outcomes were used.

RESULTS

At 73%, schizophrenia and schizoaffective disorder were the most common diagnoses in the patient group. The results in patients (n=903) and population (n=7238) showed significant differences in lower EQ5D among patients. According to the definition by the International Diabetes Federation (IDF), elevated blood pressure was the only metabolic risk associated with lower HRQoL in patients. Raised LDL-cholesterol levels were also significantly related to lower HRQoL.

CONCLUSION

patients suffering from psychosis had significantly lower HRQoL regarding all components in EQ5D, except for the pain/discomfort component. Almost half of the patient group met the criteria for metabolic syndrome. According to the IDF criteria, elevated blood pressure was the only metabolic risk factor that had an impact on HRQoL.

Alcohol and cannabis use and mortality in people with schizophrenia and related psychotic disorders

The impact of co-morbid substance use on mortality is not well studied in psychotic disorders. The objective of this study was to examine the impact of substance use on mortality in people with psychotic disorders and alcohol and/or drug use. We examined the rate of substance use and the risk of substance use on mortality risk over a 4-10 year period in 762 people with psychotic disorders. Deceased patients were identified from the Social Security Death Index and the Maryland Division of Vital Records. Substance use was defined as regular and heavy use or abuse or dependence. Seventy seven percent had co-morbid lifetime substance use, with co-morbid cannabis and alcohol use occurring most commonly. Out of 762 subjects, 62 died during follow up. In a Cox model, predicted mortality risk was higher in age group 35-55 compared to <35 years and in males, but reduced in cannabis users. Overall five- (3.1% vs 7.5%) and ten-year mortality risk (5.5% vs. 13.6%) was lower in cannabis users than in non-users with psychotic disorders (p = 0.005) in a survival model. Alcohol use was not predictive of mortality. We observed a lower mortality risk in cannabis-using psychotic disorder patients compared to cannabis non-users despite subjects having similar symptoms and treatments. Future research is warranted to replicate these findings and to shed light on the anti-inflammatory properties of the endocannabinoid system and its role in decreased mortality in people with psychotic disorders.

Psychometric properties of the Drug Use Disorders Identification Test (DUDIT) with substance abusers in outpatient and residential treatment

The psychometric properties of the Drug Use Disorders Identification Test (DUDIT), an 11-item self-report questionnaire developed to screen individuals for drug problems, are evaluated. The measure, developed in Sweden and evaluated there with individuals with severe drug problems, has not been evaluated with less severe substance abusers or with clinical populations in the United States. Participants included 35 drug abusers in an outpatient substance abuse treatment program, 79 drug abusers in a residential substance abuse treatment program, and 39 alcohol abusers from both treatment settings who did not report a drug abuse problem. The DUDIT was found to be a psychometrically sound drug abuse screening measure with high convergent validity (r=.85) when compared with the Drug Abuse Screening Test (DAST-10), and to have a Cronbach's alpha of .94. In addition, a single component accounted for 64.91% of total variance, and the DUDIT had sensitivity and specificity scores of .90 and .85, respectively, when using the optimal cut-off score of 8. Additionally, the DUDIT showed good discriminant validity as it significantly differentiated drug from alcohol abusers. These findings support the DUDIT as a reliable and valid drug abuse screening instrument that measures a unidimensional construct. Further research is warranted with additional clinical populations.

The use of screening instruments for detecting alcohol and other drug use disorders in first-episode psychosis

The high rate of drug abuse among patients with psychosis represents a challenge to clinicians in their treatment of the patients. Powerful screening tools to detect problematic drug use in an early phase of psychotic illness are needed. The aim of the present study was to investigate prevalence of drug use disorders and psychometric properties of the Alcohol Use Disorder Identification Test (AUDIT) and the Drug Use Disorder Identification Test (DUDIT) in 205 first-episode psychosis patients in Oslo, Norway. Internal consistency of the instruments and criterion-based validity as compared to a current DSM-IV diagnosis of abuse or dependence of alcohol or other drugs were analyzed. Fifteen percent of the men and 11% of the women had a DSM-IV diagnosis of alcohol use disorders while 33% of the men and 16% of the women had non-alcohol drug use disorders. The instruments were reliable (Cronbach's alpha above 0.90) and valid (Area under the curve above 0.83). Suitable cut-off scores (sensitivity >0.80 and specificity >0.70) were ten for men and eight for women on AUDIT and three for men and one for women on DUDIT. The results of this study suggest that AUDIT and DUDIT are powerful screening instruments for detecting alcohol and other drug use disorders in patients with first-episode psychosis.

Secondary prevention of hazardous alcohol consumption in psychiatric out-patients: a randomised controlled study

BACKGROUND

Hazardous alcohol use is associated with an increased risk for development of a substance use disorder, leading to negative outcomes in psychiatric patients.

AIMS

In order to investigate whether psychiatric outpatients' hazardous alcohol consumption could be reduced by way of a brief intervention by telephone.

METHOD

Non-psychotic psychiatric outpatients, n = 1,670, completed a self-rating form concerning alcohol habits (AUDIT). Participants with scores indicating risk consumption (n = 344) were randomised to intervention (immediate advice) or control (advice after 6 months).

RESULTS

Hazardous alcohol habits occurred among 19% of the women and 24% of the men. In the intervention group, half of the patients reduced their alcohol consumption to non-hazardous levels at 6-month follow-up (ITT analysis). In women, 41.5% in the intervention group had no hazardous consumption at follow-up compared to 24.7% in the control group (P = 0.003), corresponding figure for men was 49.1 and 34.0%.

CONCLUSION

Brief intervention seems to be effective to reduce hazardous alcohol consumption in psychiatric outpatients.