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Filov I. Antisocial Personality Traits as a Risk Factor of Violence between Individuals with Mental Disorders. Open Access Maced J Med Sci 2019; 7:657-662. [PMID: 30894931 PMCID: PMC6420958 DOI: 10.3889/oamjms.2019.146] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 02/04/2019] [Accepted: 02/05/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND Mental disorder can increase the likelihood of taking violent acts of some individuals, but only a small percentage of violence in societies could be attributed to patients with mental health problems. For the past several years numerous studies related to forensic psychiatry has confirmed a close causal relationship between violent offenders and psychiatric comorbidity. Several studies have provided strong evidence that antisocial personality disorders (APD) represent a significant clinical risk for violence. AIM This study aims to show the relationship between antisocial personality disorder and antisocial personality traits with the other mental disorders and the manifestation of violence between the forensic populations of patients. METHODS The survey was conducted at the Psychiatric Hospitals and the Mental Health Centre. The research was carried out between two groups: one group of perpetrators of violence (PV) and a control group divided into two subgroups, a control group without violence (CG WV) and a group of respondents forcibly hospitalised CG FH. After obtaining consent for participation in the study, patients were interviewed, and questionnaires were applied. The research methodology included using measuring instrument-Psychopathy Checklist-revised (Hare's PCL-R). RESULTS The results show that in the group PV antisocial personality disorder is present in 45 patients, or 50% of the total sample. According to statistical research in between groups PV, CG WV and CG WV, there were determent significant differences in specifically listed items from Hare's PCL-R. CONCLUSIONS Psychopathological traits of mental disorders which are pathognomonic of committing violence are paranoid schizophrenia, as the most present and antisocial personality disorder in comorbidity, as the highest risk factor among the population with mental disorders that manifest violence.
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Affiliation(s)
- Izabela Filov
- Higher Medical School, University “St Kliment Ohridski”, Bitola, Republic of Macedonia
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Bowe A, Rosenheck R. PTSD and substance use disorder among veterans: characteristics, service utilization and pharmacotherapy. J Dual Diagn 2015; 11:22-32. [PMID: 25513763 DOI: 10.1080/15504263.2014.989653] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE While there has been considerable concern about veterans with dually diagnosed posttraumatic stress disorder (PTSD) and comorbid substance use disorders, a national study of clinical characteristics, service utilization, and psychotropic medication use of such veterans in Veterans Affairs (VA) has yet to be conducted. We hypothesized that veterans having both PTSD and substance use disorder would have lower socioeconomic status, greater medical and psychiatric comorbidity, higher medical service utilization, and more psychotropic pharmacotherapy fills. METHODS National VA data from fiscal year 2012 were used to compare veterans with dually diagnosed PTSD and substance use disorder to veterans with PTSD without substance use disorder on sociodemographic characteristics, psychiatric and medical comorbidities, mental health and medical service utilization, and psychotropic pharmacotherapy. Comparisons were based on bivariate and Poisson regression analyses. RESULTS The sample included all 638,451 veterans who received the diagnosis of PTSD in the VA in fiscal year 2012: 498,720 (78.1%) with PTSD alone and 139,731 (21.9%) with dually diagnosed PTSD and a comorbid substance use disorder. Veterans with dual diagnoses were more likely to have been homeless and to have received a VA disability pension. Medical diagnoses that were more strongly associated with veterans with dual diagnosis included seizure disorders, liver disease, and human immunodeficiency virus (HIV). Psychiatric comorbidities that distinguished veterans with dual diagnoses included bipolar disorder and schizophrenia. Veterans with dually diagnosed PTSD and substance use disorder also had a greater likelihood of having had mental health inpatient treatment. There were no substantial differences in other measures of service use or prescription fills for psychotropic medications. CONCLUSIONS Several substantial differences were observed, each of which represented more severe medical and psychiatric illness among veterans with dually diagnosed PTSD and substance use disorder compared to those with PTSD alone. However, effective treatments are available for these disorders and special efforts should be made to ensure that veterans with dual diagnoses receive them.
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Affiliation(s)
- Adina Bowe
- a Department of Psychiatry, Yale Medical School , New Haven , Connecticut , USA
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Richards CM, Sharif F, Eischen S, Thomas J, Wang Q, Guo H, Luo X, Okuyemi K. Retention of Homeless Smokers in the Power to Quit Study. Nicotine Tob Res 2014; 17:1104-11. [PMID: 25301816 DOI: 10.1093/ntr/ntu210] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Accepted: 09/26/2014] [Indexed: 11/12/2022]
Abstract
INTRODUCTION Concerns about retention are a major barrier to conducting studies enrolling homeless individuals. Since smoking is a major problem in homeless communities and research on effective methods of promoting smoking cessation is needed, we describe strategies used to increase retention and participant characteristics associated with retention in smoking cessation study enrolling homeless adults. METHODS The parent study was a 2-group randomized controlled trial with 26-week follow-up enrolling 430 homeless smokers from emergency shelters and transitional housing units in Minneapolis/Saint Paul, MN, USA. Multiple strategies were used to increase retention, including conducting visits at convenient locations for participants, collecting several forms of contact information from participants, using a schedule that was flexible and included frequent low-intensity visits, and providing incentives. Participant demographics as well as characteristics related to tobacco and drug use and health status were analyzed for associations with retention using univariate and multivariate analysis. RESULTS Overall retention was 75% at 26 weeks. Factors associated with increased retention included greater age; having healthcare coverage; history of multiple homeless episodes, lower stress level; and higher PHQ-9 (Patient Health Questionnaire-9) score. A history of excessive drinking and drug use were associated with decreased retention. CONCLUSIONS It is possible to successfully retain homeless individuals in a smoking cessation study if the study is designed with participants' needs in mind.
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Affiliation(s)
- Christina M Richards
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN; Program in Health Disparities Research, University of Minnesota, Minneapolis, MN
| | - Faduma Sharif
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN; Program in Health Disparities Research, University of Minnesota, Minneapolis, MN
| | - Sara Eischen
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN; Program in Health Disparities Research, University of Minnesota, Minneapolis, MN
| | | | - Qi Wang
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN
| | - Hongfei Guo
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Xianghua Luo
- Masonic Cancer Center, University of Minnesota, Minneapolis, MN; Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN
| | - Kolawole Okuyemi
- Department of Family Medicine and Community Health, University of Minnesota, Minneapolis, MN; Program in Health Disparities Research, University of Minnesota, Minneapolis, MN; Center for Health Equity, University of Minnesota, Minneapolis, MN; Masonic Cancer Center, University of Minnesota, Minneapolis, MN;
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Characteristics and treatment interests among individuals with substance use disorders and a history of past six-month violence: findings from an emergency department study. Addict Behav 2014; 39:265-72. [PMID: 24148140 DOI: 10.1016/j.addbeh.2013.10.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2013] [Revised: 09/08/2013] [Accepted: 10/01/2013] [Indexed: 11/22/2022]
Abstract
The study examined clinical characteristics and treatment interests of individuals identified to have substance use disorders (SUDs) in an urban emergency department (ED) who reported past six-month history of violence or victimization. Specifically, participants were 1441 ED patients enrolled in a randomized controlled trial of interventions designed to link those with SUDs to treatment. To examine factors related to violence type, four groups based on participants' reports of violence toward others were created: no violence (46.8%), partner violence only (17.3%), non-partner violence only (20.2%), and both partner and non-partner violence (15.7%). Four groups based on participants' reports of victimization were also created: no violence (42.1%), victimization from partner only (18.7%), victimization from non-partner only (20.2%), and both partner and non-partner victimization (17.7%). Separate multinomial logistic regression analyses were conducted to examine which variables distinguished the violence and victimization groups from those reporting no violence or victimization. For violence toward others, demographic variables, alcohol and cocaine disorders, and rating treatment for psychological problems were higher for violence groups, with some differences depending on the type of violence. For victimization, demographic variables, having an alcohol disorder, and rating treatment for family/social problems were higher for violence groups, also with some differences depending on the type of violence. Findings from the present study could be useful for designing effective brief interventions and services for ED settings.
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Fitzpatrick-Lewis D, Ganann R, Krishnaratne S, Ciliska D, Kouyoumdjian F, Hwang SW. Effectiveness of interventions to improve the health and housing status of homeless people: a rapid systematic review. BMC Public Health 2011; 11:638. [PMID: 21831318 PMCID: PMC3171371 DOI: 10.1186/1471-2458-11-638] [Citation(s) in RCA: 133] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2011] [Accepted: 08/10/2011] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Research on interventions to positively impact health and housing status of people who are homeless has received substantially increased attention over the past 5 years. This rapid review examines recent evidence regarding interventions that have been shown to improve the health of homeless people, with particular focus on the effect of these interventions on housing status. METHODS A total of 1,546 articles were identified by a structured search of five electronic databases, a hand search of grey literature and relevant journals, and contact with experts. Two reviewers independently screened the first 10% of titles and abstracts for relevance. Inter-rater reliability was high and as a result only one reviewer screened the remaining titles and abstracts. Articles were included if they were published between January 2004 and December 2009 and examined the effectiveness of an intervention to improve the health or healthcare utilization of people who were homeless, marginally housed, or at risk of homelessness. Two reviewers independently scored all relevant articles for quality. RESULTS Eighty-four relevant studies were identified; none were of strong quality while ten were rated of moderate quality. For homeless people with mental illness, provision of housing upon hospital discharge was effective in improving sustained housing. For homeless people with substance abuse issues or concurrent disorders, provision of housing was associated with decreased substance use, relapses from periods of substance abstinence, and health services utilization, and increased housing tenure. Abstinent dependent housing was more effective in supporting housing status, substance abstinence, and improved psychiatric outcomes than non-abstinence dependent housing or no housing. Provision of housing also improved health outcomes among homeless populations with HIV. Health promotion programs can decrease risk behaviours among homeless populations. CONCLUSIONS These studies provide important new evidence regarding interventions to improve health, housing status, and access to healthcare for homeless populations. The additional studies included in this current review provide further support for earlier evidence which found that coordinated treatment programs for homeless persons with concurrent mental illness and substance misuse issues usually result in better health and access to healthcare than usual care. This review also provides a synthesis of existing evidence regarding interventions that specifically support homeless populations with HIV.
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Affiliation(s)
- Donna Fitzpatrick-Lewis
- The Effective Public Health Practice Project, School of Nursing, McMaster University, Hamilton, Canada
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Pennington K, Coast MJ, Kroh M. Health Care for the Homeless: A Partnership Between a City and a School of Nursing. J Nurs Educ 2010; 49:700-3. [DOI: 10.3928/01484834-20100930-02] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2009] [Accepted: 02/01/2010] [Indexed: 11/20/2022]
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Kertesz SG, Crouch K, Milby JB, Cusimano RE, Schumacher JE. Housing first for homeless persons with active addiction: are we overreaching? Milbank Q 2009; 87:495-534. [PMID: 19523126 PMCID: PMC2881444 DOI: 10.1111/j.1468-0009.2009.00565.x] [Citation(s) in RCA: 123] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
CONTEXT More than 350 communities in the United States have committed to ending chronic homelessness. One nationally prominent approach, Housing First, offers early access to permanent housing without requiring completion of treatment or, for clients with addiction, proof of sobriety. METHODS This article reviews studies of Housing First and more traditional rehabilitative (e.g., "linear") recovery interventions, focusing on the outcomes obtained by both approaches for homeless individuals with addictive disorders. FINDINGS According to reviews of comparative trials and case series reports, Housing First reports document excellent housing retention, despite the limited amount of data pertaining to homeless clients with active and severe addiction. Several linear programs cite reductions in addiction severity but have shortcomings in long-term housing success and retention. CONCLUSIONS This article suggests that the current research data are not sufficient to identify an optimal housing and rehabilitation approach for an important homeless subgroup. The research regarding Housing First and linear approaches can be strengthened in several ways, and policymakers should be cautious about generalizing the results of available Housing First studies to persons with active addiction when they enter housing programs.
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Affiliation(s)
- Stefan G Kertesz
- Center for Surgical, Medical Acute Care Research and Transitions at the Birmingham Veterans Affairs Medical Center, University of Alabama, Birmingham, AL 35294, USA.
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Abstract
BACKGROUND Comorbid substance use and mental illness is prevalent and often results in serious consequences. However, little is known about the efficacy of treatments for patients with dual diagnosis. METHODS This paper reviews both the psychosocial and medication treatments for those diagnosed with a substance-related disorder and one of the following disorders: (a) depression, (b) anxiety disorder, (c) schizophrenia, (d) bipolar disorder, (e) severe mental illness, and (f) nonspecific mental illness. We made no restriction of study design to include all published studies, due to the dearth of studies on treatments of patients with dual diagnosis. RESULTS Fifty-nine studies were identified (36 randomized-controlled trials; RCT). Limited number of studies, especially RCTs, have been conducted within each comorbid category. This review did not find treatments that had been replicated and consistently showed clear advantages over comparison condition for both substance-related and other psychiatric outcomes. CONCLUSIONS Although no treatment was identified as efficacious for both psychiatric disorders and substance-related disorder, this review finds: (1) existing efficacious treatments for reducing psychiatric symptoms also tend to work in dual-diagnosis patients, (2) existing efficacious treatments for reducing substance use also decrease substance use in dually diagnosed patients, and (3) the efficacy of integrated treatment is still unclear. This review provides a critique of the current state of the literature, identifies the directions for future research on treatment of dual-diagnosis individuals, and calls for urgent attention by researchers and funding agencies to conduct more and more methodologically rigorous research in this area.
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Affiliation(s)
- Quyen Q Tiet
- Center for Health Care Evaluation, VA Palo Alto Health Care System, Palo Alto, California 94025, USA.
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