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Radua J, Fortea L, Goikolea JM, Zorrilla I, Bernardo M, Arrojo M, Cunill R, Castells X, Becoña E, López-Durán A, Torrens M, Tirado-Muñoz J, Fonseca F, Arranz B, Garriga M, Sáiz PA, Flórez G, San L, González-Pinto A. Meta-analysis of the effects of adjuvant drugs in co-occurring bipolar and substance use disorder. REVISTA DE PSIQUIATRIA Y SALUD MENTAL 2023:S1888-9891(23)00006-X. [PMID: 37689524 DOI: 10.1016/j.rpsm.2023.01.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 01/30/2023] [Accepted: 01/31/2023] [Indexed: 02/10/2023]
Abstract
BACKGROUND Individuals with bipolar disorder (BD) often have co-occurring substance use disorders (SUDs), which substantially impoverish the course of illness. Despite the importance of this dual diagnosis, the evidence of the efficacy and safety of adjuvant treatments is mostly unknown. OBJECTIVE To perform a meta-analysis to evaluate the efficacy and safety of adjuvant drugs in patients with co-occurring BD and SUD. METHODS We searched PubMed, Scopus, and Web of Knowledge until 30th April 2022 for randomized clinical trials (RCT) evaluating the efficacy and safety of adjuvant drugs compared to placebo in patients with a dual diagnosis of BD and SUD. We meta-analyzed the effect of adjuvant drugs on general outcomes (illness severity, mania, depression, anxiety, abstinence, substance craving, substance use, gamma-GT, adherence, and adverse events) and used the results to objectively assess the quality of the evidence according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach. For completeness, we also report the specific effects of specific adjuvant drugs in patients with specific substance disorders. RESULTS We included 15 RCT studies (9 alcohol, 3 cocaine, 2 nicotine, and 1 cannabis) comprising 628 patients allocated to treatment and 622 to placebo. There was low-quality evidence that adjuvant drugs may reduce illness severity (g=-0.25, 95% CI: -0.44, -0.06), and very-low quality evidence that they may decrease substance use (g=-0.23, 95% CI: -0.44, -0.02) and increase substance abstinence (g=0.21, 95% CI: 0.04, 0.38). DISCUSSION There is low-quality evidence that adjuvant drugs may help reduce illness severity, probably via facilitating abstinence and lower substance use. However, the evidence is weak; thus, these results should be considered cautiously until better evidence exists.
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Affiliation(s)
- Joaquim Radua
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, CIBERSAM, Spain; Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, United Kingdom; Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden
| | - Lydia Fortea
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, CIBERSAM, Spain.
| | - José Manuel Goikolea
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, CIBERSAM, Spain
| | - Iñaki Zorrilla
- Instituto de Investigación Sanitaria BIOARABA, OSI Araba, Hospital Universitario, CIBERSAM, UPV/EHU, Vitoria, Spain
| | - Miquel Bernardo
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, CIBERSAM, Spain
| | - Manuel Arrojo
- Servicio de Psiquiatría, Instituto de Investigación Sanitaria (IDIS), Complejo Hospitalario Universitario de Santiago, Servicio Gallego de Salud (SERGAS) de Santiago de Compostela, Spain
| | - Ruth Cunill
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, CIBERSAM, Barcelona, Spain
| | - Xavi Castells
- Grupo de Investigación TransLab, Departamento de Ciencias Médicas, Universitat de Girona, Spain
| | - Elisardo Becoña
- Unidad de Tabaquismo y Trastornos Adictivos, Facultad de Psicología, Universidad de Santiago de Compostela, Spain
| | - Ana López-Durán
- Unidad de Tabaquismo y Trastornos Adictivos, Facultad de Psicología, Universidad de Santiago de Compostela, Spain
| | - Marta Torrens
- Institut de Neuropsiquiatria Addiccions - Hospìtal del Mar, Universitat Autònoma de Barcelona, Universitat de Vic-Central de Catalunya, Red de Investigación en Atención Primaria de Adicciones-RIAPAD, Barcelona, Spain
| | - Judit Tirado-Muñoz
- Departamento de Psicología, Facultad de Ciencias Biomédicas y de la Salud, Grupo de Investigación en Conducta, Emociones y Salud, Universidad Europea de Madrid, Madrid, Spain
| | - Francina Fonseca
- Institut de Neuropsiquiatria Addiccions - Hospìtal del Mar, Universitat Autònoma de Barcelona, Universitat de Vic-Central de Catalunya, Red de Investigación en Atención Primaria de Adicciones-RIAPAD, Barcelona, Spain
| | - Belén Arranz
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, CIBERSAM, Barcelona, Spain
| | - Marina Garriga
- Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, Universitat de Barcelona, CIBERSAM, Spain
| | - Pilar A Sáiz
- Universidad de Oviedo, CIBERSAM, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Instituto de Neurociencias del Principado de Asturias (INEUROPA), Servicio de Salud del Principado de Asturias (SESPA), Oviedo, Spain
| | - Gerardo Flórez
- Unidad de Conductas Adictivas, Complejo Hospitalario de Ourense, CIBERSAM, Ourense, Spain
| | - Luis San
- Parc Sanitari Sant Joan de Déu, Universitat de Barcelona, CIBERSAM, Barcelona, Spain
| | - Ana González-Pinto
- Instituto de Investigación Sanitaria BIOARABA, OSI Araba, Hospital Universitario, CIBERSAM, UPV/EHU, Vitoria, Spain
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Sherwood Brown E, McArdle M, Palka J, Bice C, Ivleva E, Nakamura A, McNutt M, Patel Z, Holmes T, Tipton S. A randomized, double-blind, placebo-controlled proof-of-concept study of ondansetron for bipolar and related disorders and alcohol use disorder. Eur Neuropsychopharmacol 2021; 43:92-101. [PMID: 33402258 DOI: 10.1016/j.euroneuro.2020.12.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 12/04/2020] [Accepted: 12/15/2020] [Indexed: 01/17/2023]
Abstract
Bipolar disorder is associated with high rates of alcohol use disorder. However, little is known about the treatment of this dual diagnosis population. Previous studies suggest that ondansetron decreases alcohol use, particularly in people with specific single nucleotide polymorphism (SNP) alleles. A 12-week, randomized, double-blind, placebo-controlled trial of ondansetron was conducted in 70 outpatients with bipolar spectrum disorders and early onset alcohol use disorder. Outcome measures included alcohol use, assessed with the Timeline Followback method, Penn Alcohol Craving Scale (PACS), Hamilton Rating Scale for Depression (HRSD), Inventory of Depressive Symptomatology-Self-report, and Young Mania Rating Scale. SNPs rs1042173, rs1176713 and rs1150226 were explored as predictors of response. Participants had a mean age of 44.9 ± 9.4 years, were mostly men (60.0%), and African American (51.4%). Mean ondansetron exit dose was 3.23 ± 2.64 mg. No significant between-group differences in alcohol use measures were observed. However, a significant reduction in HRSD scores was observed (p = 0.045). Inclusion of SNPs increased effect sizes for some alcohol-related outcomes and the HRSD. Ondansetron was well tolerated. This proof-of-concept study is the first report on ondansetron in bipolar people with bipolar disorders and alcohol use disorder. Alcohol use did not demonstrate a significant between-group difference. However, the findings suggest that ondansetron may be associated with reduction in depressive symptom severity in persons with bipolar illnesses and alcohol use disorder. A larger trial is needed to examine the effects of ondansetron on bipolar depression.
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Affiliation(s)
- E Sherwood Brown
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Meagan McArdle
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jayme Palka
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Collette Bice
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Elena Ivleva
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Alyson Nakamura
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Markey McNutt
- The Eugene McDermott Center for Human Growth and Development, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Zena Patel
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Traci Holmes
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Shane Tipton
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA
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Eggink E, de Waal MM, Goudriaan AE. Criminal offending and associated factors in dual diagnosis patients. Psychiatry Res 2019; 273:355-362. [PMID: 30682557 DOI: 10.1016/j.psychres.2019.01.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 12/10/2018] [Accepted: 01/13/2019] [Indexed: 12/24/2022]
Abstract
Dual diagnosis patients perpetrate crime more often than healthy individuals. Crime perpetration has major mental health consequences for the victim. Knowledge of factors related to perpetration is needed for the development of prevention programs. However, in dual diagnosis patients, very little is known about factors explaining criminal behavior. The current study investigated cross-sectional associations between demographic and clinical factors and perpetration of three crime types (violence, threat, and property crime) in 243 treatment-seeking dual diagnosis patients. In our sample, perpetration of violence was independently associated with younger age, severity of alcohol use problems, lifetime trauma exposure, and higher manic symptom scores. Expression of threat was independently associated with severity of alcohol use problems and higher manic symptom scores. Perpetration of property crime was independently associated with severity of alcohol and drug use problems. Remarkably, gender was not associated with any type of perpetration. These findings indicate that criminal offending is a significant problem among dual diagnosis patients and are a first step towards understanding the complex causal networks that lead to criminal perpetration. Future longitudinal research should investigate additional risk factors and establish causality to support the development of treatment programs to prevent criminal offending by dual diagnosis patients.
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Affiliation(s)
- Esmé Eggink
- Amsterdam UMC, University of Amsterdam, Department of General Practice, Amsterdam, the Netherlands; Department of Research, Arkin Mental Health Care, Amsterdam, the Netherlands
| | - Marleen M de Waal
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Institute for Addiction Research, Amsterdam, the Netherlands; Department of Research, Arkin Mental Health Care, Amsterdam, the Netherlands.
| | - Anna E Goudriaan
- Amsterdam UMC, University of Amsterdam, Department of Psychiatry, Amsterdam Institute for Addiction Research, Amsterdam, the Netherlands; Department of Research, Arkin Mental Health Care, Amsterdam, the Netherlands
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Abstract
Aims and MethodAssociations have been reported between aggression and psychoactive substance use, and a link with violence has been demonstrated in community samples. This study aimed to assess the prevalence and nature of aggressive incidents and to examine the factors associated with violence in a specialist substance misuse treatment unit. Data were collected about assaults, aggressive patients and the object of their aggression during a 12-month period.ResultsEighteen of 165 patients admitted during this period were involved in aggressive incidents. Patients dependent on more than one substance were significantly more aggressive than other categories of drug users. Past history of assaultive behaviour, younger age group and shorter duration of use were also significantly associated with incidents of aggression. Socio-demographic variables such as gender, marital and employment status were poor predictors of aggression.ConclusionsThe incidence of serious violence in this substance misuse treatment unit was low when compared with other psychiatric units. The findings suggest that there are differences in levels of aggression among the various types of drug users. The study reinforces the need for an accurate drug history in order to improve the quality of risk assessment.
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Tyrer P, Weaver T. Desperately seeking solutions: the search for appropriate treatment for comorbid substance misuse and psychosis. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.28.1.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Williams R, Cohen J. Substance use and misuse in psychiatric wards. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.24.2.43] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Substance use has reached endemic proportions. Inevitably, the world of psychiatric wards must reflect issues arising in our society. Given that the populations of psychiatric wards are disproportionately younger, male and socially disadvantaged (quite apart from the impact of patients' problems that prompt admission), one might expect that drug misuse in them would match, if not outstrip, the general trend. Recognition of its impact is a key issue for patients and staff alike.
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Bayney R, St John-Smith P, Conhye A. MIDAS: a new service for the mentally ill with comorbid drug and alcohol misuse. PSYCHIATRIC BULLETIN 2018. [DOI: 10.1192/pb.26.7.251] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Aims and MethodTo describe the work and patient characteristics of one of the first combined mental illness and drug and alcohol services (MIDAS) in the UK. We examined MIDAS as an assertive community service, for individuals receiving long-term community care. We selected the case files of the first 80 patients accepted over a 10-month period and examined variables including demographic details, diagnosis, associated substance use and length of engagement with the service.ResultsOur findings show that there was no relationship between responders to the service and basic demographic data. Patients with bipolar affective disorder and personality disorders were more likely to use the service than patients with unipolar disorder or schizophrenia. Despite the use of an assertive service, there was difficulty engaging patients with schizophrenia and comorbid drug use. These same patients also had a high level of criminal convictions as well as a trend towards using alcohol and cannabis as their main substances of misuse. At 18 months 38% of patients had failed to remain engaged with the service.Clinical ImplicationsThis specialist type of service may be more useful than other services in engaging patients with comorbidity. Systematic research is required in the UK to explore the effectiveness of this type of new service. More innovative resources need to be identified to specifically deal with patients with severe mental illness and comorbid substance use.
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Quinn J, Kolla NJ. From Clozapine to Cognitive Remediation. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2017; 62:94-101. [PMID: 27335156 PMCID: PMC5298523 DOI: 10.1177/0706743716656830] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Although a minority of persons with schizophrenia (SCZ) commits violent acts, SCZ remains a risk factor for violence. Here, we present a broad overview of evidence-based treatments for violence in SCZ, including biological and psychosocial interventions. METHOD We conducted MEDLINE and PsychINFO literature searches to retrieve articles relating to treatments for violent, hostile, or aggressive behaviours in SCZ. RESULTS Clozapine shows the strongest evidence for treating the acute violence of SCZ. Other atypical antipsychotics also possess antiaggressive effects, although the evidence is not as robust as that for clozapine. Psychosocial treatments can be useful adjuncts to pharmacotherapy once patients' positive symptoms have stabilized. Cognitive behavioural therapy for psychosis and cognitive remediation are 2 psychosocial interventions that have demonstrated positive outcomes for violence in SCZ. Most psychosocial studies that examined violence as an outcome were conducted in forensic psychiatric settings. CONCLUSIONS Effective treatments exist for persons with SCZ who pose a risk for violent and aggressive behaviour, although the overall evidence base remains relatively weak. More randomized controlled trials of programs showing evidence for reduction of violence in SCZ are required. Further research should delineate which patients could benefit from multimodal treatment and where and when such treatments are optimally delivered.
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Affiliation(s)
- Jason Quinn
- 1 Department of Psychiatry, University of Toronto, Toronto, Ontario
| | - Nathan J Kolla
- 2 Complex Mental Illness Program, Forensic Service, Violence Prevention Neurobiological Research Unit, Centre for Addiction and Mental Health, Toronto, Ontario.,3 Institute of Medical Science, University of Toronto, Toronto, Ontario.,4 Centre for Criminology and Sociolegal Studies, University of Toronto, Toronto, Ontario
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Mental distress following inpatient substance use treatment, modified by substance use; comparing voluntary and compulsory admissions. BMC Health Serv Res 2017; 17:5. [PMID: 28049461 PMCID: PMC5210285 DOI: 10.1186/s12913-016-1936-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2016] [Accepted: 12/06/2016] [Indexed: 11/10/2022] Open
Abstract
Background Treatment services to patients with substance use disorders (SUDs), including those mandated to treatment, needs to be evaluated and evidence based. The Norwegian Municipal Health Care Act (NMHCA) calls for compulsory treatment for persons with “severe and life-threatening substance use disorder” if these individuals are not otherwise willing to be voluntarily treated and consequently risk their lives over drug use. Mental distress is known to be high among SUD patients admitted to inpatient treatment. The purpose of this study is to describe changes in mental distress from admission to a 6-month follow-up in patients with SUDs, which underwent either voluntary or compulsory treatment. Method This prospective study followed 202 hospitalized patients with SUDs who were admitted voluntarily (VA; n = 137) or compulsorily (CA; n = 65). Levels of mental distress were assessed with SCL-90-R. Of 123 patients followed-up at 6 months, 97 (62 VA and 35 CA) had rated their mental distress at admission, discharge and follow-up. Sociodemographics and substance use severity were recorded with the use of The European Addiction Severity Index (EuropASI). We performed a regression analysis to examine factors associated with changes in psychiatric distress at the 6-month follow-up. Results The VA group exhibited higher mental distress than the CA group at admission, but both groups improved significantly during treatment. At the 6-month follow-up, the VA group continued to show reduced distress, but the CA group showed increases in mental distress to the levels observed before treatment. The deterioration appeared to be associated with higher scores that reflected paranoid ideas, somatization, obsessive-compulsive symptoms, interpersonal sensitivity, and depression. Active substance use during follow-up was significantly associated with increased mental distress. Conclusion In-patient treatment reduces mental distress for both CA and VA patients. The time after discharge seems critical especially for CA patients regarding active substance use and severe mental distress. A greater focus on continuing care initiatives to assist the CA patients after discharge is needed to maintain the reduction in mental distress during treatment. Continuing-care initiatives after discharge should be intensified to assist patients in maintaining the reduced mental distress achieved with treatment. Trial registration ClinicalTrials.gov NCT 00970372 December 02, 2016.
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Melton V, Ledwith S. Node-link mapping, an asset? ADVANCES IN DUAL DIAGNOSIS 2016. [DOI: 10.1108/add-07-2015-0019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The purpose of this paper is to evaluate the use of node-link mapping (NLM) on the effectiveness of a structured treatment for dual diagnosis for men living in a low-secure environment.
Design/methodology/approach
– In total, 15 participants were recruited and randomly allocated to one of two conditions. The control group, treatment as usual (TAU) or the treatment group, TAU with NLM. Outcome measures used were: a qualitative evaluation form, The Alcohol and Illegal Drugs Decisional Balance Scale and the Brief Situational Confidence Questionnaire.
Findings
– Results indicate no statistically significant difference for either group on the pre- and post-treatment outcome measures used. Qualitative data indicated that those using NLM reported the intervention as useful and instructive more often.
Research limitations/implications
– The results gained were only a snapshot of the intervention straight after treatment and did not take into account any long-term benefits of therapy such as substance use relapse rates. The outcome measures used may not have been properly understood by all respondents, or reflect practical change. The NLM tool may not have been used as confidently as TAU. The TAU condition needs to be reviewed to improve effectiveness, and NLM to be included to improve the accessibility. A study comparing other outcome tools needs to be completed. Training for staff using NLM may require coaching.
Originality/value
– This paper has a high/low originality. It highlights a number of advantages to NLM when comparing this to TAU.
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“A new horizon?”: evaluation of an integrated Substance Use Treatment Programme (SUTP) for mentally disordered offenders. ADVANCES IN DUAL DIAGNOSIS 2015. [DOI: 10.1108/add-03-2015-0002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose
– The treatment of substance use amongst mentally disordered offenders (MDOs) remains a challenge for secure forensic mental health services. The purpose of this paper is to present an integrated three-stage substance use treatment programme (SUTP) for male and female MDO’s in medium security.
Design/methodology/approach
– In total, 45 (72.6 per cent) MDO’s were referred (39 males/6 females). Standardised outcome measures were administered pre-SUTP, post-SUTP and at one year follow-up. Abstinence rates and location was determined via case notes at three year follow-up.
Findings
– All MDO’s had a past history of substance use, approximately three-quarters reporting problematic use prior to admission. Over half completed all three SUTP stages, less than 5 per cent dropping out during active treatment. The SUTP supported abstinence throughout the one year follow-up period and significantly improved MDO’s adaptive beliefs about substances and craving by one year follow-up amongst attendees. At three years, most MDO’s were in the community and almost three-quarters were abstinent. There was no significant difference in abstinent rates between community and hospital. There was a non-significant trend suggesting SUTP attendance supported abstinence. Both male and female participants appear to have benefited from treatment and satisfaction was high, reflecting the specific aims and objectives of treatment.
Research limitations/implications
– The small non-randomised sample from one area limits the generalisability of findings and statistical power.
Originality/value
– Findings indicate further support for the limited evidence base that small but clinically meaningful and maintained changes to problematic substance use are possible following integrated substance use treatment for male and female MDO’s.
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Childhood- versus adolescent-onset antisocial youth with conduct disorder: psychiatric illness, neuropsychological and psychosocial function. PLoS One 2015; 10:e0121627. [PMID: 25835393 PMCID: PMC4383334 DOI: 10.1371/journal.pone.0121627] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Accepted: 01/31/2015] [Indexed: 01/24/2023] Open
Abstract
Objective The present study investigates whether youths with childhood-onset antisocial behavior have higher rates of psychiatric illness, neuropsychological and psychosocial dysfunction than youths who engage in antisocial behavior for the first time in adolescence. Prior studies have generally focused on single domains of function in heterogeneous samples. The present study also examined the extent to which adolescent-onset antisocial behavior can be considered normative, an assumption of Moffitt’s dual taxonomy model. Method Forty-three subjects (34 males, 9 females, mean age = 15.31, age range 12–21) with a diagnosis of conduct disorder (CD) were recruited through Headspace Services and the Juvenile Justice Community Centre. We compared childhood-onset antisocial youths (n = 23) with adolescent-onset antisocial youths (n = 20) with a conduct disorder, across a battery of psychiatric, neuropsychological and psychosocial measures. Neuropsychological function of both groups was also compared with normative scores from control samples. Results The childhood-onset group displayed deficits in verbal learning and memory, higher rates of psychosis, childhood maltreatment and more serious violent behavior, all effects associated with a large effect size. Both groups had impaired executive function, falling within the extremely low range (severely impaired). Conclusions Childhood-onset CD displayed greater cognitive impairment, more psychiatric symptoms and committed more serious violent offences. The finding of severe executive impairment in both childhood- and adolescent-onset groupings challenges the assumption that adolescent-onset antisocial behavior is a normative process.
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Benzerouk F, Dereux A, Gorsane MA, Lançon C. L’addictologie est-elle une spécialisation de la psychiatrie ? ANNALES MEDICO-PSYCHOLOGIQUES 2014. [DOI: 10.1016/j.amp.2014.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Abstract
AbstractObjectives: The aim of this study was to examine the prevalence of, and factors associated with violence in a drug treatment centre.Method: This study is a retrospective audit of all incident forms completed at an urban drug treatment centre between December 1991 and July 1996 with reference to case notes for additional clinical information on individuals involved in violent incidents.Participants included all patients attending the centre in the aforementioned time period who were involved in violent incidents. Information was obtained about the prevalence and severity of violent incidents and patient details including main drug of abuse, route of use, reason for attendance, comorbid axis 1 diagnosis, history of previous incidents and HIV status at the time of the incident.Results: One per cent of all patients were involved in violent incidents. Less than one quarter of incidents involved serious injury or assault. Most perpetrators were male intravenous heroin users on a methadone maintenance programme. Nurses and doctors were most frequently the victims of incidents. Ten per cent of patients had a history of previous incidents and almost half the perpetrators were HIV positive. A comorbid axis 1 diagnosis was found in 9% of perpetrators (n = 6), mainly alcohol dependence syndrome.
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Abstract
AIMS AND OBJECTIVES To describe the types and frequency of conflict behaviours exhibited by patients during the first 2 weeks of admission to acute psychiatric units, the methods staff use to manage them and bring to the surface underlying common patterns. BACKGROUND Many studies have investigated the prevalence and impact of psychiatric inpatient aggression. Much of the research to date has studied conflict and containment behaviours separately; however, some studies have reported relationships between certain behaviours suggesting that there are complex causal links between conflict and containment behaviours. DESIGN A cross-sectional survey of conflict and containment events. METHODS Nursing notes were accessed for 522 patients during the first 2 weeks of admission, in 84 wards in 31 hospitals in the South East of England. Conflict and containment events occurring during this period were recorded retrospectively. RESULTS Factor analysis revealed six patterns of conflict behaviour, which were related to containment methods and patient demographic factors. These factors confirm some previously reported patterns of conflict. CONCLUSIONS This study brings to light underlying common patterns of disruptive behaviour by psychiatric inpatients. The reasons for these remain obscure, but may relate to (1) national variations in policy and practice shaping static structural differences of interest between patients and staff and (2) normal developmental age and gender-specific behaviours. RELEVANCE TO CLINICAL PRACTICE Conflict behaviour patterns may be differently motivated and therefore require different management strategies by staff. There is a need for awareness by clinical staff to the fact that different types of conflict behaviours may be co-occurring or indicative of each other. Clinical staff should consider that implementation of and changes to hospital policies have the potential to change the nature and frequencies of certain conflict behaviours by patients.
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Affiliation(s)
- Jamie Ross
- e-Health Unit, UCL Research Department of Primary Care & Population Health, Upper 3rd Floor, Royal Free Hospital, Rowland Hill Street, London NW3 2PF, UK.
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Daffern M, Day A, Cookson A. Implications for the prevention of aggressive behavior within psychiatric hospitals drawn from interpersonal communication theory. INTERNATIONAL JOURNAL OF OFFENDER THERAPY AND COMPARATIVE CRIMINOLOGY 2012; 56:401-419. [PMID: 21518699 DOI: 10.1177/0306624x11404183] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
Although interpersonal style is a defining feature of personality and personality disorder and is commonly identified as an important influence on aggressive behavior, treatment completion, and the development of an effective therapeutic alliance, it is rarely considered in practice guidelines for preventing, engaging, and managing patients at risk of aggression. In this article, the authors consider three potential applications of interpersonal theory to the care and management of patients at risk of aggression during hospitalization: (a) preventing aggression through theoretically grounded limit setting and de-escalation techniques, (b) developing and using interventions to alter problematic interpersonal styles, and (c) understanding therapeutic ruptures and difficulties establishing a therapeutic alliance. Interpersonal theory is proposed to offer a unifying framework that may assist development of intervention and management strategies that can help to reduce the occurrence of aggression in institutional settings.
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Affiliation(s)
- Michael Daffern
- Centre for Forensic Behavioral Science, Melbourne, Australia.
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Prevalence of substance misuse comorbidity in an Irish university training hospital. Ir J Psychol Med 2011; 28:201-204. [PMID: 30200007 DOI: 10.1017/s0790966700011654] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Substance misuse complicates an individual's management in adult Mental Health services. This study aimed to examine both the overall prevalence of substance misuse in those admitted to the psychiatric unit and additionally those admitted with a primary diagnosis and comorbid substance misuse. The study focuses on the associated diagnoses and demographics in 100 consecutive admissions to an acute psychiatric unit in an Irish university hospital. METHOD Clinical notes were reviewed independently by two members (one being a doctor), of the multi-professional research team within four days of their admission. Substance misuse proximal to the/at the time of admission (reflecting the current usage) was noted. RESULTS The combined prevalence of mental illness and substance misuse was 47% (CI 37-57%). Twenty two out of 100 (22%, CI 14-32%) were admitted primarily for the management of substance misuse and dependence (plus psychosocial reasons). Twenty-five of the patients admitted with a primary psychiatric illness (25%, CI 17-31%) were discovered to have comorbid substance misuse. At risk groups were found to be males and aged under 45 years. CONCLUSION Our study demonstrates the importance of screening and identification for substance misuse in psychiatric inpatient units; and consequently, the need for individual case management, additional development of dual diagnosis services and accurate patient data reporting to facilitate forward service-planning.
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Bo S, Abu-Akel A, Kongerslev M, Haahr UH, Simonsen E. Risk factors for violence among patients with schizophrenia. Clin Psychol Rev 2011; 31:711-26. [PMID: 21497585 DOI: 10.1016/j.cpr.2011.03.002] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Revised: 02/24/2011] [Accepted: 03/02/2011] [Indexed: 10/18/2022]
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New long-stay psychiatric in-patients: a comparison of UK and Irish national audit. Ir J Psychol Med 2011; 28:104-105. [PMID: 30200046 DOI: 10.1017/s0790966700011587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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20
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Lyne JP, O'Donoghue B, Clancy M, O'Gara C. Comorbid psychiatric diagnoses among individuals presenting to an addiction treatment program for alcohol dependence. Subst Use Misuse 2011; 46:351-8. [PMID: 21303253 DOI: 10.3109/10826081003754757] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A retrospective patient record review was conducted to examine comorbid psychiatric diagnoses, and comorbid substance use, among 465 patients below 45 years of age, presenting to a national alcohol addiction treatment unit in Dublin, between 1995 and 2006. Rates were high for depressive disorder (25.3%) particularly among females (35.4%). Lifetime reported use of substances other than alcohol was 39.2%, and further analysis showed significantly higher rates of deliberate self-harm among this group. Lifetime reported use of ecstasy was also significantly associated with depression in this alcohol-dependent population using logistic regression analysis. Implications and limitations of the findings are discussed.
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Affiliation(s)
- John Paul Lyne
- Addictions Department, St. John of God Hospital, Stillorgan, Co. Dublin, Ireland.
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Carlborg A, Winnerbäck K, Jönsson EG, Jokinen J, Nordström P. Suicide in schizophrenia. Expert Rev Neurother 2010; 10:1153-64. [PMID: 20586695 DOI: 10.1586/ern.10.82] [Citation(s) in RCA: 86] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
Schizophrenia is a disorder with an estimated suicide risk of 4-5%. Many factors are involved in the suicidal process, some of which are different from those in the general population. Clinical risk factors include attempted suicide, depression, male gender, substance abuse and hopelessness. Biosocial factors, such as a high intelligence quotient and high level of premorbid function, have also been associated with an increased risk of suicide in patients with schizophrenia. Suicide risk is especially high during the first year after diagnosis. Many of the suicides occur during hospital admission or soon after discharge. Management of suicide risk includes both medical treatment and psychosocial interventions. Still, risk factors are crude; efforts to predict individual suicides have not proved useful and more research is needed.
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Brown ES, Carmody TJ, Schmitz JM, Caetano R, Adinoff B, Swann AC, John Rush A. A randomized, double-blind, placebo-controlled pilot study of naltrexone in outpatients with bipolar disorder and alcohol dependence. Alcohol Clin Exp Res 2009; 33:1863-9. [PMID: 19673746 DOI: 10.1111/j.1530-0277.2009.01024.x] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Alcohol dependence is extremely common in patients with bipolar disorder and is associated with unfavorable outcomes including treatment nonadherence, violence, increased hospitalization, and decreased quality of life. While naltrexone is a standard treatment for alcohol dependence, no controlled trials have examined its use in patients with co-morbid bipolar disorder and alcohol dependence. In this pilot study, the efficacy of naltrexone in reducing alcohol use and on mood symptoms was assessed in bipolar disorder and alcohol dependence. METHODS Fifty adult outpatients with bipolar I or II disorders and current alcohol dependence with active alcohol use were randomized to 12 weeks of naltrexone (50 mg/d) add-on therapy or placebo. Both groups received manual-driven cognitive behavioral therapy designed for patients with bipolar disorder and substance-use disorders. Drinking days and heavy drinking days, alcohol craving, liver enzymes, and manic and depressed mood symptoms were assessed. RESULTS The 2 groups were similar in baseline and demographic characteristics. Naltrexone showed trends (p < 0.10) toward a greater decrease in drinking days (binary outcome), alcohol craving, and some liver enzyme levels than placebo. Side effects were similar in the 2 groups. Response to naltrexone was significantly related to medication adherence. CONCLUSIONS Results suggest the potential value and acceptable tolerability of naltrexone for alcohol dependence in bipolar disorder patients. A larger trial is needed to establish efficacy.
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Affiliation(s)
- E Sherwood Brown
- Department of Psychiatry, The University of Texas Southwestern Medical Center, Dallas, TX, USA.
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Cummings TM, Neal MT. The concepts of aggression and substance dependence. JOURNAL OF SUBSTANCE USE 2009. [DOI: 10.3109/14659899909053032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Crawford V, Crome IB, Clancy C. Co-existing Problems of Mental Health and Substance Misuse (Dual Diagnosis): a literature review. DRUGS-EDUCATION PREVENTION AND POLICY 2009. [DOI: 10.1080/0968763031000072990] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Vanessa Crawford
- Consultant in General Adult Psychiatry, Homerton Hospital, Homerton Row, London E9 6SR, UK
| | - Ilana B. Crome
- Professor of Addiction Psychiatry/Academic Director of Psychiatry, Academic Psychiatry Unit, Keele University Medical School (Harplands Campus), Academic Suite, Harplands Hospital, Hilton Road, Harpfields, Stoke on Trent ST4 6TH, UK
| | - Carmel Clancy
- Senior Lecturer--Mental Health and Addictions, Department of Mental Health, School of Health and Social Sciences, Middlesex University, Highgate Hill, London N19 3UA, UK
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Weaver T, Stimson G, Tyrer P, Barnes T, Renton A. What are the implications for clinical management and service development of prevalent comorbidity in UK mental health and substance misuse treatment populations? DRUGS-EDUCATION PREVENTION AND POLICY 2009. [DOI: 10.1080/09687630410001687851] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Rhodes T, Lilly R, Fernández C, Giorgino E, Kemmesis UE, Ossebaard HC, Lalam N, Faasen I, Spannow KE. Risk factors associated with drug use: the importance of ‘risk environment’. DRUGS-EDUCATION PREVENTION AND POLICY 2009. [DOI: 10.1080/0968763031000077733] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Afuwape SA, Johnson S, Craig TJK, Miles H, Leese M, Mohan R, Thornicroft G. Ethnic differences among a community cohort of individuals with dual diagnosis in South London. J Ment Health 2009. [DOI: 10.1080/09638230600900140] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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Carrà G, Johnson S. Variations in rates of comorbid substance use in psychosis between mental health settings and geographical areas in the UK. A systematic review. Soc Psychiatry Psychiatr Epidemiol 2009; 44:429-47. [PMID: 19011722 DOI: 10.1007/s00127-008-0458-2] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Revised: 10/16/2008] [Indexed: 01/14/2023]
Abstract
BACKGROUND Comorbid substance misuse in psychosis is associated with significant clinical, social and legal problems. An epidemiologically informed approach to planning service delivery requires an understanding of which clinical populations are at particularly high risk for such 'dual diagnosis'. Evidence has now been accumulating in the UK since the early 1990s, and allows a relatively comprehensive comparison of rates between service settings, geographical areas and social contexts in terms of ethnic background. METHODS A literature search was carried out with the aim of investigating: (a) comorbid alcohol and drug misuse rates in people with established psychosis in different mental health and addiction settings in the UK, (b) variations in such rates between different population groups. RESULTS There are wide variations in reported drug and alcohol misuse rates in psychosis. Most recent UK studies report rates between 20 and 37% in mental health settings, while figures in addiction settings are less clear (6-15%). Rates are generally not as high as in US studies, but appear to be especially high in inpatient and crisis team settings (38-50%) and forensic settings. In terms of geography, rates appear highest in inner city areas. Some ethnic groups are over-represented among clinical populations of people with dual diagnosis. CONCLUSIONS Rates of substance misuse in psychosis are likely to be influenced by service setting, population composition and geography. Acute and forensic settings are especially appropriate for the development of targeted interventions.
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Affiliation(s)
- Giuseppe Carrà
- Dept. of Mental Health Sciences, Royal Free and University College Medical School, Charles Bell House, 67-73 Riding House Street, London, W1W 7EY, UK.
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Evaluation of a urine on-site drugs of abuse screening test in patients admitted to a psychiatric emergency unit. J Clin Psychopharmacol 2009; 29:248-54. [PMID: 19440078 DOI: 10.1097/jcp.0b013e3181a45e78] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The objective of this study was to characterize the usefulness and reliability of a commonly used urinary on-site drugs of abuse screening test device when used routinely at admittances to a psychiatric emergency unit. Urine samples from 262 emergency psychiatric admittances representing 217 patients were analyzed by a commercially available on-site test for the detection of amphetamines, benzodiazepines, cannabis, cocaine, and opiates in urine. The samples were first screened by nurses at the psychiatric department, thereafter by 2 technicians at the laboratory, and finally, analyzed by liquid chromatography/mass spectrometry. Results of 45.8% of the screening tests were true negative for all 5 drugs/drug groups tested, whereas those of 29.4% were true positive for 1 or several drugs/drug groups and true negative for the others. Thus, in total, 75.2% were correct for all 5 drugs/drug groups. In general, the sensitivities (42.9%-90.0% for the various drug groups) were lower than the specificities (92.7%-100.0%). The accuracies were 86.3% for benzodiazepines, 92.4% for cannabis, 94.7% for opiates, and 97.0% for amphetamines. No cocaine was found in any of the samples. For cannabis, the accuracy was higher among the laboratory technicians than among the nurses. The results from on-site screening testing should not be considered as the final conclusion on the intake of drugs of abuse but must be interpreted with caution.
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WEAVER TIM, HICKMAN MATTHEW, RUTTER DEBORAH, WARD JENNI, STIMSON GERRY, RENTON ADRIAN. The prevalence and management of co-morbid substance misuse and mental illness: results of a screening survey in substance misuse and mental health treatment populations. Drug Alcohol Rev 2009. [DOI: 10.1080/09595230120092724] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Oddie S, Davies J. A Multi-Method Evaluation of a Substance Misuse Program in a Medium Secure Forensic Mental Health Unit. J Addict Nurs 2009. [DOI: 10.1080/10884600903078944] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Schulte SJ, Meier PS, Stirling J, Berry M. Treatment approaches for dual diagnosis clients in England. Drug Alcohol Rev 2008; 27:650-8. [PMID: 18830860 DOI: 10.1080/09595230802392816] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION Dual diagnosis (DD, co-occurrence of substance use and mental health problems) prevalence data in England are limited to specific regions and reported rates vary widely. Reliable information on actual service provision for dual diagnosis clients has not been collated. Thus a national survey was carried out to estimate dual diagnosis prevalence in treatment populations and describe the service provision available for this client population in drug/alcohol (DAS) and mental health services (MHS). DESIGN A questionnaire was sent to managers of 706 DAS and 2374 MHS. Overall, 249 (39%) DAS and 493 (23%) MHS participated in the survey. RESULTS In both DAS and MHS, around 32% of clients were estimated to have dual diagnosis problems. However, fewer than 50% of services reported assessing clients for both problem areas. Regarding specific treatment approaches, most services (DAS: 88%, MHS: 87%) indicated working jointly with other agencies. Significantly fewer services used joint protocols (DAS: 55%, MHS: 48%) or shared care arrangements, including access to external drug/alcohol or mental health teams (DAS: 47%, MHS: 54%). Only 25% of DAS and 17% of MHS employed dual diagnosis specialists. CONCLUSIONS Dual diagnosis clients constitute a substantial proportion of clients in both DAS and MHS in England. Despite recent policy initiatives, joint working approaches tend to remain unstructured.
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Affiliation(s)
- Sabrina J Schulte
- Department of Psychology, Elizabeth Gaskell Campus, Manchester Metropolitan University, UK.
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Ringen PA, Melle I, Birkenaes AB, Engh JA, Faerden A, Vaskinn A, Friis S, Opjordsmoen S, Andreassen OA. The level of illicit drug use is related to symptoms and premorbid functioning in severe mental illness. Acta Psychiatr Scand 2008; 118:297-304. [PMID: 18759810 DOI: 10.1111/j.1600-0447.2008.01244.x] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVE There is conflicting data on drug abuse and outcome in severe mental illness. This study aims to investigate if the amount of illicit psychoactive drug use is related to symptom load or premorbid functioning across diagnosis in patients with severe mental illness. METHOD Symptom load, sociodemographic status, premorbid functioning and the level of use of illicit psychoactive drugs were assessed in 423 subjects with schizophrenia or bipolar disorder in a cross-sectional study. RESULTS High amount of illicit drug use was associated with poorer premorbid academic functioning. In schizophrenia, there was a significant positive association between amount of drug use and severity of psychiatric symptoms. The association between symptom load and drug use was significant after controlling for premorbid functioning. CONCLUSION The results suggest a direct association between the quantity of current drug use and more severe symptoms in schizophrenia. Poor premorbid functioning was related to high amount of use, but did not explain the difference in symptom load.
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Affiliation(s)
- P A Ringen
- Institute of Psychiatry, University of Oslo, Oslo, Norway.
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Derry A, Batson A. Getting out and staying out: does substance use treatment have an effect on outcome of mentally disordered offenders after discharge from medium secure service? ACTA ACUST UNITED AC 2008. [DOI: 10.1108/14636646200800009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Abstract
BACKGROUND Schizophrenia is known to be associated with a range of adverse outcomes, which have an impact atthe societal level and are therefore of public concern. AIMS To examine the epidemiology and methods for measuring six adverse outcomes in schizophrenia: violence, victimisation, suicide/self-harm, substance use, homelessness and unemployment. METHOD A review ofthe literature was carried out for each adverse outcome, with attention to critical appraisal of existing measurement tools. RESULTS Schizophrenia is associated strongly with all six outcomes, although research has mainly focused on violence. Each outcome acts as a risk factor for at least some of the other outcomes. There are few standardised or validated measures for these 'hard' outcomes. Each measure has inherent biases but a growing trend is for these to be minimised by using multiple measures. CONCLUSIONS A single instrument which systematically measures multiple societal outcomes of schizophrenia would be extremely useful for both clinical and research purposes.
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Affiliation(s)
- Iain Kooyman
- Department of Forensic Mental Health, Institute of Psychiatry, London, UK.
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Manning V, Strathdee G, Best D, Keaney F, Bhui K, Gossop M. Differences in mental health, substance use, and other problems among dual diagnosis patients attending psychiatric or substance misuse treatment services. ACTA ACUST UNITED AC 2008. [DOI: 10.1080/17523280701772337] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Rao H, Luty J, Trathen B. Characteristics of patients who are violent to staff and towards other people from a community mental health service in South East England. J Psychiatr Ment Health Nurs 2007; 14:753-7. [PMID: 18039298 DOI: 10.1111/j.1365-2850.2007.01182.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Professionals working in the public sector in the UK report widespread violence towards staff working in areas such as health care, social services and education. This study compares the characteristics of patients with and without a history of violence in a large sample of patients attending a community mental health service in South East England. The data were taken from a study of comorbidity and cannabis use in a mental health trust covering a semi-rural population of 250,000 people in Harlow and the surrounding area of South East England. Key workers were interviewed using semi-structured questionnaires from the Comorbidity of Substance Misuse and Mental illness in Community Mental Health and Substance Misuse Services study. Rates of violence against health workers were more than 20 times higher among those patients with a history of violence (23.6% vs. 1%, P<0.001). Alcohol and drug use was more frequent in those who were violent. Prevalence of comorbidity, schizophrenia and personality disorders was high. Key workers' estimates suggested that there was no difference in aggression, engagement or adherence to care plan among those with a history of violence.
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Affiliation(s)
- H Rao
- Specialist Registrar in Psychiatry, Lakes Mental Health Center, Colchester General Hospital, Colchester, UK.
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Trathen B, O'gara C, Sarkhel A, Sessay M, Rao H, Luty J. Co-morbidity and cannabis use in a mental health trust in South East England. Addict Behav 2007; 32:2164-77. [PMID: 17434688 DOI: 10.1016/j.addbeh.2007.02.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2006] [Revised: 01/08/2007] [Accepted: 02/28/2007] [Indexed: 11/15/2022]
Abstract
AIM The prevalence of co-morbidity (severe mental illness and substance) may be less in rural and semi-rural areas than inner cities. The aims were therefore to measure the prevalence of co-morbidity among patients of attending a mental health service in a semi-rural area South East England. DESIGN AND PARTICIPANTS Cross-sectional prevalence survey of 1,808 patients with detailed assessments from a representative sample of 373 patients identified as having a combination of severe mental illness and substance misuse. Interviews with key workers were performed using validated methods from the COSMIC study. RESULTS The response rates equalled or exceeded 90% for the various parts of the study. One-tenth of patients attending the Community Mental Health Teams (CMHTs) reported problematic use of illicit drugs and 17% reported alcohol problems in the past year. 22% of Community Drug and Alcohol Service (CDAS) clients reported a severe mental illness and 46% reported some other form of psychiatric disorder. Of patients with a combined diagnosis of mental illness and substance misuse, cannabis use was 4-fold more common amongst patients attending the CMHT than CDAS (33% vs. 8%) while use of amphetamine was five-fold higher in the CMHT group (10% vs. 2%). Patients with concurrent psychiatric and substance misuse problems represent a similar proportion of the aggregate caseload of both treatment services with observed prevalence amongst the CDAS and CMHT patients with a diagnosis for anxiety disorder (18% vs. 26%), minor depression (42% vs. 32%), personality disorders (32% vs. 36%), histories of self-harm (52% vs. 46%) and violence (33% vs. 30%) respectively. CONCLUSIONS Co-morbidity is common in clients amongst CMHT and CDAS clients although use of cannabis was significantly more common in CMHT clients than in CDAS clients.
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Affiliation(s)
- Bruce Trathen
- CDAT, 2nd floor Aylmer House, Kitson Way, Harlow Essex CM20 1DL, United Kingdom.
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Coombes L, Wratten A. The lived experience of community mental health nurses working with people who have dual diagnosis: a phenomenological study. J Psychiatr Ment Health Nurs 2007; 14:382-92. [PMID: 17517029 DOI: 10.1111/j.1365-2850.2007.01094.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Dual diagnosis (the combination of mental health and substance misuse problems) is a significant facing mental health nurses in the UK. The purpose of the study was to describe the lived experience of community mental health nurses working with people who have a dual diagnosis. A phenomenological approach was us and a purposive sample of seven community mental health nurses with experience of working with people with a dual diagnosis was selected. Data were collected through audiotaped, semi-structured interviews lasting approximately 1 h in duration and analysed using Colaizzi's (1978) method. Thirteen theme clusters relating to three major themes were identified: (1) difficulties in understanding the concept of dual diagnosis; (2) feeling deskilled when working with people who have a dual diagnosis; (3) struggling to work in a system which seeks to avoid people with dual diagnosis. Recommendations regarding the need for increased joint working between professionals, improved education and further research are made.
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Affiliation(s)
- L Coombes
- Mental Health Nursing, School of Health and Social Care, Oxford Brookes University, Oxford, UK.
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Kuipers E, Garety P, Fowler D, Freeman D, Dunn G, Bebbington P. Cognitive, emotional, and social processes in psychosis: refining cognitive behavioral therapy for persistent positive symptoms. Schizophr Bull 2006; 32 Suppl 1:S24-31. [PMID: 16885206 PMCID: PMC2632539 DOI: 10.1093/schbul/sbl014] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Psychosis used to be thought of as essentially a biological condition unamenable to psychological interventions. However, more recent research has shown that positive symptoms such as delusions and hallucinations are on a continuum with normality and therefore might also be susceptible to adaptations of the cognitive behavioral therapies found useful for anxiety and depression. In the context of a model of cognitive, emotional, and social processes in psychosis, the latest evidence for the putative psychological mechanisms that elicit and maintain symptoms is reviewed. There is now good support for emotional processes in psychosis, for the role of cognitive processes including reasoning biases, for the central role of appraisal, and for the effects of the social environment, including stress and trauma. We have also used virtual environments to test our hypotheses. These developments have improved our understanding of symptom dimensions such as distress and conviction and also provide a rationale for interventions, which have some evidence of efficacy. Therapeutic approaches are described as follows: a collaborative therapeutic relationship, managing dysphoria, helping service users reappraise their beliefs to reduce distress, working on negative schemas, managing and reducing stressful environments if possible, compensating for reasoning biases by using disconfirmation strategies, and considering the full range of evidence in order to reduce high conviction. Theoretical ideas supported by experimental evidence can inform the development of cognitive behavior therapy for persistent positive symptoms of psychosis.
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Affiliation(s)
- Elizabeth Kuipers
- King's College London, Institute of Psychiatry, Department of Psychology, PO Box 77, London SE5 8AF, UK.
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Fakhoury WKH, Priebe S. An unholy alliance: substance abuse and social exclusion among assertive outreach patients. Acta Psychiatr Scand 2006; 114:124-31. [PMID: 16836600 DOI: 10.1111/j.1600-0447.2005.00740.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To investigate the relationship between social exclusion and outcomes of mentally ill patients with substance abuse problems receiving assertive outreach treatment in London. METHOD Analysis was conducted on data on 580 patients from the 'Pan-London Assertive Outreach Study (PLAO)'. Data were collected using clinician-rated scales of alcohol and drug abuse in the last 6 months before baseline. Outcomes - hospitalization and compulsory hospitalization- were assessed over a 9-month follow-up period. RESULTS The analysis identified a group of patients with substance abuse who suffer from social exclusion and forensic problems (n = 77, 15.8%), and had poorer outcomes than the rest of the patients in terms of hospitalization (52% vs. 36% respectively) and compulsory (39% vs. 22% respectively) hospitalization. CONCLUSION There is a distinct group of patients whose treatment requires social inclusion and forensic expertise. Future research into which model of service is suitable for these patients and in what setting is recommended.
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Affiliation(s)
- W K H Fakhoury
- Unit for Social and Community Psychiatry, Barts and The London School of Medicine, Queen Mary, University of London, London, UK.
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Bonsack C, Camus D, Kaufmann N, Aubert AC, Besson J, Baumann P, Borgeat F, Gillet M, Eap CB. Prevalence of substance use in a Swiss psychiatric hospital: interview reports and urine screening. Addict Behav 2006; 31:1252-8. [PMID: 16137835 DOI: 10.1016/j.addbeh.2005.08.008] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2005] [Revised: 06/07/2005] [Accepted: 08/03/2005] [Indexed: 11/25/2022]
Abstract
BACKGROUND Co-morbid substance misuse is common in psychiatric disorders, has potentially severe adverse consequences and may be frequently undetected. AIMS To measure the prevalence of substance use among patients admitted to a Swiss psychiatric hospital and to examine the potential utility of routine urine drug screening in this setting. METHOD 266 inpatients were included. 238 patients completed the interview and 240 underwent a urine drug screening. RESULTS Lifetime prevalence of substance use among psychiatric patients was very high for alcohol (98%; 95% CI: 96-100), benzodiazepines (86%; 95% CI: 82-91) and cannabis (53%; 95% CI: 47-60), but also for "hard drugs" like cocaine (25% ; 95% CI: 19-30) or opiates (20%; 95% CI: 15-25). Regular current use of alcohol (32%; 95% CI: 26-38) or cannabis (17%; 95% CI: 12-22) was the most frequent. Substance use was associated with male sex, younger age, unmarried status and nicotine smoking. Urine screening confirms reports from patients on recent use, and remained positive for cannabis during hospitalisation, but not for cocaine nor for opiates. CONCLUSION Substance use is frequent among psychiatric patients. Systematic interviewing of patients about their substance use remains essential, and is usually confirmed by urine screening. Urine screening can be useful to provide specific answers about recent use.
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Affiliation(s)
- Charles Bonsack
- Unité de recherche évaluative et clinique, Département Universitaire de Psychiatrie Adulte, Hôpital de Cery, 1008 Prilly, Suisse.
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Hiday VA. Putting community risk in perspective: a look at correlations, causes and controls. INTERNATIONAL JOURNAL OF LAW AND PSYCHIATRY 2006; 29:316-31. [PMID: 16533532 DOI: 10.1016/j.ijlp.2004.08.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2003] [Revised: 03/29/2004] [Accepted: 08/25/2004] [Indexed: 05/07/2023]
Abstract
Much research, but not all, appears to show that persons with severe mental illness are more dangerous and violent than others; but it is misleading and feeds the stigma cannon. This paper critically reviews reported correlations between severe mental illness and violence, examines their statistical confounds, highlights studies which seek causal mechanisms explaining the associations, points to what those causal mechanisms tell us about controlling risk in the community, and reviews legal attempts to control community risk in light of those causal mechanisms.
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Affiliation(s)
- A Young
- Faculty of Health and Wellbeing, Sheffield Hallam University, UK.
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Conrod PJ, Stewart SH. A Critical Look at Dual-Focused Cognitive-Behavioral Treatments for Comorbid Substance Use and Psychiatric Disorders: Strengths, Limitations, and Future Directions. J Cogn Psychother 2005. [DOI: 10.1891/jcop.2005.19.3.261] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Several large-scale studies examining outcome predictors across various substance use treatments indicate a need to focus on psychiatric comorbidity as a very important predictor of poorer SUD treatment involvement and outcome. We have previously argued that current cognitive-behavioral treatments (CBT) approaches to SUD treatment do not focus on the necessary content in treatment in order to effectively address specific forms of psychiatric comorbidity, and thus only provide clients with generic coping strategies for managing psychiatric illness (as would be achieved in other SUD treatment approaches; Conrod et al., 2000). Furthermore, following our review of the literature on dual-focused CBT treatment programs for concurrent disorders in this article, we argue that combining CBT-oriented SUD treatments with specific CBT treatments for psychiatric disorders is not as straightforward as one would think. Rather, it requires very careful consideration of the functional relationship between specific disorders, patient reactions to specific treatment components, and certain barriers to treatment in order to achieve an integrated dual-diagnosis focus in treatment that is meaningful and to which clients can adhere.
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Abstract
SUDs are common in people with BPD. The reasons for this association are not well understood and may be related to several factors. When present,SUDs in BPD patients seem to be associated with a poor prognosis. The treatment of patients with BPD and an SUD has been the subject of relatively little investigation, but medications that are effective mood stabilizers seem to decrease substance use in some reports.
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Affiliation(s)
- E Sherwood Brown
- Psychoneuroendocrine Research Program, Department of Psychiatry, University of Texas Southwestern Medical Center at Dallas, 5323 Harry Hines Boulevard, Dallas, TX 75390, USA.
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Timmerman IGH, Emmelkamp PMG. An integrated cognitive-behavioural approach to the aetiology and treatment of violence. Clin Psychol Psychother 2005. [DOI: 10.1002/cpp.447] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Keown P, Holloway F, Kuipers E. The impact of severe mental illness, co-morbid personality disorders and demographic factors on psychiatric bed use. Soc Psychiatry Psychiatr Epidemiol 2005; 40:42-9. [PMID: 15624074 DOI: 10.1007/s00127-005-0842-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/21/2004] [Indexed: 10/26/2022]
Abstract
BACKGROUND The use of inpatient psychiatric services has been correlated with certain demographic and clinical variables. However, there is limited information about the impact of personality disorder. AIMS To describe the impact of severe mental illness, personality disorders and demographic variables on psychiatric bed use amongst people in contact with a Community Mental Health Team (CMHT). METHOD Two-year retrospective and 2-year prospective bed use by the caseload of one Community Mental Health Team. RESULTS Psychotic disorders (odds ratio 2.7), personality disorders (OR 2.2), marital status (OR 2.1) and unemployment (OR 1.9) were significantly related to psychiatric admissions from community care. Gender, accommodation, drug and alcohol problems, and ethnicity were not. CONCLUSIONS Psychosis, personality disorder and unemployment appear to have independent effects on psychiatric bed use. Patients with a combination of psychotic disorders and diffuse personality disorders were very high users of inpatient services. This suggests that this group have particular needs that community mental health teams find difficult to manage.
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Affiliation(s)
- Patrick Keown
- Dept. of Psychiatry, The Royal Victoria Infirmary, Queen Victoria Road, Newcastle upon Tyne NE1 4LP, UK
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Foley SR, Kelly BD, Clarke M, McTigue O, Gervin M, Kamali M, Larkin C, O'Callaghan E, Browne S. Incidence and clinical correlates of aggression and violence at presentation in patients with first episode psychosis. Schizophr Res 2005; 72:161-8. [PMID: 15560961 DOI: 10.1016/j.schres.2004.03.010] [Citation(s) in RCA: 92] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2004] [Revised: 03/25/2004] [Accepted: 03/25/2004] [Indexed: 01/13/2023]
Abstract
This study aimed to identify the incidence and clinical correlates of aggression and violence in first episode psychosis. We prospectively recruited subjects with a first episode of DSM-psychosis presenting from a geographically defined catchment area to a secondary referral psychiatric service over a four-year period (n = 157). We used the Modified Overt Aggression Scale to retrospectively assess aggression (a hostile or destructive mental attitude, including verbal aggression, physical aggression and/or violence) and violence (the exercise of physical force), blind to diagnosis. One in three patients with psychosis was aggressive at the time of presentation. One patient in 14 engaged in violence that caused, or was likely to cause, injury to other people. Aggression was independently associated with drug misuse (odds ratio (OR) 2.80, 95% confidence interval 1.12-6.99) and involuntary admission status (OR = 3.62, 95% CI 1.45-9.01). Violence in the week prior to presentation was associated with drug misuse (OR = 2.75, CI 1.04-7.24) and involuntary admission status (OR = 3.21, CI 1.21-8.50). Violence in the week following presentation was associated with poor insight (OR 2.97, CI 1.03-8.56) and pre-contact violence (OR 3,82, CI 1.34-10.88). In patients with schizophrenia, violence in the week following presentation was associated with drug misuse (OR = 7.81, CI 1.33-45.95) and high psychopathology scores (OR = 20.59, CI 1.66-254.96). Overall, despite a high rate of verbal aggression, physical violence towards other people is uncommon in individuals presenting with first episode psychosis.
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Affiliation(s)
- Sharon R Foley
- The Stanley Research Unit, Department of Adult Psychiatry, Hospitaller Order of St. John of God, Cluain Mhuire Service, Co Dublin, Ireland
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Abstract
An early recognition of bipolar disorders may have an important impact on the prognosis of this disorder according to different mechanisms. Bipolar disorder is nevertheless not easy to detect, the diagnosis being correctly proposed after, in average more than a couple of Years and three different doctors assessments. A short delay before introducing the relevant treatment should help avoiding inappropriate treatments (prescribing, for example, neuroleptics for long periods, antidepressive drugs each time depressive symptoms occurs, absence of treatment despite mood disorders), with their associated negative impact such as mood-switching, rapid cycling or presence of chronic side-effects stigmates. Furthermore, non-treated mood disorders in bipolar disorder are longer, more stigmatizing and may be associated with an increased risk of suicidal behaviour and mortality. Lastly, compliance, an important factor regarding the long term prognosis of bipolar disorder, should be improved when there is a short delay between correct diagnosis and treatment and onset of the disorder. We therefore propose to review the literature for the different pitfalls involved in the diagnosis of bipolar disorder. Non-bipolar mood-disorders are frequently quoted as one of the alternative diagnosis. Hyperthymic temperament, side-effects of prescribed treatments and organic comorbid disorders may be involved. Bipolar disorders have a sex-ratio closer to 1 (men are thus more frequently of the bipolar type in mood-disorders), with earlier age at onset, and more frequent family history of suicidal attempts and bipolar disorder. Schizo-affective disorders are also a major concern regarding the diagnosis of bipolar disorder. This is explained by flat affects sometimes close to anhedonia, presence of a schizoïd personality in bipolar disorder, persecutive hostility that can be considered to be related to irritability rather than a schizophrenic symptom. Rapid cycling, mixed episodes and short euthymia periods may also increase the risk to shift from bipolar to schizophrenia diagnosis. Schizophreniform disorder ("bouffée délirante" aiguë in France) is a frequent form of bipolar disorder onset when major dissociative features are not obvious. The borderline personality is also a problem for the diagnosis of bipolar disorder, some Authors proposing that bipolar disorder is a mood-related personality disorder, sometimes improved by mood-stabilizers. Phasic instead of reactional, weeks and not days-length, clearcut onset and recovery versus non-easy to delimit mood-episodes may help to adjust the diagnosis. Organic disorders may lead to diagnostic confusion, but it is generally proposed that bipolar disorder should be treated the same way, whether or not an organic condition is detected (with special focus on treatment tolerance). Addictive disorders are frequent comorbid conditions in bipolar disorders. Psychostimulants (such as amphetamins or cocaine) intoxications sometimes mimic manic episodes. As these drugs are preferentially chosen by subjects with bipolar disorder, the later diagnosis should be systematically assessed. Puerperal psychosis is a frequent type of onset in female bipolar disorder. The systematic prescription of mood-stabilizers for and after such episode, when mood elation is a major symptom, is generally proposed. Attention deficit-hyperactivity disorder also has unclear border with bipolar disorder, as a quarter of child hyperactivity may be latterly associated with bipolar disorder. The assessment of mood cycling and their follow-up in adulthood may thus be particularly important. Lastly, presence of some anxious disorders may delay the diagnosis of comorbid bipolar disorder.
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Affiliation(s)
- P Gorwood
- Hôpital Louis Mourier, Service de Psychiatrie, 178, rue des Renouillers, 92700 Colombes, Paris, France
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