The Experts below are selected from a list of 23670 Experts worldwide ranked by ideXlab platform
Constance Weisner - One of the best experts on this subject based on the ideXlab platform.
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chemical dependency patients with cooccurring psychiatric diagnoses service patterns and 1 year outcomes
Alcoholism: Clinical and Experimental Research, 2006Co-Authors: Derek D Satre, Constance WeisnerAbstract:Background: Improving services and treatment outcomes for indiviDuals with cooccurring alcohol and drug use disorders and psychiatric conditions has been a critical challenge to clinicians and policy makers. This study examined 1-year outcomes for indiviDuals entering chemical dependency (CD) treatment with and without cooccurring psychiatric diagnoses targeted by California parity legislation. Among those with cooccurring conditions (i.e., Dual-Diagnosis patients), we examined a model including indiviDual characteristics, treatment services, and extratreatment characteristics to understand CD outcome predictors in this population. We hypothesized that longer CD treatment duration and receiving psychiatric services would predict higher abstinence levels. In particular,patterns of psychiatric services (amount of services, receiving a critical dose, or receiving services concurrently with CD treatment) were assessed in relation to outcome. Methods: We examined abstinence rates 1 year after intake for 747 adults with and without cooccurring conditions. Among Dual-Diagnosis patients, logistic regression was used to examine predictors of abstinence. Results: At baseline, Dual-Diagnosis patients (N=104) had higher levels of medical, family, and employment problems than others. They had similar CD retention and received more psychiatric services during the year after intake and had comparable CD outcomes at 1 year. Length of stay in CD treatment, hours of psychiatric services, number of months with concurrent CD and psychiatric services, and number of 12-step meetings attended were independent predictors of abstinence for Dual Diagnosis patients. Conclusions: Chemical dependency outcomes in patients with cooccurring psychiatric conditions were positively associated with the number and patterning of services. Receiving psychiatric services concurrently with CD treatment may be beneficial for Dual-Diagnosis patients. Future studies should examine how best to integrate services to optimize treatment outcomes.
Ronald W Pies - One of the best experts on this subject based on the ideXlab platform.
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the bipolar patient with comorbid substance use disorder recognition and management
CNS Drugs, 2004Co-Authors: Mark J Albanese, Ronald W PiesAbstract:Bipolar patients with comorbid substance abuse or dependence ("Dual Diagnosis" patients) represent a major public health problem. Substance abuse generally predicts poor outcome and higher morbidity/mortality in bipolar disorder. For the purposes of this review, open and controlled studies of Dual Diagnosis assessment and treatment were located through electronic searches of several databases. Pertinent case reports were also evaluated. The results of the search were evaluated in light of the authors' own research on Dual Diagnosis patients. Literature searching revealed few controlled studies to guide pharmacotherapy of bipolar patients with comorbid substance abuse or dependence. However, preliminary evidence suggests that the best outcomes are usually achieved with antiepileptic mood stabilisers and/or atypical antipsychotics, combined with appropriate psychosocial interventions. The latter may include classical 12-step groups, integrated group therapy or indiviDual psychotherapy. While it is often difficult to determine the precise pathway to comorbid bipolar disorder/substance abuse, it is clear that both disorders must be vigorously treated. This requires a carefully integrated biopsychosocial approach, involving appropriate mood stabilisers and psychosocial interventions. Many more controlled studies of these combined treatment approaches are needed.
Nieves Martinezluna - One of the best experts on this subject based on the ideXlab platform.
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psychiatric comorbidities in opioid dependent patients undergoing a replacement therapy programme in spain the proteus study
Psychiatry Research-neuroimaging, 2016Co-Authors: Carlos Roncero, Carmen Barral, Laia Rodriguezcintas, Jesus Perezpazos, Nieves MartinezlunaAbstract:Opioid-dependent patients show a high rate of psychiatric comorbidities. The prevalence and characteristics of patients with Dual Diagnosis have not been well established in Spanish opioid agonist treatment (OAT) programmes. Thus, 621 opioid-dependent patients enrolled in OAT programmes were assessed, using the EuropASI questionnaire, for psychiatric comorbidities, which were detected in 67% of patients (anxiety 53%, mood disorders 48%, sleep disorders 41%, substance-related disorders 36%). In addition, compared with patients without a Dual Diagnosis, patients with Dual pathology were significantly older, used benzodiazepines and cannabis in significantly greater percentages, and showed significantly more frequent infectious and non-infectious comorbidities, worse overall working status, a lower proportion of drivers and higher levels of severity regarding medical, employment, alcohol, legal, family and psychological issues. Therefore, the data showed a very high prevalence of psychiatric comorbidity in opioid-dependent patients receiving OAT in Spain and several problems frequently associated with patients with Dual Diagnosis. Physicians treating opioid-dependent patients should be aware of these facts to correctly identify and manage patients with a Dual Diagnosis.
Graham Thornicroft - One of the best experts on this subject based on the ideXlab platform.
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Dual Diagnosis in the suburbs prevalence need and in patient service use
Social Psychiatry and Psychiatric Epidemiology, 2000Co-Authors: S L Wright, Kevin Gournay, Emily Glorney, Graham ThornicroftAbstract:Background: Previous research has found comorbid severe mental illness and substance misuse (Dual Diagnosis) to be highly prevalent and to be associated with serious clinical and social problems, and increased service use in inner-city populations. The present study measures the prevalence of Dual Diagnosis, patterns of substance misuse, and associated in-patient use in a more demographically representative population in a suburban area of South London Method: We identified representative prevalent cases with psychotic illnesses who had been in contact with services in a geographically defined catchment area in Croydon over the previous 6 months. Cases of alcohol or substance misuse and dependence were identified through standardised interviews with patients and keyworkers, and socio- demographic and in-patient psychiatric service use data were also recorded. Results: Sixty-one of the 124 cases identified were randomly selected for interview, of whom 66% responded (N = 40). The prevalence rates of Dual Diagnosis (DD) observed were 33% (95% CI 18–47%) for any substance misuse, 20% (95% CI 8–32%) for alcohol misuse only, 5% (95% CI −16 to 26%) for drug misuse only, and 8% (95% CI −0.7 to 16%) for both drug and alcohol misuse. A lifetime history of any illicit drug use was observed in 35% of the sample (95% CI 20–50%). Patients who misuse alcohol and drugs were not found to be more likely to have been admitted to hospital in the previous 2 years, with little difference being observed between DD and psychosis-only patients in the mean number of in-patient admissions in this period (mean difference 0.25, 95% CI for difference −1.5 to 2.0). However, the DD patients were found to have spent on average over twice as long in hospital as other psychotic in-patients over the previous 2 years (mean difference 67.3 days, 95% CI for difference −205.9 to 71.2 days). DD patients were also found to have a greater number of unmet areas of need than the psychosis-only patients, which included accommodation, daytime activity, and social life, as well as substance misuse. Conclusions: The prevalence of substance misuse in patients with severe mental disorders in a suburban area is about as high as that for similar patients in inner-city London. While DD patients are not admitted more often than patients with psychosis alone, they have double the length of in-patient stay, which may be attributable to higher levels of unmet need.
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Dual Diagnosis of severe mental health problems and substance abuse dependence a major priority for mental health nursing
Journal of Psychiatric and Mental Health Nursing, 1997Co-Authors: Kevin Gournay, T Sandford, Sonia Johnson, Graham ThornicroftAbstract:It is now established that very significant numbers of people with severe mental illness abuse or depend on drugs and/or alcohol. This combination (Dual Diagnosis) leads to increased rates of violence and service use, a reduction in adherence to treatment regimes, an increase in susceptibility to human immunodeficiency virus (HIV) infection and is now found in in-patient populations. Because of their vulnerability to accidents and physical illnesses, Dual Diagnosis patients are found increasingly in accident and emergency departments, general medical wards and primary care settings. For this reason nurses and other health professionals working in general hospitals should be as aware as their mental health colleagues of the specific needs of this population. There are some excellent models of service organization and training for dealing with Dual diagnoses populations in some parts of the USA. However, there is little such development in the UK. There are clear pathways to be followed, but the need for action is urgent.
John W Finney - One of the best experts on this subject based on the ideXlab platform.
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Dual Diagnosis patients in substance abuse treatment relationship of general coping and substance specific coping to 1 year outcomes
Addiction, 1999Co-Authors: Franz Moggi, Paige Ouimette, Rudolf H Moos, John W FinneyAbstract:Aims. This study examined general and substance-specific coping skills and their relationship to treatment climate, continuing care and 1-year post-treatment functioning among Dual Diagnosis patients (i.e. co-occurrence of substance use and psychiatric disorders). Design. In a prospective multi-site study, Dual Diagnosis patients participating in substance abuse treatment were assessed at intake, discharge and at a 1-year follow-up. Setting. Patients were recruited from 15 substance abuse treatment programs, which were selected from a larger pool of 174 inpatient treatment programs in the Department of Veterans Affairs Health Care System. Participants. A total of 981 male Dual Diagnosis patients participated in the study. Measurements. Assessments included general and substance-specific coping skills, treatment climate, continuing outpatient care, abstinence and clinically significant psychiatric symptoms. Findings. Dual Diagnosis patients modestly improved on general and substance-specific coping skills over the 1-year follow-up period. Patients who were in programs with a 'Dual Diagnosis treatment climate' and who participated in more 12-Step self-help groups showed slightly more gains in adaptive coping. Both general and substance-specific coping were associated with abstinence, but only general coping was associated with freedom from significant psychiatric symptoms. Conclusions. Enhancing general and substance-specific coping skills in substance abuse treatment may reduce Dual Diagnosis patients' post-treatment substance use and improve their psychological functioning.
