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Rammouz I, Merzouki M, Bouri S, Rachid A, Bout A, Boujraf S. Are Patients with Schizophrenia Reliably Reporting their Cannabis Use? An African Cross-sectional Study. Cent Nerv Syst Agents Med Chem 2022; 22:188-197. [PMID: 35726408 DOI: 10.2174/1871524922666220620150033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 04/07/2022] [Accepted: 04/20/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Most studies of the prevalence of cannabis use among patients with schizophrenia used a self-report as declared by the patient himself. We hypothesize that patients with schizophrenia did not tell the truth and might underreport their use for many reasons to be discussed later. Indeed, the under-report of cannabis use among these patients can affect the effectiveness of their treatment. AIMS To assess the degree of agreement between the prevalence values obtained from patients' reports and the results of the toxicological tests. METHODS A cross-sectional study was carried out on 403 patients with schizophrenia. A sociodemographic, psychiatric history and illicit drug use profile was performed for each patient. We assessed the patients with the Positive and Negative Syndrome Scale (PANSS), Calgary Depression score (CDSS), Barratt Impulsiveness Score (BIS-10) and Medication Adherence Rating Scale (MARS). The consumption of cannabis used was confirmed with MINI International Neuropsychiatric Interview (MINI-DSM IV) and using toxicological analysis. RESULTS Among the 403 patients who consented to give their urine samples, 49.1% (198/403) tested positive for cannabis, and 41.41% (82/198) underreported their use. The sensitivity and specificity of the questionnaire were 0.58 and 0.74. Based on the comparison between sociodemographic and psychiatric history data of patients who self-report and underreport their cannabis use, no significant difference was observed except for the duration of cannabis use and the score on the medication adherence scale. Moreover, it was found that impulsivity, PANSS score, CDSS score, and the type of schizophrenia are not involved in predicting the underreporting of cannabis use. CONCLUSION The rate of patients who under-report cannabis use is important. Therefore, toxicological analysis is becoming relevant for identifying drug use among schizophrenic patients and in the addictive comorbidity research field.
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Affiliation(s)
- Ismail Rammouz
- Faculty of Medicine, Health Sciences Research Laboratory, Ibn Zohr University, Agadir, Morocco
| | - Mohamed Merzouki
- Faculté de Sciences et Techniques, Moulay Sliman University, Beni Mellal, Morocco
| | - Sara Bouri
- Faculty of Medicine, Clinical Neurosciences Laboratory, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Aalouane Rachid
- Faculty of Medicine, Clinical Neurosciences Laboratory, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Amine Bout
- Faculty of Medicine, Clinical Neurosciences Laboratory, Sidi Mohamed Ben Abdellah University, Fez, Morocco
| | - Saïd Boujraf
- Faculty of Medicine, Clinical Neurosciences Laboratory, Sidi Mohamed Ben Abdellah University, Fez, Morocco
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Levin-Rector A, Hourani LL, Van Dorn RA, Bray RM, Stander VA, Cartwright JK, Morgan JK, Trudeau J, Lattimore PK. Predictors of Posttraumatic Stress Disorder, Anxiety Disorders, Depressive Disorders, and Any Mental Health Condition Among U.S. Soldiers and Marines, 2001-2011. J Trauma Stress 2018; 31:568-578. [PMID: 30025180 DOI: 10.1002/jts.22316] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 04/27/2018] [Accepted: 04/28/2018] [Indexed: 11/10/2022]
Abstract
Understanding mental health disorder diagnosis and treatment seeking among active-duty military personnel is a topic with both clinical and policy implications. It has been well documented in military populations that individual-level military experience, including deployment history and combat exposure, influences mental health outcomes, but the impact of unit-level factors is less well understood. In the current study, we used administrative longitudinal data to examine a comprehensive set of unit- and individual-level predictors of posttraumatic stress disorder (PTSD), non-PTSD anxiety disorders, depressive disorders, and overall mental health diagnoses among Army and Marines Corps personnel. Using Cox survival models for time-dependent variables, we analyzed time from military accession (between January 1, 2001 and December 31, 2011) until first mental health diagnosis for 773,359 soldiers and 332,093 Marines. Prior diagnosis of a substance abuse disorder during one's military career, hazard ratios (HRs) = 1.68-3.10, and cumulative time spent deployed, HRs = 1.11-2.04, were the most predictive risk factors for all outcomes. Male sex, HRs = 0.35-0.57, and officer rank, HRs = 0.13-0.23, were the most protective factors. Unit-level rate of high deployment stress was a small but significant predictor of all outcomes after controlling for individual-level deployment history and other predictors, HRs = 1.01-1.05. Findings suggest both unit- and individual-level risk and protective factors of mental health diagnoses associated with treatment seeking. Clinical, including mental health assessment and management, and policy implications related to the military environment and the individual as it relates to mental health disorders are discussed.
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Affiliation(s)
| | | | | | - Robert M Bray
- RTI International, Research Triangle Park, North Carolina, USA
| | | | | | | | - James Trudeau
- RTI International, Research Triangle Park, North Carolina, USA
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Bennett ME, Bradshaw KR, Catalano LT. Treatment of substance use disorders in schizophrenia. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 43:377-390. [DOI: 10.1080/00952990.2016.1200592] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
- Melanie E. Bennett
- Department of Psychiatry, University of Maryland School of Medicine, Baltimore, MD, USA
- VA VISN 5 Mental Illness Research, Education, and Clinical Center, Baltimore, MD, USA
| | - Kristen R. Bradshaw
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA
| | - Lauren T. Catalano
- Department of Psychology, University of Maryland, College Park, College Park, MD, USA
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Johnson KL, Desmarais SL, Swartz MS, Van Dorn RA. Latent class analysis of discordance between results of drug use assessments in the CATIE data. Schizophr Res 2015; 161:434-8. [PMID: 25476120 PMCID: PMC4827431 DOI: 10.1016/j.schres.2014.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Revised: 11/11/2014] [Accepted: 11/17/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The primary aim is to examine concordant/discordant results of drug use assessments in adults with schizophrenia. METHODS Latent class analysis and multinomial logistic regression were used to examine concordance/discordance between drug use measures and identify characteristics differentiating participants across classes. RESULTS Four classes - non-users, users, probable users, and RIA discordant - fit best. Age, sex, race/ethnicity, and psychiatric symptoms differed significantly across classes. CONCLUSIONS Findings showed that discordance between results occurs at non-trivial rates and is, in part, attributable to individual characteristics. Results suggest the need for strategies to limit discordance and improve detection of drug use in adults with schizophrenia.
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Affiliation(s)
- Kiersten L Johnson
- Department of Psychology, North Carolina State University, Campus Box 7650, Raleigh, NC 27695, United States.
| | - Sarah L Desmarais
- Department of Psychology, North Carolina State University, Campus Box 7650, Raleigh, NC 27695, United States.
| | - Marvin S Swartz
- Department of Psychiatry & Behavioral Sciences, Duke University Medical Center, 238 Civitan Building, Box 3173, Durham, NC 27710, United States.
| | - Richard A Van Dorn
- Behavioral Health Epidemiology Program, RTI International, 3040 E. Cornwallis Road, P.O. Box 12194, Research Triangle Park, NC 27709, United States.
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Batalla A, Garcia-Rizo C, Castellví P, Fernandez-Egea E, Yücel M, Parellada E, Kirkpatrick B, Martin-Santos R, Bernardo M. Screening for substance use disorders in first-episode psychosis: implications for readmission. Schizophr Res 2013; 146:125-31. [PMID: 23517662 PMCID: PMC4390132 DOI: 10.1016/j.schres.2013.02.031] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Revised: 02/05/2013] [Accepted: 02/24/2013] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Screening of substance use may prove useful to prevent readmission after the first episode of psychosis. The aim of the present study was to evaluate the influence of drug use on readmission risk in a first-episode psychosis sample, and to determine whether the cannabis/cocaine subscale of the Dartmouth Assessment of Lifestyle Inventory (DALI) is a better predictive instrument than urinary analysis. METHODS After admission, first-episode psychotic patients were interviewed for substance use and assessed with the DALI scale. They also underwent blood and urine sampling. Time to readmission was studied as a dependent outcome. The Kaplan-Meier estimator was applied to estimate the survival curves for bivariate analysis. The Cox proportional hazards model for multivariate analysis was assessed in order to control for potential confounders. ROC curve and validity parameters were used to assess validity to detect readmission. RESULTS Fifty-eight patients were included. The DALI cannabis/cocaine subscale and urinalysis were associated with increased readmission risk in survival curves, mainly the first five years of follow-up. After controlling for potential confounding variables for readmission, only the DALI cannabis/cocaine subscale remained as a significant risk factor. In terms of validity, the DALI cannabis/cocaine subscale was more sensitive than urinalysis. Alcohol assessments were not related to readmission. CONCLUSIONS The findings demonstrated that a quick screening self-report scale for cannabis/cocaine use disorders is superior to urinary analysis for predicting readmission. Future research should consider longitudinal assessments of brief validated screening tests in order to evaluate their benefits in preventing early readmission in first-episode psychosis.
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Affiliation(s)
- Albert Batalla
- Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer, Centro de Investigación Biomédica en Red en Salud Mental, 08036 Barcelona, Spain.
| | - Clemente Garcia-Rizo
- Schizophrenia Program, Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, IDIBAPS, CIBERSAM, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Pere Castellví
- Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Spain, Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), and CIBER Epidemiología y Salud Pública (CIBERESP), Doctor Aiguader 88, 08033, Barcelona, Spain, CIBER Epidemiología y Salud Pública (CIBERESP), Doctor Aiguader 88, 08033, Barcelona, Spain
| | - Emili Fernandez-Egea
- Good Outcome Schizophrenia Clinic, Cambridgeshire and Peterborough NHS Foundation Trust, UK, Department of Psychiatry and Behavioural and Clinical Neuroscience Institute (BCNI), University of Cambridge, Forvie Site, Cambridge CB2 0SZ, UK
| | - Murat Yücel
- School of Psychology and Psychiatry, Monash University, Clayton Campus, Melbourne, Victoria 3800, Australia
| | - Eduard Parellada
- Schizophrenia Program, Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, IDIBAPS, CIBERSAM, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Brian Kirkpatrick
- Department of Psychiatry, Texas A&M University College of Medicine, Scott & White Healthcare, 1901 South Veterans Memorial Drive, 76504, Temple, TX, United States
| | - Rocío Martin-Santos
- Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, Hospital Clínic, Institut d'Investigació Biomèdica August Pi i Sunyer (IDIBAPS), Centro de Investigación Biomédica en Red en Salud Mental (CIBERSAM), Spain, Department of Psychiatry and Clinical Psychobiology, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
| | - Miguel Bernardo
- Schizophrenia Program, Department of Psychiatry and Psychology, Clinical Institute of Neuroscience, IDIBAPS, CIBERSAM, Hospital Clínic, University of Barcelona, Villarroel 170, 08036, Barcelona, Spain
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Abstract
OBJECTIVE This study examined relationships among family history of alcohol, drug, and psychiatric problems and substance use severity, interpersonal relationships, and service use in individuals with dual diagnosis. METHODS Data were collected with the family history section of the Addiction Severity Index administered as part of three studies of individuals with dual disorders (N=413). Participants were categorized into family history risk groups for each problem domain based on the number of first and second degree relatives with alcohol, drug, or psychiatric problems. RESULTS Rates of alcohol, drug, and psychiatric problems were high across family member categories and highest overall for siblings. Over two-thirds of the sample was categorized in the high-risk group in the alcohol problem domain, almost half of the sample was categorized as high-risk in the drug problem domain, and over a third of the sample was categorized as high-risk in the psychiatric problem domain. Across problem domains, individuals in the high-risk group reported more relationship problems with parents and siblings and higher rates of lifetime emotional, physical, and sexual abuse than did those in the low or moderate-risk groups. CONCLUSIONS Family history of alcohol, drug, and psychiatric problems is associated with greater rates of poor family relationships and history of abuse. Assessment of these different forms of family history in multiple family members can aid treatment providers in identifying individuals with dual disorders who may benefit from trauma-informed care as part of their overall mental health and substance abuse treatment services.
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Affiliation(s)
- Camille S Wilson
- University of Maryland-Baltimore County, Baltimore, Maryland, USA
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Mueser KT, Gingerich S. Treatment of co-occurring psychotic and substance use disorders. SOCIAL WORK IN PUBLIC HEALTH 2013; 28:424-439. [PMID: 23731429 DOI: 10.1080/19371918.2013.774676] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
People with psychotic disorders and other serious mental illnesses, such as schizophrenia, bipolar disorder, and severe major depression, have high rates of co-occurring substance use disorder, which can wreak havoc in their lives. In this article the authors describe strategies for assessing substance use problems in people with serious mental illnesses, and then address the treatment of these co-occurring disorders. The authors review principles of treatment of co-occurring disorders, including integration of mental health and substance abuse services, adopting a low-stress and harm-reduction approach, enhancing motivation, using cognitive-behavioral therapy strategies to teach more effective interpersonal and coping skills, supporting functional recovery, and engaging the social network. The authors include a section on how social workers may play a key role in assessment, treatment, or referral for co-occurring disorders in a variety of settings. Throughout the article the authors emphasize that belief in the possibility of recovery from co-occurring disorders and instilling hope in clients, their family members, and other treatment providers, are vital to the effective treatment of co-occurring disorders.
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Affiliation(s)
- Kim T Mueser
- Center for Psychiatric Rehabilitation, Boston University, Boston, MA 02215, USA.
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McDonell MG, Kerbrat AH, Comtois KA, Russo J, Lowe JM, Ries RK. Validation of the co-occurring disorder quadrant model. J Psychoactive Drugs 2012; 44:266-73. [PMID: 23061327 DOI: 10.1080/02791072.2012.705065] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
The co-occurring disorders quadrant model has been used as a framework for characterizing the heterogeneity in persons with low- and high-severity substance use and psychiatric disorders. This study investigated the validity and stability of the quadrant model in 155 adults who presented to one county hospital with psychiatric, substance use, or medical complaints. Quadrant placement was defined using data that is routinely gathered in clinical care or available in administrative data sets (i.e., substance dependence diagnosis, Global Assessment of Functioning scores). Fifty-four percent (n = 84) of study participants were categorized into quadrant IV (high-severity psychiatric/substance use), followed by quadrant I (low-severity psychiatric/substance use) (n = 32, 21%), quadrant II (high-severity psychiatric & low-severity substance use) (n = 25, 16%), and quadrant III (low-severity psychiatric & high-severity substance use) (n = 14, 9%). Quadrant placement was correlated with psychiatric and/or substance use diagnoses, psychiatric symptom severity, drug/alcohol toxicology and psychiatric and substance use health utilization, supporting the concurrent validity of the model. Initial quadrant placement was correlated with validity measures administered at three-month follow-up supporting predictive validity of the model. Initial and follow-up quadrant placement was significantly correlated suggesting stability of the quadrant model. Data support the validity of the quadrant model for application in clinical and administrative purposes.
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Affiliation(s)
- Michael G McDonell
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Box 359911, Harborview Medical Center, 325 Ninth Ave, Seattle, WA 98104-2499, USA.
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McDonell MG, Angelo F, Sugar A, Rainey C, Srebnik D, Roll J, Short R, Ries RK. A pilot study of the accuracy of onsite immunoassay urinalysis of illicit drug use in seriously mentally ill outpatients. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2011; 37:137-40. [PMID: 21219262 DOI: 10.3109/00952990.2010.548015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES This pilot study investigated the accuracy of onsite immunoassay urinalysis of illicit drug use in 42 outpatients with co-occurring substance use disorders and serious mental illness. METHODS Up to 40 urine samples were submitted by each participant as part of a larger study investigating the efficacy of contingency management in persons with co-occurring disorders. Each sample was analyzed for the presence of amphetamine, methamphetamine, cocaine, marijuana, and opiates or their metabolites using onsite qualitative immunoassays. One onsite urinalysis was randomly selected from each participant for confirmatory gas chromatography-mass spectrometry (GC-MS) analyses. RESULTS Agreement between immunoassay and GC-MS was calculated. Agreement was high, with 98% agreement for amphetamine, methamphetamine, opiate, and marijuana. Agreement for cocaine was 93%. CONCLUSIONS Results of this pilot study support the use of onsite immunoassay screening cups as an assessment and outcome measure in adults with serious mental illness. SCIENTIFIC SIGNIFICANCE Data suggest that onsite urinalysis screenings may be a helpful assessment tool for measuring clinical and research outcomes.
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Affiliation(s)
- Michael G McDonell
- Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98104, USA.
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