Journal of Dual Diagnosis最新文献

Objective: Colorectal cancer (CRC) is the second leading cause of cancer death in the US. Screening has decreased CRC mortality. However, disadvantaged patients, particularly those with mental illness or substance use disorder (SUD), are less likely to be screened. The aim of this trial was to evaluate the impact of a patient navigation program on CRC screening in patients with mental illness and/or SUD.

Methods: A pilot randomized nonblinded controlled trial was conducted from January to June 2017 in an urban community health center serving a low-income population. We randomized 251 patients aged 50-74 years with mental illness and/or SUD diagnosis overdue for CRC screening to intervention (n = 126) or usual care (n = 125) stratified by mental illness, SUD, or dual diagnosis. Intervention group patients received a letter followed by a phone call from patient navigators. Navigators helped patients overcome their individual barriers to CRC screening including: education, scheduling, explanation of bowel preparation, lack of transportation or accompaniment to appointments. If patient refused colonoscopy, navigators offered fecal occult blood testing. The main measure was proportion of patients completing CRC screening in intervention and usual care groups.

Results: Navigators contacted 85 patients (67%) in the intervention group and 26 declined to participate. In intention-to treat analysis, more patients in the intervention group received CRC screening than in the usual care group, 19% versus 10.4% (p = .04). Among 56 intervention patients who received navigation, 19 completed screening (33.9% versus 10.4% in the control group, p = .001). In the subgroup of patients with SUD, 20% in the intervention group were screened compared to none in the usual care group (p = .05).

Conclusions: A patient navigation program improved CRC screening rates in patients with mental illness and/or SUD. Larger studies in diverse care settings are needed to demonstrate generalizability and explore which modality of CRC screening is most acceptable and which navigator activities are most effective for this vulnerable population.

Trials registration number: 2016P001322.

Objective: The objective of the study was to investigate whether a diagnosis of posttraumatic stress disorder (PTSD; full or partial) or specific PTSD symptom clusters predicted failure in quitting smoking in a trauma-exposed population. Methods: Participants were 310 smokers who attempted quitting smoking, either successfully (quitters, n = 213) or not (relapsers, n = 97), who lived in slums and were attending a family doctor program. Measurements included a general questionnaire covering sociodemographic characteristics, clinical status and life habits, and the Posttraumatic Stress Disorder Checklist - Civilian Version. Differences in sociodemographic, clinical and lifestyle characteristics between quitters and relapsers were compared using a chi-square test. Because of the small sample size, full and partial PTSD were collapsed into a single category. Results: Significant differences (p ≤ .15) between quitters and relapsers were found in age, body mass index (BMI), income, alcohol consumption, and in the presence of full/partial PTSD diagnosis and of all three symptom clusters separately. Four logistic regression models predicting smoking cessation were modeled to control for confounding factors and included as independent variables a full/partial PTSD diagnosis and the three posttraumatic symptom clusters. The avoidance/numbing cluster presented the strongest association with relapse status (ORa 2.04, 95% CI [1.15, 3.63], p = .015), followed by the full/partial PTSD (ORa 1.80, 95% CI [1.04, 3.14], p = .038). The re-experiencing and the hyperarousal clusters were non-significantly associated with smoking cessation (ORa 1.34, 95% CI [0.80, 2.31], ns and ORa 1.65, 95% CI [0.96, 2.84], ns, respectively). Conclusions: Full/partial PTSD and posttraumatic symptom clusters uniquely predict risk for smoking relapse and thus may be a useful therapeutic target in trauma-exposed smokers.

Objective: The objective of this study was to investigate the feasibility and acceptability of a multi-component mobile contingency management (CM) pilot intervention for smoking cessation for people with schizophrenia. Methods: This intervention included mobile CM (i.e., monetary compensation for bioverification of abstinence through using a phone app), cognitive behavioral therapy (CBT), and pharmacotherapy for smoking cessation. This intervention was compared to an intensive treatment comparison (ITC), which contained all components except the CM. Participants were bioverified with carbon monoxide and saliva cotinine at a 6-month follow-up session. Results: In this pilot, the treatment group did not differ from the ITC at any time point. However, measures of treatment feasibility and acceptability indicated that smokers with schizophrenia were able to navigate the CM phone application and adhere to the protocol, demonstrating the potential utility of mobile interventions in this population. Conclusions: Despite lack of long-term abstinence for participants, adherence to the mobile application intervention indicates the potential for future investigation of mobile smoking cessation treatments for people with schizophrenia.

Objectives: Technology-assisted treatment (TAT) holds promise for innovative assessment, prevention, and treatment of substance use disorders (SUD). The widespread access to TAT makes it a potentially cost-effective and inventive option available for delivery in multiple settings. This study assessed acceptability of the web-based Therapeutic Education System (TES) in hospitalized dual diagnosis patients with SUDs and other psychiatric disorders. Methods: Eligible participants were nonpsychotic, voluntary patients with self-reported drug or alcohol use in the 30 days prior to admission. They were randomly assigned to treatment as usual (TAU, n = 47) or TAU + TES (n = 48). Acceptability of this Internet-based intervention was assessed by observed utilization and self-report. Results: The TAU + TES group (# analyzed = 41) completed a mean total of 5.5 (SEM = 0.8) modules with about one module per day while hospitalized and rated TES highly on several constructs of acceptability, including novelty, usefulness and ease of understanding. Conclusions: These findings support further exploration of TAT for treatment expansion in a high acuity, dual diagnosis population and indicate the value of future research on efficacy. ClinicalTrials.gov Identifier: NCT02674477.

Objective: To determine the prevalence of self-induced vomiting (SIV) in a sample of patients with Alcohol Use Disorder (AUD), and to explore whether such behavior is associated with a comorbid eating disorder psychopathology and other clinical symptomatology, such as impulsivity. Methods: This cross-sectional descriptive study was carried out at the Alcohol Rehabilitation Unit at Stikland Psychiatric Hospital, South Africa. All consecutive inpatient admissions between April and June 2017 were invited to participate in an hour-long data interview. The Alcohol Use Disorders Identification Test (AUDIT), Bulimic Investigatory Test, Edinburgh (BITE), and the Barratt Impulsiveness Scale (BIS-11) were used to collect data from 104 adults. Results: A total of 29% of patients with AUD reported SIV. The main reason stated for SIV was to prevent hangover (66%). There were no significant differences in BITE and BIS110 scores between participants who reported SIV and those who did not. Conclusions: Almost a third of patients with AUD reported SIV. BITE scores indicated no relationship between eating disorders and alcohol-related SIV in this sample. Our findings also did not support an etiological role for impulsivity in alcohol-related SIV.

Objective: The aim of this study was to examine health, demographic, and service utilization characteristics of veterans with multimorbid tobacco use disorder (TUD) and morbid obesity compared to those with either condition alone. Methods: Health record data were extracted from the computerized patient record system of the Veterans Health Administration (VHA; October 1, 2011 to September 30, 2012). Bivariate and multivariate logistic regression models were used to compare veterans with both TUD and morbid obesity (body mass index [BMI] ≥ 40 kg/m²) to veterans with each condition alone on a range of demographic, health, and service utilization outcome variables that also were extracted from the VHA administrative record. Results: Veterans with both morbid obesity and TUD showed higher rates of medical and psychiatric comorbidity than did veterans with either condition alone. However, while veterans with TUD and morbid obesity showed higher rates of comorbid substance use disorders than veterans with morbid obesity alone, veterans with both conditions showed substantially lower rates of substance use disorders than those with TUD alone. Conclusions: Veterans with co-occurring morbid obesity and TUD appear to be at greater risk for medical disease and psychiatric conditions. The unexpected finding that veterans with TUD alone had more concurrent substance use disorders than veterans with both TUD and morbid obesity suggest the possibility that overeating may be a substitute for substance use in the context of TUD. The multimorbidity profile described here may suggest unique treatment needs for individuals with both TUD and morbid obesity. Highlights Medical multimorbidities predict additional health conditions and poorer outcomes. Obesity and tobacco use may share common underlying vulnerabilities. Veterans with both conditions showed higher rates of certain multimorbidities. Obesity may protect against substance use in tobacco users.

Objective: The purpose of the present investigation was to examine the unique explanatory role of cannabis use motives above the effects of each other, for the relationship between obsessive-compulsive symptomatology and different aspects of cannabis misuse among young adults. The transitional years of young adulthood are characterized by new opportunities for experimentation as well as novel external stressors. Collectively, this makes this developmental epoch a sensitive time for manifestations of cannabis misuse. Methods: Bivariate correlations were conducted to examine the association between obsessive-compulsive symptomatology and risky cannabis use, cannabis use problems, and the average quantity of cannabis used per occasion among a young ethno-racially diverse sample of college students with the past year history of cannabis use (N = 177, 68.95% female, Mage = 21.51, SD = 4.24). Next, multiple mediation analyses were conducted to examine the unique explanatory role of cannabis use motives (e.g., enhancement, conformity, coping, social, and expansion) for the association between the obsessive-compulsive symptoms and cannabis misuse variables which showed significant correlation with these symptoms at the bivariate level. Results: Obsessive-compulsive symptoms were significantly correlated with risky cannabis use (r = .19; p = .02), but not cannabis use problems or the average quantity of cannabis used per occasion. Conducting the multiple mediation for the relationship with the significant bivariate correlation, coping motives significantly explained the relationship between obsessive-compulsive symptoms and risky cannabis use (b = 0.04, SE = 0.02, 95% Bootstrapped CI [0.003, 0.10], Completely Standardized Indirect Effects = 0.07), after controlling for the variance accounted for by problematic alcohol use and smoking status. This indirect effect was not significant after adding anxiety and depressive symptoms as covariates to the model. Conclusions: These findings are discussed in terms of the development of specialized treatments to specifically target cannabis use coping motives among individuals with comorbid obsessive-compulsive disorder and cannabis misuse.

Objective: Rhabdomyolysis is associated with methamphetamine, amphetamine, and methylenedioxymethamphetamine (MA) use. The aim of this study was to determine the frequency, severity, and risk factors of rhabdomyolysis associated with MA use. Methods: We reviewed patients with an MA-positive toxicology screen with and without diagnosed rhabdomyolysis based on initial creatine kinase (CK) concentration over a period of 6 years. Demographics, vital signs, disposition, diagnoses, and laboratory results were recorded. Results: There were 7,319 patients with an MA-positive toxicology screen, of whom 957 (13%) were screened for rhabdomyolysis and included in the study. The majority were male, White, and middle-aged and smoked tobacco. Psychiatric (34%), neurological (15%), and trauma (13%) were the most common discharge diagnostic groups. The majority (55%) were admitted, and 8% were discharged to an inpatient psychiatric facility. Concomitant substance use included ethanol (10%) and cocaine (8%), and 190 (20%) had rhabdomyolysis with median (interquartile range) CK of 2,610 (1,530-6,212) U/L and range 1,020 to 98,172 U/L. There was significant difference in renal function between the rhabdomyolysis and non-rhabdomyolysis patients. Other differences included gender and troponin I concentration. A higher proportion of patients screening positive for both MA and cocaine use experienced rhabdomyolysis. Multiple logistic regression analysis revealed elevated troponin I, blood urea nitrogen, and/or creatinine concentration and male gender to be significant factors associated with rhabdomyolysis. Conclusions: The frequency of rhabdomyolysis in patients screening positive for MA was 20%. Factors associated with rhabdomyolysis in MA-positive patients included elevated troponin, blood urea nitrogen, creatinine concentration, and male gender. Clinicians caring for patients who screen positive for MA should also consider concomitant rhabdomyolysis, especially if renal/cardiac laboratory tests are abnormal and even if there is no history of injury, agitation, or physical restraint.

Objectives: Posttraumatic stress disorder (PTSD) is a problem of growing importance among female veterans, which is especially challenging when accompanied by comorbid substance use disorder (SUD). Since women are still a small minority of Veterans Health Administration (VHA) patients, there is concern that outcomes among dually diagnosed women may be worse than among men.

Method: National program evaluation data were collected at admission and 4 months after discharge from 7,074 dually diagnosed veterans including 203 women (2.9%) treated at 57 specialized intensive VHA PTSD treatment programs between 1993 and 2011. Multiple regression was used to compare clinical change in women and men adjusting for baseline differences.

Results: Women showed no significant differences from men in measures of substance use or total PTSD symptoms at admission although they were more likely to have experienced sexual trauma and less likely to report combat exposure. With adjustment for these differences, there were no significant gender differences in length of stay, satisfaction with treatment, or measures of change in substance use or total PTSD symptoms 4 months after discharge. Reductions in an index of days of substance use was associated with reduction in total PTSD symptoms among both women (R = 0.33; p = .01) and men (R = 0.44, p < .0001) with no significant gender difference.

Conclusion: No significant gender differences were observed in substance use or PTSD outcomes, despite the extreme minority status of women in VHA programs. Highly vulnerable women can benefit as much as men, even when treatment is not formally tailored to address gender-specific needs.

Objective: Ethnic minorities report different levels of drinking and smoking and higher rates of depression compared to native populations. In this study we aimed to investigate in six ethnic groups whether tobacco and alcohol use were associated with depressive symptoms, which are more prevalent in ethnic minorities.Methods: Cross-sectional data from the multi-ethnic Healthy Life in an Urban Setting (HELIUS) study sample (N = 22,471) was used, comprising 4,580 native Dutch participants which were compared with participants from five ethnic minority groups (3,259 South Asian Surinamese, 4,292 African Surinamese, 2,262 Ghanaian, 3,891 Turkish, and 4,187 Moroccan).Results: Alcohol misuse was positively associated with depressed mood in all ethnic groups except for the Dutch and the Ghanaians. Nicotine dependence was positively associated with depressed mood in all ethnic groups except for the Ghanaian group.Conclusions: Alcohol misuse and nicotine dependence were significantly associated with depressed mood in most but not all ethnic groups and especially in men. However, across all groups the contribution of alcohol misuse and nicotine dependence to depressed mood was small. Prospective multi-ethnic studies should confirm whether the relations are causal and elucidate their direction.