Mental health and substance use : dual diagnosis最新文献

英文中文

Problematic substance use in two mental health NGOs, and staff, client and general public attitudes towards problematic substance use amongst people with mental illness 两个精神卫生非政府组织的问题物质使用情况，以及工作人员、客户和公众对精神疾病患者使用问题物质的态度

Mental health and substance use : dual diagnosis

Pub Date : 2012-10-05 DOI: 10.1080/17523281.2012.702518

Grenville J. Rose, I. Beale, J. Malone, J. Higgin, Melanie Whiticker, L. Brener

A significant proportion of people with mental illness are thought to have co-occurring problematic substance use but there is little published information available and that which is published can be contradictory and vary according to a number of factors. Additionally, the stigma surrounding co-occurrence is little understood and an exploration of attitudes would benefit mental health service design and delivery. The study aimed to measure the rates of concurrent problematic substance use in community-based health services and to compare attitudes of staff, clients and the public towards people with this population. Create an exploratory model of attitudes. Surveys distributed to staff and clients of two mental health non-government organisations (NGOs) and to a comparison sample of members of the general public. Eighty-two staff, 333 clients and 545 members of the public were surveyed. Rates of alcohol and substance use amongst service clients were similar to levels previously reported of 25% and 39%, ...

很大一部分患有精神疾病的人被认为同时存在有问题的药物使用，但可获得的公开信息很少，而公布的信息可能相互矛盾，并因许多因素而有所不同。此外，人们对共同发病的耻辱感知之甚少，对态度的探索将有利于精神卫生服务的设计和提供。这项研究的目的是衡量社区卫生服务中同时使用问题物质的比率，并比较工作人员、客户和公众对这类人群的态度。创建一个探索性的态度模型。向两间精神健康非政府机构的工作人员和服务对象分发调查问卷，并以普通市民为样本进行比较。共有82名员工、333名客户和545名市民接受了调查。服务客户的酒精和药物使用率与先前报告的25%和39%相似。

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引用次数: 1

Tobacco, caffeine, alcohol and illicit substance use among consumers of a national community managed mental health service 国家社区管理的精神卫生服务消费者的烟草、咖啡因、酒精和非法药物使用情况

Mental health and substance use : dual diagnosis

Pub Date : 2012-10-05 DOI: 10.1080/17523281.2012.703225

A. Zimmermann, D. Lubman, Merrilee Cox

Previous research has consistently documented high rates of tobacco smoking and substance use disorders among people with serious mental illness. However, limited studies have been conducted outside traditional clinical settings. In an attempt to address this shortfall and to better understand the needs of people accessing its services, a national community managed mental health service (Neami) examined the prevalence and impact of substance use among 489 consumers from across Australia. Results indicated extremely high rates of tobacco use, with 64.8% of participants identified as daily smokers. Approximately 86% of participants met abuse or dependence criteria for their caffeine use. In addition, 27.6% met criteria for an alcohol use disorder, whilst 28% met criteria for a cannabis use disorder. Overall rates of other illicit substance use were low. This study reinforces the need for routine alcohol and drug screening and assessment across all mental health settings, as well as appropriate support strat...

先前的研究一致证明，严重精神疾病患者中吸烟和物质使用障碍的比例很高。然而，在传统临床环境之外进行的研究有限。为了解决这一不足并更好地了解获得其服务的人的需求，一个由社区管理的全国精神卫生服务机构(Neami)调查了澳大利亚各地489名消费者使用药物的普遍程度和影响。结果显示烟草使用率极高，64.8%的参与者被确定为每日吸烟者。大约86%的参与者符合咖啡因滥用或依赖标准。此外，27.6%符合酒精使用障碍的标准，28%符合大麻使用障碍的标准。其他非法药物使用的总体比率很低。这项研究强调了在所有精神卫生机构中进行常规酒精和药物筛查和评估的必要性，以及适当的支持战略。

引用次数: 3

The impact of training within a comprehensive dual diagnosis strategy: the Combined Psychosis and Substance Use (COMPASS) experience 培训在综合双重诊断策略中的影响:精神病和药物使用联合(COMPASS)经验

Mental health and substance use : dual diagnosis

Pub Date : 2012-07-10 DOI: 10.1080/17523281.2012.660191

A. Copello, K. Walsh, Hermine L. Graham, D. Tobin, S. Fellows, E. Griffith, E. Day, M. Birchwood

This article is a service report based on the experience of the Combined Psychosis and Substance Use Programme (COMPASS), which aims to provide integrated treatment for people who experience coexisting mental health and substance use problems. A fundamental role of the service is to deliver a structured training package based on a Cognitive-Behavioural Integrated Treatment approach to staff within mental health services. We aimed to establish whether the needs of staff prior to training were consistent across various service areas and whether our training package can enhance staff confidence and skills to work with this client group. The final aim was to consider if confidence and skills can be maintained over an extended period of time. This article is based on service evaluation data collected between the late 1990s and 2011. Data that had been collected from staff across diverse service areas within a large Mental Health Trust in the UK were analysed. There was a high degree of consistency across the s...

本文是一份基于精神病和物质使用联合规划(COMPASS)经验的服务报告，该规划旨在为同时存在精神健康和物质使用问题的人提供综合治疗。该服务的一个基本作用是向精神卫生服务部门的工作人员提供基于认知-行为综合治疗方法的结构化培训包。我们的目标是确定员工在培训前的需求在不同的服务领域是否一致，以及我们的培训方案是否能增强员工与这一客户群合作的信心和技能。最终目的是考虑信心和技能能否在较长一段时间内保持。本文基于20世纪90年代末至2011年间收集的服务评估数据。对英国一家大型心理健康信托基金不同服务领域的员工收集的数据进行了分析。整个国家的情况高度一致。

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引用次数: 8

Marijuana impacts mood in bipolar disorder: a pilot study. 大麻影响双相情感障碍患者的情绪:一项初步研究。

Mental health and substance use : dual diagnosis

Pub Date : 2012-07-10 DOI: 10.1080/17523281.2012.659751

S. Gruber, Kelly A Sagar, M. Dahlgren, D. Olson, F. Centorrino, S. Lukas

Patients with bipolar disorder (BP) often report subjective mood improvements after smoking marijuana (MJ); however, empirical studies supporting this claim have not been conducted. We conducted this study to determine if marijuana has an impact on mood in bipolar patients who smoke marijuana (MJBP), hypothesizing MJBP participants would experience improved mood after smoking MJ. All participants completed electronic mood ratings three times daily and recorded episodes of MJ use using Palm Pilot devices in their own environments in order to examine the impact of MJ use on mood in MJ-smoking bipolar patients (n = 12) and pure MJ smokers (MJ; n = 20). Difference scores were calculated between pre and post-MJ scales. Patients with BP (n = 11) who did not smoke MJ were also included as a comparison group. Significant mood improvement was observed in the MJBP group on a range of clinical scales after smoking MJ, while the MJ group reported a slight worsening of symptoms. Notably, total mood disturbance, a composite of the Profile of Mood States, was significantly reduced in the MJBP group, but increased in the MJ group after smoking. Further, while the MJBP group reported generally worse mood ratings than the BP group prior to smoking MJ, they demonstrated improvement on several scales post-MJ use as compared to BP participants. These data provide empirical support for anecdotal reports that MJ acts to alleviate mood-related symptoms in at least a subset of bipolar patients and underscore the importance of examining MJ use in this population.

双相情感障碍(BP)患者经常报告吸大麻(MJ)后主观情绪有所改善;然而，支持这一说法的实证研究尚未进行。我们进行了这项研究，以确定大麻是否对吸食大麻(MJBP)的双相情感障碍患者的情绪有影响，假设MJBP参与者在吸食大麻后情绪会有所改善。所有参与者每天完成三次电子情绪评分，并在自己的环境中使用Palm Pilot设备记录MJ使用情况，以检查MJ使用对MJ吸烟双相患者(n = 12)和纯MJ吸烟者(MJ;N = 20)。计算mj前后量表的差异得分。不吸烟MJ的BP患者(n = 11)也被纳入对照组。在抽MJ后，MJBP组在一系列临床量表上观察到明显的情绪改善，而MJ组报告症状轻微恶化。值得注意的是，吸烟后，MJBP组的总情绪障碍(情绪状态谱的综合指标)显著减少，而MJ组则有所增加。此外，虽然MJBP组在吸烟前的情绪评分普遍比BP组差，但与BP组相比，他们在使用MJ后的几个尺度上都有所改善。这些数据为MJ至少在一部分双相患者中缓解情绪相关症状的轶事报道提供了经验支持，并强调了在这一人群中检查MJ使用的重要性。

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引用次数: 11

Guidelines on the management of co-occurring mental health conditions in alcohol and other drug treatment settings: how useful are they? 在酒精和其他药物治疗环境中同时发生的精神健康状况管理指南:它们有多大用处?

Mental health and substance use : dual diagnosis

Pub Date : 2012-03-21 DOI: 10.1080/17523281.2011.631502

K. Mills, M. Deady, M. Teesson, C. Sannibale, Heather Proudfoot, L. Burns, R. Mattick

There has been a growing literature documenting the high prevalence of co-occurring mental health disorders among clients of substance use treatment services and the challenges clinicians face when treating comorbid clients. To assist alcohol and other drug (AOD) workers in working with these clients, the Australian Government Department of Health and Ageing funded the development of ‘Guidelines on the management of co-occurring alcohol and other drug and mental health conditions in alcohol and other drug treatment settings.’ Too often guidelines are produced but not evaluated. The present study aimed to examine the extent to which this resource is perceived to be relevant and useful to clinical practice. Ninety-seven AOD workers from across Australia completed an online survey. A series of questions asked respondents to rate the relevance and usefulness of the Guidelines to their clinical practice. Overall, the responses received were overwhelmingly positive. The vast majority of respondents perceived th...

越来越多的文献记录了在药物使用治疗服务的客户中同时发生的精神健康障碍的高发率以及临床医生在治疗合并症客户时面临的挑战。为了协助酒精和其他药物(AOD)工作人员与这些客户合作，澳大利亚政府卫生和老龄部资助制定了《在酒精和其他药物治疗环境中同时发生的酒精和其他药物及精神健康状况管理准则》。“经常是制定了指导方针，但没有进行评估。目前的研究旨在检查这种资源被认为是相关的和有用的临床实践的程度。来自澳大利亚各地的97名AOD员工完成了一项在线调查。一系列的问题要求受访者评价指南对其临床实践的相关性和有用性。总的来说，收到的反馈绝大多数是积极的。绝大多数受访者认为……

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引用次数: 27

Prolonged exposure to post-traumatic stress disorder (PTSD) in an active substance abuser 活跃药物滥用者长期暴露于创伤后应激障碍(PTSD)

Mental health and substance use : dual diagnosis

Pub Date : 2012-03-21 DOI: 10.1080/17523281.2011.611118

Theresa Souza, C. Spates, C. Rankin

Effective treatments for post-traumatic stress disorder (PTSD) have been the focus of research studies for many years, with exposure therapy consistently emerging as the leading treatment for this disorder. However, for a variety of reasons most studies exclude individuals suffering from concurrent substance use disorders. In recent years, this omission has been addressed, and the belief that substance dependent individuals cannot benefit from trauma treatment until they are free from substances is losing favor. Early studies have demonstrated that prolonged exposure therapy can be effective for persons suffering from both disorders. The current case study seeks to provide information on the length of time and type of symptom change in an individual suffering from comorbid PTSD-substance abuse (PTSD-SA). Therefore, prolonged exposure was utilized to treat PTSD in an active abuser of both alcohol and marijuana. Pre- and post-treatment assessments demonstrate dramatic reductions in PTSD symptoms, general an...

多年来，创伤后应激障碍(PTSD)的有效治疗一直是研究的焦点，暴露疗法一直是该疾病的主要治疗方法。然而，由于各种原因，大多数研究排除了同时患有物质使用障碍的个体。近年来，这种遗漏已经得到解决，并且认为物质依赖个体在摆脱物质依赖之前无法从创伤治疗中受益的观点正在失去支持。早期的研究表明，长期暴露疗法对患有这两种疾病的人都有效。目前的案例研究旨在提供关于ptsd -物质滥用(PTSD-SA)共病患者症状改变的时间长度和类型的信息。因此，长期暴露于酒精和大麻滥用者的创伤后应激障碍被用于治疗。治疗前和治疗后的评估显示，创伤后应激障碍症状显著减轻，一般和…

引用次数: 2

Interprofessional relationships in dual diagnosis discourse in an Australian State: are we respecting each other yet? 澳大利亚双重诊断话语中的跨专业关系:我们是否尊重彼此?

Mental health and substance use : dual diagnosis

Pub Date : 2012-03-21 DOI: 10.1080/17523281.2011.618995

Bridget Roberts

‘Dual diagnosis’ discourse has emerged since the 1980s, with the dominant message of ensuring people with both mental health (MH) and alcohol and other drug problems receive coordinated or integrated treatment for both types of problem. In a climate of rapprochement (required or voluntary) between service sectors, mutual understanding and respect are essential. While the literatures refer to interprofessional and intersectoral tensions, there is little thorough contemporary exploration of these as barriers to effective treatment and support. This article discusses the implications of a ‘no wrong door’ policy for the staff of acute MH services in an Australian State. The nature of interprofessional and intersectoral contestations is explored and it is argued that addressing these is a necessary step in discovery of better approaches to the complexities of people's experience of what is considered to be ‘dual diagnosis’. The article draws on findings from a single case study of the emergence of dual diagnos...

自1980年代以来出现了"双重诊断"论述，其主要信息是确保有精神健康问题(MH)和酒精及其他药物问题的人对这两类问题接受协调或综合治疗。在服务部门之间(必要或自愿)和解的气氛中，相互理解和尊重是必不可少的。虽然文献提到了跨专业和跨部门的紧张关系，但对这些障碍进行有效治疗和支持的当代探索很少。这篇文章讨论了“没有错的门”政策的含义为急性MH服务的工作人员在澳大利亚国家。探讨了跨专业和跨部门争论的本质，并认为解决这些问题是发现更好的方法来解决人们被认为是“双重诊断”的复杂性的必要步骤。这篇文章从一个双重诊断出现的个案研究中得出结论。

引用次数: 8

Differences in substance-related risk behavior between dual and triple diagnosed severely mentally ill adults. 双重诊断和三重诊断的严重精神病成人在药物相关风险行为方面的差异。

Mental health and substance use : dual diagnosis

Pub Date : 2012-02-01 Epub Date: 2011-11-29 DOI: 10.1080/17523281.2011.608374

Michelle Decoux Hampton, Linda Chafetz, Carmen Portillo

OBJECTIVES: The purpose of this study was to determine if differences exist between adults with dual and triple diagnoses with regard to substance-related risk behaviors. METHODS: This secondary analysis was a cross-sectional study. There were 252 subjects with dual and triple diagnoses recruited from residential crisis programs in San Francisco. Using descriptive and logistic regression analyses, subjects in the two groups were compared with regard to demographic data, types of substances, and routes of administration used in the previous 30 days to determine risk for exposure and/or transmission of HIV/HCV. RESULTS: When compared to the dual diagnosis group, subjects with triple diagnoses were four times more likely to have engaged in IDU (p=.001) and 2.6 times more likely to use amphetamines (p=.05). They also reported using more types of substances over the lifetime (p<.0001). But with regard to other risk behaviors such as alcohol use to intoxication and cocaine/crack use, there were no significant differences. CONCLUSION: Though many substance-related risk behaviors occurred in both groups, adults with triple diagnoses were more likely to engage in IDU, amphetamine use, and to use more types of substances over the lifetime. This information has the potential to inform interventions that might prevent/reduce substance-related risk in this population.

研究目的本研究旨在确定双重诊断和三重诊断的成年人在药物相关危险行为方面是否存在差异。方法：这项二次分析是一项横断面研究。从旧金山的寄宿危机计划中招募了 252 名具有双重和三重诊断的受试者。通过描述性分析和逻辑回归分析，比较了两组受试者在过去 30 天内的人口统计学数据、药物类型和给药途径，以确定暴露和/或传播 HIV/HCV 的风险。结果：与双重诊断组相比，三重诊断组受试者参与注射吸毒的可能性高出四倍（p=.001），使用苯丙胺的可能性高出 2.6 倍（p=.05）。他们还报告在一生中使用过更多种类的药物（p

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引用次数: 0

Childhood trauma among individuals with co-morbid substance use and post traumatic stress disorder. 伴随物质使用和创伤后应激障碍的儿童创伤。

Mental health and substance use : dual diagnosis

Pub Date : 2011-11-01 DOI: 10.1080/17523281.2011.598462

Philippa L Farrugia, Katherine L Mills, Emma Barrett, Sudie E Back, Maree Teesson, Amanda Baker, Claudia Sannibale, Sally Hopwood, Julia Rosenfeld, Sabine Merz, Kathleen T Brady

BACKGROUND: Little is known about the impact of childhood trauma (CT) on the clinical profile of individuals with co-occurring substance use disorder (SUD) and post traumatic stress disorder (PTSD). AIMS: To compare the clinical characteristics of individuals with SUD+PTSD who have a history of CT with SUD+PTSD individuals who have experienced trauma during adulthood only. METHOD: Data were collected on 103 individuals as part of a randomised controlled trial examining the efficacy of an integrated psychosocial treatment for SUD+PTSD. Participants were recruited from substance use treatment services, community referrals and advertising. Data were collected on demographic characteristics, substance use and treatment histories, lifetime trauma exposure, and current physical and mental health functioning. RESULTS: The vast majority (77%) of the sample had experienced at least one trauma before the age of 16, with 55% of those endorsing childhood sexual abuse. As expected individuals with a CT history, as compared to without, evidenced significantly longer duration of PTSD. Those with a CT history also had more extensive lifetime trauma exposure, an earlier age of first intoxication, and reported more severe substance use (e.g., a greater number of drug classes used in their lifetime, higher severity of dependence scores and greater number of drug treatment episodes). CONCLUSION: Individuals with co-morbid SUD+PTSD who have experienced CT present with a more severe and chronic clinical profile in relation to a number of trauma and substance use characteristics, when compared to individuals with adulthood only trauma histories. It is therefore important for SUD+PTSD treatment planning that CT be carefully assessed.

背景:儿童创伤(CT)对同时发生物质使用障碍(SUD)和创伤后应激障碍(PTSD)的个体的临床特征的影响知之甚少。目的:比较有CT史的SUD+PTSD患者与仅在成年期经历创伤的SUD+PTSD患者的临床特征。方法:收集103名患者的数据，作为一项随机对照试验的一部分，研究综合心理社会治疗对SUD+PTSD的疗效。参与者是从药物使用治疗服务、社区转诊和广告中招募的。收集了人口统计学特征、药物使用和治疗史、终生创伤暴露以及当前身心健康功能方面的数据。结果:绝大多数(77%)的样本在16岁之前至少经历过一次创伤，其中55%的人赞同童年性虐待。正如预期的那样，与没有CT病史的人相比，有CT病史的人PTSD持续时间明显更长。那些有CT史的人也有更广泛的终身创伤暴露，第一次中毒的年龄更早，并且报告更严重的物质使用(例如，一生中使用的药物种类更多，依赖程度评分更高，药物治疗次数更多)。结论:与只有成年期创伤史的个体相比，经历过CT的合并SUD+PTSD的个体在许多创伤和物质使用特征方面表现出更严重和慢性的临床特征。因此，仔细评估CT对SUD+PTSD治疗计划非常重要。

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引用次数: 54

The prevalence and manifestation of substance use paralleling behaviours in a secure forensic psychiatric hospital 安全法医精神病院药物使用平行行为的流行和表现

Mental health and substance use : dual diagnosis

Pub Date : 2011-10-03 DOI: 10.1080/17523281.2011.598464

R. Schaefer, M. Daffern, A. Ferguson

Co-morbid substance dependence is common in patients of secure psychiatric services. Identifying opportunities for intervention, monitoring progress in treatment and assessing risk of relapse are compromised by this group's limited access to illicit substances. This research investigated the validity of the substance use paralleling behaviour (SUPB) framework, which was developed to assist staff in identifying behaviours indicative of substance dependence in controlled environments. Thirty-one patients admitted to the acute units of a secure forensic psychiatric hospital were interviewed and assessed with the Brief Psychiatric Rating Scales, the structured clinical interview for DSM disorders substance use disorders module, and an original questionnaire measuring motivations for drug use and behaviours indicative of substance dependence in a controlled setting (SUPBs). Results showed that patients with a history of substance dependence preceding admission engaged in more SUPBs during hospitalisation than ...

合并症的物质依赖在有保障的精神科服务的病人中很常见。由于这一群体获得非法药物的机会有限，确定干预机会、监测治疗进展和评估复发风险受到了影响。本研究调查了物质使用平行行为(SUPB)框架的有效性，该框架旨在帮助工作人员识别受控环境中表明物质依赖的行为。对一家安全的法医精神病医院急症病房收治的31名患者进行了访谈，并使用精神病学简要评定量表、DSM障碍物质使用障碍模块的结构化临床访谈和一份测量药物使用动机和受控环境中表明物质依赖的行为的原始问卷(supb)进行了评估。结果表明，入院前有物质依赖史的患者在住院期间参与supb的次数多于…

引用次数: 3

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