The role of dual diagnosis in health-related quality of life among treatment-seeking patients in Spain (original) (raw)

2017, Quality of Life Research

Purpose The comorbidity of any substance use disorder and another mental disorder is defined as dual diagnosis. Dual diagnosis is very common and clinical and therapeutic consequences have been described. This cross-sectional study aimed to analyse health-related quality of life (HRQoL) according to clinical characteristics and psychiatric comorbidities in patients with substance dependence. Methods A total of 1276 substance-dependent patients seeking treatment were recruited. HRQoL was evaluated by the Short-Form 36 (SF-36) questionnaire. The SCID-I, SCID-II and Conners' adult ADHD diagnostic interview were used to evaluate dual diagnosis. A visual analogue scale was used to measure craving. Bivariate and multivariate analyses were performed, and correction for multiple tests was conducted. Results Substance-dependent patients had impaired quality of life, especially in the mental component. SF-36 physical and mental component scores were 47.7 ± 10.9 and 36.1 ± 14.1, respectively. Furthermore, 65% of the patients had dual diagnosis, 51% had an Axis I DSM-IV-TR mental disorder and 35% had some personality disorder. Impaired physical quality of life was independently associated with medical condition, age, being female, depressive disorder and anxiety disorder. Depression disorder, any personality disorder, active consumption last month, Attention deficit hyperactivity disorder, anxiety disorder, suicide attempt were independently associated with worse mental quality of life. Conclusion These findings emphasize the significance of dual diagnosis in the impairment of HRQoL in substancedependent patients, particularly with regard to mental component. In addicted patients with low scores on SF-36, psychiatric comorbidity should be evaluated and treated in an integrated approach.

Psychiatric comorbidity among inpatients in an addiction clinic and its association with the process of addiction

Dusunen Adam: The Journal of Psychiatry and Neurological Sciences, 2015

Psychiatric comorbidity among inpatients in an addiction clinic and its association with the process of addiction Objective: Epidemiological studies find a high comorbidity of other Axis I and Axis II disorders with substance use disorders among adults. This study examines comorbid Axis I and Axis II disorders in order to investigate their association with sociodemographic variables and relapse among inpatients diagnosed with substance use disorders. Method: Of 403 inpatients hospitalized between January 2012 and December 2013 in an addiction clinic, 323 were enrolled in this retrospective study using their medical records and sociodemographic data. These patients were all diagnosed with alcohol and substance abuse/dependence according to DSM-IV TR by two different psychiatrists, and comorbidities were also diagnosed by two different psychiatrists. Results: Among 323 inpatients with substance use disorder, 240 (74.3%) were diagnosed with another Axis I comorbidity and 238 (73.7%) had an Axis II disorder. No statistical difference was found between patients with and without an Axis I or Axis II comorbidity in terms of age, years of education, marital status, occupation, duration of drug use, rate of relapse in 6 months, and rate of dropout. Comorbidity of an Axis I and/or Axis II disorder raised the number of hospitalizations; comorbid Axis I disorder prolonged the duration of hospitalization, whereas Axis II disorder had an inverse effect. In addition, inpatients with an Axis II comorbidity had more legal issues and shorter duration until first use after treatment than inpatients without comorbidity. Conclusion: Comorbidity of substance use disorders and other Axis I and Axis II disorders is very common. Patients with dual diagnose use health services more often and have more legal issues than patients with substance use disorders only. Comprehensive care and treatment are needed for dual-diagnosed patients.

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...

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.

Comorbidity of mental disorders and substance use: A brief guide for the primary care clinician

2008

THE COMMON DRUG GROUPS Cannabis/Hallucinogens Alcohol Opioids Stimulants Benzodiazepines Tobacco DEPRESSION AND SUBSTANCE USE Comorbidity Major clinical issues with cannabis, hallucinogens and depression Major Clinical issues with alcohol and depression Major clinical issues with depression and opiate use Major clinical issues with depression and stimulant use Major clinical issues in depression and benzodiazepine use ANXIETY DISORDERS AND SUBSTANCE USE Anxiety Subtypes Comorbidity Major clinical issues with anxiety disorders and cannabis/hallucinogens Major clinical issues with alcohol and anxiety disorders Major clinical issues anxiety disorders and opiate use Major clinical issues anxiety disorders and stimulant use Major issues with benzodiazepines and anxiety disorders PSYCHOSIS (SCHIZOPHRENIA AND BIPOLAR DISORDER) AND SUBSTANCE USE Comorbidity with psychosis Major clinical issues in the management of psychosis and cannabis/hallucinogens. Major clinical issues with alcohol and psychosis Major clinical issues with schizophrenia and opiate use Major clinical issues with psychosis and stimulant use. Major clinical issues with benzodiazepine use and the psychoses. PERSONALITY DISORDERS AND SUBSTANCE USE Comorbidity with personality disorders Major issues with personality disorders and cannabis/hallucinogen use Major issues with the personality disorders and alcohol use Major issues with opiate use in people with personality disorders. Major issues with people with personality disorders and stimulant use Major issues with personality disorder and benzodiazepine use EATING DISORDERS Anorexia Bulimia Physical and Medical Complications of Eating Disorders Comorbidity of eating disorders and substance use Major clinical issues with comobrbidity of eating disorders and cannabis/hallucinogen use Major clinical issues with the comorbidity of alcohol abuse and eating disorders Major issues with eating disorders and opiate use Major issues with eating disorders and stimulants Major clinical issues with eating disorders and benzodiazepines SOMATOFORM DISORDERS

A 12-month prospective follow-up study of patients with schizophrenia-spectrum disorders and substance abuse: Changes in psychiatric symptoms and substance use

Schizophrenia Research, 2006

While it is widely known that patients with schizophrenia-spectrum psychoses and co-occurring substance use disorders are more difficult to manage, there is limited data on the course of their psychiatric symptoms when they remain in treatment over time. This prospective 12-month study evaluated changes in psychiatric symptoms and substance use to ascertain if the co-existence of substance use disorders influences ratings of psychiatric symptoms at follow-up. 147 outpatients in a continuing care program were assessed at intake and followed prospectively for 12 months. Psychiatric symptoms were measured at baseline and 12-month follow-up using the Positive and Negative Syndrome Scale (PANSS) and Hamilton Depression Rating Scale (HAM-D). Subjective psychological distress was rated with the Brief Symptom Inventory (BSI) and quality of life by the Satisfaction with Life Domains Scale (SDLS). Drug and alcohol use was measured with the Addiction Severity Index (ASI). 50.3% of patients were diagnosed with dual disorders (DD) (current and lifetime). The most common primary substances of abuse were alcohol (35.6%) and cannabis (35.1%). DD subjects had higher baseline PANSS positive scores but experienced a greater reduction at 12 months compared to single diagnosis (SD) patients. Severity of substance abuse as measured by ASI composite scores did not decrease significantly between baseline and 12 months. DD patients with schizophrenia and related psychoses treated for their psychiatric illness showed a reduction in PANSS scores over 12 months, even when their substance use remained largely unchanged. However, co-morbidity cases continued to show higher depression and anxiety ratings. Ongoing substance abuse appears to be related to levels of depression as 62.5% of DD-current versus 34.7% of SD patients had HAM-D scores in the depressed range at 12-month follow-up. Implications for treatment are discussed.

Loading...

Loading Preview

Sorry, preview is currently unavailable. You can download the paper by clicking the button above.