Comorbidity of mental disorders and substance use: A brief guide for the primary care clinician (original) (raw)
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Mental Disorders and Illicit Drug Use Expert Group
According to an approach being used across searches undertaken for the 2005 Global Burden of Disease project (GBD), a systematic review was undertaken for cannabis dependence and use. Standardised approaches to literature searches, search terms, data collection, data extraction, consistency and error checking, and expert consultation and review were taken. These are mentioned below and are all documented in further detail on the methodology page of the GBD expert group's website: http://www. gbd. unsw. edu.
Assessing Comorbid Mental and Substance-Use Disorders
Journal of Psychiatric Practice, 1996
The authors review the assessment of comorbid mental and substance-use disorders and provide practical guidelines to inform the clinician's diagnostic decisions. They describe how to differentiate between intoxication and withdrawal syndromes and substanceinduced and primary disorders as defined in DSM-FV and present different viewpoints about how comorbid, substance-induced, primary, and secondary disorders can be defined. They discuss the types of psychiatric symptoms that may be associated with different substances (both substances of abuse and prescribed medications), focusing on mood, anxiety, and psychotic disorders. How to assess personality disorders in the context of substance use is also reviewed. Finally, the authors provide examples of questions the clinician can use during the patient evaluation to facilitate diagnostic decision making.
International Journal of Occupational Medicine and Environmental Health
This study analyzed the prevalence of new psychoactive substance (NPS) use in the analyzed group and compared demographic features and psychoactive substance profiles between the 2 subgroups (NPS users, non-NPS users). The secondary measure was used to determine the prevalence of psychiatric comorbidities in study group and to compare demographic features and psychoactive substance profiles between 2 subgroups (the F11-19 only diagnosed group and the F11-19 group with psychiatric comorbidities according to ICD-10). Material and Methods: A 12-month retrospective cross-sectional analysis of medical records compiled for adult psychiatric patients who had been admitted to the Regional Psychiatric Hospital in Olsztyn, Poland, in October 1, 2016-September 30, 2017 was conducted. After analyzing the available medical records, 157 cases were included and analyzed. Data for the study were collected in a specially designed monitoring card from discharge reports, including data from psychiatric examinations, especially anamnesis. Results: The most commonly declared psychoactive substances were amphetamine (AMF)-54% and cannabinoids-46%. The prevalence of NPS use in the study group was 34%. Inpatients taking NPS, as compared with non-NPS users, were younger and more often admitted to hospital through the Emergency Department. It was also found that NPS users more often took AMF or cannabinoids, and less frequently benzodiazepines (BDZ) or opioids. However, the taking of AMF, cannabinoids and BDZ was also age-dependent. Conclusions: The prevalence of psychiatric comorbidities in the study group was 9%. Inpatients with psychiatric comorbidities were older and took BDZ significantly more often than AMF. In addition, NPS use affects different groups, including a specific group as the analyzed sample, which shows a similar NPS use profile as different groups described in the literature.
Psychiatry research, 2016
This study aimed to determine if current comorbid psychiatric disorders differ in adults with cocaine use disorder, other stimulant (primarily methamphetamine) use disorder, or both, and identify demographic and clinical characteristics in those with increasing numbers of comorbid disorders. Baseline data from a randomized controlled trial beginning in residential settings (N=302) was used. Mood disorders were present in 33.6%, and anxiety disorders in 29.6%, with no differences among stimulant use disorder groups. Panic disorder was more frequently present with other stimulant use disorder. Those with two or more comorbid psychiatric disorders were more often female, White, had more symptoms of depression, greater propensity and risk for suicidal behavior, lower functioning in psychiatric and family domains, lower quality of life, more symptoms with stimulant abstinence and greater likelihood of marijuana dependence. Those with one or more comorbid disorders had more medical disord...
Comorbidity of Substance Dependence and Other Psychiatric Disorders
2008
Background and aim: The relationship between psychiatric and drug abuse disorders had been suggested by psychometric studies and structured clinical interviews. An individual suffering from these forms of comorbidity also have a worsened clinical course outcome and are at an increased risk of suicide, impairment and disability. This study aims to detect comorbid psychiatric disorder in substance dependent patients and associated pattern of personality traits. Method: Psychiatric morbidity and personality assessment were studied in a sample of 65 male patients recruited from the inpatient psychiatric unit of Assiut University Hospital who were admitted for treatment either of drug dependence or associated psychiatric disorder. The subjects were interviewed using the Arabic translation of the Structured Clinical Interview for DSM-III-R (SCID). In addition, Structured Interview for Five Factor Model of personality (SIFFM) was used for assessment of personality. Results: Smoking represe...
Disorders related to use of psychoactive substances in DSM-5: Changes and challenges
Indian Journal of Psychological Medicine, 2015
These changes have gained attention of academics and researchers globally and have been discussed at length. [3-5] However, a critical review of these changes in the Indian context has been restricted to only a few disorders and sections. [6-8] Substance use disorder section in DSM-5 includes changes in terminology; sections and categories; diagnostic criteria; threshold for diagnosis; severity; and specifier. Critical evaluation of the changes made to the section on disorders related to substance use in Indian context has not been published so far. Terminology, sections and categories In DSM-4 TR disorders associated with use of psychoactive substances were grouped under the category 'substance related disorders'. In DSM-5 these disorders have been categorized as 'substance related and In the most recent edition of Diagnostic and Statistical Manual (DSM) that is DSM-5 many modifications have been made in substance use disorder section. These include changes in terminology; sections and categories; diagnostic criteria; threshold for diagnosis; severity; and specifier. Additionally, there have been certain additions and omissions from the earlier version. Critical evaluation of the changes made to the section on disorders related to use of psychoactive substances in India context has not been published so far. The current paper presents a critique of the changes made to the substance use disorder section in DSM-5. The rationale for these changes put forth by DSM-5 work group on substance related disorders have been discussed. Additionally, attempt has been made to highlight the possible future challenges consequent to the current nosological revision for substance use disorder category. Overall DSM-5 seems to be promising in fulfilling its goal of DSM-ICD harmonisation and movement towards an internationally compatible and practical diagnostic system for mental health disorders. It has increased the scope of addiction by inclusion of behavioural addiction. It has also tried to balance the categorical and dimensional approach to diagnosis. However, the real test of this newer edition of one of the most commonly used nosological systems will be during clinical care and research. This will help address the debatable issues regarding the changes that DSM-5 brings with it.
Psychiatric comorbidity in illicit drug users: Substance-induced versus independent disorders
Drug and Alcohol Dependence, 2011
Background: Few studies have differentiated between independent and substance-induced psychiatric disorders. In this study we determine the risks associated with independent and substance-induced psychiatric disorders among a sample of 629 illicit drug users recruited from treatment and out of treatment settings. Methods: Secondary analysis of five cross-sectional studies conducted during 2000-2006. Independent and substance-induced DSM-IV psychiatric diagnoses were assessed using the Psychiatric Research Interview for Substance and Mental Disorders. Results: Lifetime prevalence of Axis I disorders other than substance use disorder (SUD) was 41.8%, with independent major depression being the most prevalent (17%). Lifetime prevalence of antisocial or borderline personality disorders was 22.9%. In multinominal logistic regression analysis (SUD only as the reference group), being female (OR 2.45; 95% CI 1.59, 3.77) and having lifetime borderline personality disorder (OR 2.45; 95% CI 1.31, 4.59) remained significant variables in the group with independent disorders. In the group with substance-induced disorders, being recruited from an out of treatment setting (OR 3.50; 95% CI 1.54, 7.97), being female (OR 2.38; 95% CI 1.24, 4.59) and the number of SUD (OR 1.31; 95% CI 1.10, 1.57) remained significant in the model. These variables were also significant in the group with both substance-induced and independent disorders, together with borderline personality disorder (OR 2.53; 95% CI 1.03, 6.27). Conclusions: Illicit drug users show high prevalence of co-occurrence of mainly independent mood and anxiety psychiatric disorders. Being female, recruited from an out of treatment setting and the number of SUD, are risk factors for substance-induced disorders.