Managing patients with dual diagnosis in psychiatric practice

Baigent, Michael

doi:10.1097/yco.0b013e3283523d3d

Cited by 43 publications

(36 citation statements)

References 22 publications

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“…This difference is striking in 2003-2004 patients: SMI-SUD patients are more frequently affected by personality disorders and "other" diagnoses (including disturbance of conduct, mental retardation, eating disorders, acute stress reaction, and adaptation reaction), whereas, in 2013-2014, there is still a difference as far as personality disorders is concerned, albeit less striking, together with differences in "other" diagnoses and schizophrenia, which is more frequent in SMI-SUD than in SMI patients. These results are partially consistent with the existing literature [37,[94][95][96][97] especially because of the underrepresentation of mood disorders in the SMI-SUD group of patients. On the contrary, this change in diagnosis is interesting, as it may suggest a different pattern of substance use after 10 years.…”

Section: Clinical Featuressupporting

confidence: 82%

“…As far as diagnosis is concerned, the same study mentioned above, which assessed the period 2003-2012, found affective and "other" disorders associated with an increased risk of comorbid SUD, compared to personality disorders, which according to Baigent [94] would be more likely than Axis I disorders to be associated with chronic SUD. On the contrary, reports from the literature show mixed results about this issue, and recent studies suggest that the frequency of comorbid SUD is similar in schizophrenic psychoses and in personality disorders [37] and that primary mood and/or anxiety disorders are at high risk for comorbid SUD as well [96,97].…”

Section: Multivariate Analysismentioning

confidence: 99%

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Dual Diagnosis Patients First Admitted to a Psychiatric Ward for Acute Psychiatric Patients: 2-Year Period 2003–2004 versus 2013–2014

Gramaglia¹,

Lombardi²,

Rossi³

et al. 2016

Recent Advances in Drug Addiction Research and Clinical Applications

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Dual diagnosis (DD) is the coexistence of severe mental illness (SMI) and substance use disorder (SUD). The increase of DD observed in recent years has important implications for mental health services organization. The aim of this study is to assess the prevalence and features of DD over a decade, comparing the periods 2003-2004 and 2013-2014. We performed a retrospective study retrieving sociodemographic and clinical data from the medical records of patients at their first admission to the Psychiatric Ward of University Hospital "Maggiore della Carità" in Novara, Italy. Patients with SMI and comorbid SUD (SMI-SUD) and patients with SMI without comorbidity (SMI) were compared in the two periods, 2003-2004 versus 2013-2014. SMI-SUD patients in both 2-year periods were more likely to be male, younger, unemployed, living with parents (or alone, for the 2013-2014 period) rather than with a family of their own, and single (or divorced, in 2003-2004). The 2003-2004 patients were more frequently diagnosed with a personality disorder, whereas the 2013-2014 patients had mixed diagnoses. We have found differences in the possible predictors of substance abuse in the two periods as well: in both periods, male gender was associated with an increased risk of DD, whereas age >61 years was associated with decreased risk. Only in the first period (2003)(2004) was having a university degree associated with a decreased risk of DD, whereas the diagnosis of a personality disorder was associated with an increased risk of DD; on the contrary, in the second period (2013)(2014), living in a protective environment was associated with a decreased risk of DD. The identification of changes in the prevalence of first admission DD patients and their clinical and sociodemographic features may help to highlight an evolving pattern of substance use and to identify possible risk factors that may be the target of prevention and treatment approaches.

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Section: Clinical Featuressupporting

confidence: 82%

Section: Multivariate Analysismentioning

confidence: 99%

Dual Diagnosis Patients First Admitted to a Psychiatric Ward for Acute Psychiatric Patients: 2-Year Period 2003–2004 versus 2013–2014

Gramaglia¹,

Lombardi²,

Rossi³

et al. 2016

Recent Advances in Drug Addiction Research and Clinical Applications

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“…A retrospective study of first admissions to the University Psychiatry Ward, "Maggiore della Carità" Hospital, Novara, Italy, between 2003 and2012. The clinical charts of patients with (N=362) and without comorbid SUD (N=1111) were reviewed.…”

Section: Methodsmentioning

confidence: 99%

“…It should be remembered that SUD might increase the odds of subsequent mood disorders (Kenneson et al, 2013), and clinicians should control early on for SUD in patients with anxiety and mood disorders (Baigent, 2012) in order to avoid the revolving-door effect, which might depend on the substance used (for example, psychotic symptoms elicited by cannabis abuse in vulnerable subjects) Lange et al, 2014; Chen et al, 2013).…”

Section: Gender Differences Between Psy-sud and Psy Patientsmentioning

confidence: 99%

“…

AbstractObjectives : We assessed gender differences in a sample of first-admission psychiatric inpatients with and without comorbid Substance Use Disorder (SUD) to identify possible risk factors and targets for gender-tailored treatment interventions.

Methods:A retrospective study of first admissions to the University Psychiatry Ward, "Maggiore della Carità" Hospital, Novara, Italy, between 2003 and2012. The clinical charts of patients with (N=362) and without comorbid SUD (N=1111) were reviewed.

Results: Differences in employment, educational, and marital statuses were found between male and female psychiatric patients with and without comorbid SUD.

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mentioning

confidence: 99%

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Sex Differences in First-Admission Psychiatric Inpatients With and Without a Comorbid Substance Use Disorder

Gramaglia

Bert²,

Lombardi³

et al. 2014

Journal of Addiction Medicine

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Objectives : We assessed gender differences in a sample of first-admission psychiatric inpatients with and without comorbid Substance Use Disorder (SUD) to identify possible risk factors and targets for gender-tailored treatment interventions. Methods:A retrospective study of first admissions to the University Psychiatry Ward, "Maggiore della Carità" Hospital, Novara, Italy, between 2003 and2012. The clinical charts of patients with (N=362) and without comorbid SUD (N=1111) were reviewed.Results: Differences in employment, educational, and marital statuses were found between male and female psychiatric patients with and without comorbid SUD. Having a degree was a protective factor for males, while it was a risk factor for females. Being divorced and having family problems were both risk factors for comorbidity in females. Regarding the diagnosis, results overlapped in males and females, and both affective and other disorders were risk factors for a comorbid SUD. Conclusions:A significant difference between male and female psychiatric patients with a comorbid SUD was the males' overall poorer psychosocial functioning. Marital status and family problems were risk factors for comorbid SUD in females. Both males and females showed various pathways of access to and choices of substances and, eventually, experienced different impacts on their lives. Hospitalization might help to set up a targeted intervention for patients with comorbidity, while accounting for gender differences. With respect to males, a treatment approach focused on the substance alone might help improve their functioning; females might have a greater benefit from a treatment approach focused on distress, family problems, and relational issues. 3The co-occurrence of severe mental health conditions with a drug abuse or dependence disorder (substance use disorder, SUD) is referred to as Dual Diagnosis (DD). Psychiatric patients with a comorbid SUD represent up to half of the patients in most mental health treatment systems, and comorbidity is associated with several significant implications with respect to symptoms, course, morbidity, treatment effectiveness and adherence, social issues (e.g. legal problems), use of psychiatric and emergency room services, and regrettably, with common negative outcomes (Owen et al., 1996; Kovasznay et al., 1997; Margolese et al., 2004; Ziedonis, 2004; Tosato et al., 2013).The co-morbidity rate of SUD and major mental problems in Europe is generally not as high as in US according to various studies, and it ranges from 20% to 65% (Kessler et al., 1996;Teesson et al., 2000; Mueser et al., 2003). Additionally, comorbidity rates between psychiatric illness and SUD appear to be particularly high in inpatient, crisis team (38-50%), and forensic settings (Drake et al., 2004).Comparisons between psychiatric patients with a comorbid SUD and those without show differences in socio-demographic, clinical, substance-related characteristics, and other background variables. For instance, Katz et al. (2008) found that com...

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Sex Differences in Psychopathology Following Potentially Traumatic Experiences

Kofman,

Selbe,

Szentkúti

et al. 2024

JAMA Netw Open

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ImportanceVarious psychopathology may follow trauma; however, sex differences in these ranging manifestations of posttraumatic psychopathology remain understudied.ObjectiveTo investigate sex-specific incidence of posttraumatic psychopathology.Design, Setting, and ParticipantsThis population-based cohort study of Danish national health registries included a cohort of individuals who experienced a potentially traumatic event (PTE) from 1994 to 2016. Individuals were further categorized by presence of any pretrauma psychopathology. A comparison group of individuals who experienced a nontraumatic stressor (nonsuicide death of a first-degree relative) was examined as a reference cohort.ExposuresAt least 1 of 8 PTEs (eg, physical assault, transportation accident) derived through health registry International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes, with additional qualifiers to improve classification accuracy.Main Outcomes and MeasuresIncidence of 9 categories of ICD-10 psychiatric disorders recorded in registries within 5 years of PTEs. The standardized morbidity ratios (SMRs) for psychopathology outcomes were also calculated to compare individuals experiencing PTEs with those experiencing a nontraumatic stressor.ResultsThis study included 1 398 026 individuals who had been exposed to trauma (475 280 males [34.0%]; 922 750 females [66.0%]). The group of males who had been exposed to trauma were evenly distributed across age, while most females in the trauma-exposed group were aged 16 to 39 years (592 385 [64.2%]). Males and females were equally distributed across income quartiles and predominantly single. Following PTEs, the most common diagnosis was substance use disorders for males (35 160 [7.4%]) and depressive disorders for females (29 255 [3.2%]); incidence proportions for these and other disorders were higher among males and females with any pretrauma psychopathology. Certain PTEs had elevated onset of various psychiatric disorders and some sex differences emerged. Following physical assault, associations were found with schizophrenia or psychotic disorders for males (SMR, 17.5; 95% CI, 15.9-19.3) and adult personality disorders for females (SMR, 16.3; 95% CI, 14.6-18.3). For noninterpersonal PTEs, males had larger SMRs for substance use, schizophrenia or psychotic disorders, and adult personality disorders (SMR, 43.4; 95% CI, 41.9-45.0), and females had larger SMRs for depressive disorders (SMR, 19.0; 95% CI, 18.6-19.4). Sex differences were also observed, particularly when considering pretrauma psychopathology. For example, among interpersonal PTEs, males were most likely to develop substance use disorders after physical assault, whereas females were more likely to develop various disorders, with stronger associations seen for females without pretrauma psychiatric diagnoses. Among noninterpersonal PTEs, exposure to toxic substance showed robust associations with psychopathology, particularly in those without pretrauma psychopathology, with sex-specific differences across psychiatric categories.Conclusions and RelevanceMental disorders after trauma were wide-ranging for males and females, and sex differences in patterns of posttraumatic psychopathology were more pronounced when accounting for pretrauma psychopathology. Findings provide new insights for sex-relevant PTEs and their mental health consequences. It also outlines future directions for advancing understanding of a constellation of posttraumatic psychopathology in males and females.

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Managing patients with dual diagnosis in psychiatric practice

Cited by 43 publications

References 22 publications

Dual Diagnosis Patients First Admitted to a Psychiatric Ward for Acute Psychiatric Patients: 2-Year Period 2003–2004 versus 2013–2014

Dual Diagnosis Patients First Admitted to a Psychiatric Ward for Acute Psychiatric Patients: 2-Year Period 2003–2004 versus 2013–2014

Sex Differences in First-Admission Psychiatric Inpatients With and Without a Comorbid Substance Use Disorder

Sex Differences in Psychopathology Following Potentially Traumatic Experiences

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