Mental health and substance use : dual diagnosis最新文献

英文中文

Pathways through care for people with dual diagnosis in Europe: results from the Treatment Options for Dual Diagnosis User Zoom instrument 欧洲双重诊断患者的护理途径:双重诊断治疗选择用户变焦仪器的结果

Mental health and substance use : dual diagnosis

Pub Date : 2011-06-14 DOI: 10.1080/17523281.2011.578281

T. Greacen, A. Baldacchino, Katarzyna Charzyńska, M. Sorsa, N. Groussard-Escaffre, C. Clancy, C. Lack, E. Hyldager, C. Hodges, L. Merinder, J. Meder, Zoe Henderson, H. Laijarvi, K. Baeck-Moller

Differences in care philosophies between the mental healthcare system and the substance misuse treatment system have a significant impact on treatment options for people with dual diagnosis. The aim of the study was to identify pathways through care for people with dual diagnosis in Europe using the Treatment Options for Dual Diagnosis User Zoom instrument. Declared pathways through care were categorised for 331 subjects with severe dual diagnosis recruited after admission to psychiatric wards at seven European sites and followed up over 9 months. At baseline, more than one in four subjects did not declare using either mental health or substance misuse centres or services. Mental health centres played the major role through follow-up with similar rates of declared use at all sites. By contrast, use of substance misuse treatment centres was half as frequent and varied considerably between sites. Declaring any use of substance misuse centres was generally associated with decreased overall contact with the mental healthcare system for this population of psychotic patients with comorbid substance misuse problems.

精神卫生保健系统和药物滥用治疗系统之间的护理理念差异对双重诊断患者的治疗选择有重大影响。该研究的目的是通过使用双重诊断用户缩放仪器的治疗选择来确定欧洲双重诊断患者的护理途径。对331名重度双重诊断的受试者进行分类，这些受试者是在欧洲7个地点的精神科病房入院后招募的，随访时间超过9个月。在基线时，超过四分之一的受试者没有声明使用精神健康或药物滥用中心或服务。心理健康中心通过随访发挥了主要作用，所有场所的申报使用率相似。相比之下，药物滥用治疗中心的使用频率只有前者的一半，不同地点之间差异很大。声明任何药物滥用中心的使用通常与患有合并症药物滥用问题的精神病患者与精神卫生保健系统的总体接触减少有关。

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引用次数: 5

Trait-impulsivity moderates the relationship between rumination and number of major depressive episodes among cigarette smokers 特质冲动性调节吸烟者反刍与重度抑郁发作次数之间的关系

Mental health and substance use : dual diagnosis

Pub Date : 2011-03-09 DOI: 10.1080/17523281.2011.554326

D. McChargue, Susan Drevo, M. J. Herrera, Neal Doran, S. Salvi, Alicia K. Klanecky

Background. Despite the high prevalence of major depression among cigarette smokers, little is known about biobehavioral mechanisms that increase smokers' susceptibility to depression. Aims. The present study examined whether trait-impulsivity would moderate the relationship between rumination and number of past major depressive episodes (MDEs) among smokers (N = 128). Method. Data were derived from baseline screening questionnaires and structured diagnostic interviews of two studies examining emotional responses of smokers with a history of major depression compared with smokers without depression histories. Results. As predicted, the interaction between rumination and trait-impulsivity was a significant predictor of MDE recurrence (β = 0.259, p = 0.001, R 2 change = 0.063). Post hoc analyses tested rumination's association with past MDEs among those with high and low levels of impulsivity. Rumination predicted the number of diagnosed past MDEs among those with high levels of impulsivity (β = 0.408, p = ...

背景。尽管重度抑郁症在吸烟者中发病率很高，但人们对增加吸烟者抑郁易感性的生物行为机制知之甚少。目标本研究考察了特质冲动性是否会调节吸烟者反刍与过去重度抑郁发作(MDEs)次数之间的关系(N = 128)。方法。数据来源于基线筛选问卷和两项研究的结构化诊断访谈，这些研究检查了有严重抑郁症病史的吸烟者与没有抑郁症病史的吸烟者的情绪反应。结果。正如预测的那样，反刍和特质冲动性之间的交互作用是MDE复发的显著预测因子(β = 0.259, p = 0.001, r2变化= 0.063)。事后分析测试了在冲动程度高和低的人群中，反刍与过去的MDEs之间的联系。反刍可以预测高冲动性人群中被诊断出过去MDEs的数量(β = 0.408, p =…

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引用次数: 6

Turning of the tide: changing systems to address smoking for people with a mental illness 潮流的转变:改变解决精神疾病患者吸烟问题的制度

Mental health and substance use : dual diagnosis

Pub Date : 2011-03-09 DOI: 10.1080/17523281.2011.555073

B. Bonevski, J. Bowman, R. Richmond, Jamie Bryant, P. Wye, E. Stockings, K. Wilhelm, T. Butler, Devon Indig, A. Wodak

Smoking tobacco is common among people with a mental illness. A number of behavioural and environmental factors underlie the high smoking prevalence rates. Evidence suggests that smokers with mental illness require additional targeted support to help them stop smoking. By using a selective review of the international literature, this article will argue that a systems-level change approach is an appropriate strategy, targeting settings and environments with a number of advantages for reaching smokers with mental illness. Systems-level changes include: (1) implementing a system of identifying and recording smoking status;(2) providing education, resources and feedback to promote staff intervention;(3) dedicating staff to provide tobacco-dependence treatment;(4) promoting organisational policies that support and provide tobacco-dependence services. Three settings will be discussed – mental health services, community social service organisations and prisons. As a result of a history and culture where smoking ...

吸烟在精神疾病患者中很常见。许多行为和环境因素是造成高吸烟率的原因。有证据表明，患有精神疾病的吸烟者需要额外的有针对性的支持来帮助他们戒烟。通过对国际文献的选择性回顾，本文将论证系统级改变方法是一种适当的策略，针对具有许多优势的环境和环境，以达到患有精神疾病的吸烟者。系统层面的改变包括:(1)实施识别和记录吸烟状况的系统;(2)提供教育、资源和反馈，以促进员工干预;(3)让员工专门提供烟草依赖治疗;(4)促进支持和提供烟草依赖服务的组织政策。将讨论三种环境——精神健康服务、社区社会服务组织和监狱。由于历史和文化，吸烟……

引用次数: 12

Health behaviour risk factors for coronary heart disease (CHD) in smokers with a psychotic disorder: baseline results 伴有精神障碍的吸烟者冠心病(CHD)的健康行为危险因素:基线结果

Mental health and substance use : dual diagnosis

Pub Date : 2011-03-09 DOI: 10.1080/17523281.2011.555088

S. Filia, A. Baker, R. Richmond, D. Castle, F. Kay-Lambkin, Rebecca Sakrouge, C. Gurvich, A. D. Castella, Rachel Taylor, J. Kulkarni

Background. People with psychotic disorders are more likely to develop and die from coronary heart disease (CHD) than the general population. Aims. This study aimed to explore the level of CHD risk factors (smoking, diet and physical activity) in smokers with psychosis. The second aim was to examine the reasons for smoking/quitting, and the levels of motivation and confidence to change. Method. Forty-three smokers diagnosed with psychosis were assessed using semi-structured interviews and standardised self-report instruments. Carbon monoxide levels, blood pressure, height, weight and hip/waist measurements were assessed. Blood samples were taken for cholesterol and blood sugar levels. CHD risk percentiles were calculated using the Framingham algorithm. Results. Participants smoked heavily (mean 30.8 cigarettes per day ±12.5). The majority reported smoking due to addiction and for stress management and many contemplated quitting, mainly due to health concerns. Participants were on average moderately obese ...

背景。精神病患者比一般人群更容易患冠心病(CHD)并死于冠心病。目标本研究旨在探讨伴有精神病的吸烟者的冠心病危险因素(吸烟、饮食和体育活动)水平。第二个目的是检查吸烟/戒烟的原因，以及改变的动机和信心水平。方法。采用半结构化访谈和标准化自我报告工具对43名诊断为精神病的吸烟者进行了评估。评估了一氧化碳水平、血压、身高、体重和臀/腰测量值。采集血液样本检测胆固醇和血糖水平。采用Framingham算法计算冠心病风险百分位数。结果。参与者吸烟严重(平均每天30.8支±12.5支)。大多数人报告吸烟是由于上瘾和压力管理，许多人考虑戒烟，主要是出于健康考虑。参与者平均为中度肥胖。

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引用次数: 17

Healthy lifestyle intervention for people with severe mental disorders 严重精神障碍患者的健康生活方式干预

Mental health and substance use : dual diagnosis

Pub Date : 2011-03-09 DOI: 10.1080/17523281.2011.555086

A. Baker, F. Kay-Lambkin, R. Richmond, S. Filia, D. Castle, Jill M Williams, L. Thornton

Cardiovascular disease (CVD) is the largest single cause of death among people with severe mental disorders, such as schizophrenia and bipolar disorder. Smoking rates are very high among people with severe mental disorders, considerably increasing their risk of CVD. In addition, many people with such disorders also suffer from obesity related to inactivity, unhealthy diets, excessive alcohol consumption and some psychiatric medications. Despite increasing recognition of the widespread impact that smoking and other unhealthy behaviours have on increased morbidity and mortality, treatment of physical health problems is often neglected among people with severe mental disorders. Research evaluating interventions seeking to change multiple health behaviours indicates that these are feasible and effective. In this context, studies evaluating the effectiveness of a multi-component healthy lifestyle intervention for smoking and CVD risk behaviours among people with severe mental disorders are needed. A healthy li...

心血管疾病是精神分裂症和双相情感障碍等严重精神障碍患者死亡的最大单一原因。在患有严重精神障碍的人群中，吸烟率非常高，大大增加了他们患心血管疾病的风险。此外，许多患有这类疾病的人还患有与缺乏运动、不健康饮食、过度饮酒和一些精神药物有关的肥胖。尽管人们日益认识到吸烟和其他不健康行为对发病率和死亡率增加的广泛影响，但严重精神障碍患者往往忽视对身体健康问题的治疗。评估旨在改变多种健康行为的干预措施的研究表明，这些干预措施是可行和有效的。在此背景下，需要研究评估多组分健康生活方式干预对严重精神障碍患者吸烟和心血管疾病风险行为的有效性。健康的生活…

引用次数: 15

A comparison of accidental and intentional fatal drug overdoses within the drug death population in Scotland: a case of comortality? 苏格兰药物死亡人群中意外和故意致死性药物过量的比较:共死亡案例?

Mental health and substance use : dual diagnosis

Pub Date : 2011-01-06 DOI: 10.1080/17523281.2011.533439

A. Baldacchino, S. Walls

This article considers the social and clinical life circumstances of individuals who succumbed to drug deaths in Scotland in 2003. Specifically, comparisons are made between those who died of accidental and intentional illicit drug overdoses. A cross-linkage process allowed for a comparison of patient notes obtained from general practice, drug treatment services, the Scottish Prison service, the Scottish Criminal Records Office, acute services, non-statutory services and the Procurator Fiscal. Individuals who intentionally overdosed were older, more likely to be females and in a relationship, more likely to be living in their own homes in areas of lower deprivation, to have children and to have sought medical treatment for a psychological condition. They were less likely to have a criminal record or a history of incarceration or substance misuse problems. These findings demonstrate the diversity of the drug death population and may have implications for future prevention policies aimed at individual sub-p...

本文考虑了2003年苏格兰因吸毒死亡的个人的社会和临床生活环境。具体来说，比较了那些死于意外和故意非法药物过量的人。通过交叉联系程序，可以比较从全科诊所、药物治疗服务、苏格兰监狱服务、苏格兰刑事记录办公室、急症服务、非法定服务和检察官财政部门获得的病人记录。故意过量服用的人年龄较大，更有可能是女性，有伴侣，更有可能住在贫困程度较低的地区，有孩子，并因心理问题寻求过治疗。他们不太可能有犯罪记录、监禁史或药物滥用问题。这些发现表明了药物死亡人群的多样性，并可能对未来针对个体亚致死人群的预防政策产生影响。

引用次数: 0

Levels of risk: maternal-, middle childhood-, and neighborhood-level predictors of adolescent disinhibitory behaviors from a longitudinal birth cohort in the United States. 风险水平:来自美国纵向出生队列的青少年去抑制行为的母亲、童年中期和邻居水平预测因子。

Mental health and substance use : dual diagnosis

Pub Date : 2011-01-01 DOI: 10.1080/17523281.2011.533445

Katherine M Keyes, Margaret A Keyes, Dana March, Ezra Susser

OBJECTIVE: Disruptive behavior in adolescence may indicate a broad vulnerability to disinhibition, which begins in childhood and culminates in adult externalizing psychopathology. We utilized prospective birth cohort data to assess childhood predictors of adolescent disinhibition. We also examined the effect of pre-adolescent fluctuation in cognitive ability. METHODS: Data were drawn from the Child Health and Development Study cohort, born 1961-1963; we used the subsample who participated in follow-up through adolescence (n=1752). Six indicators of behavioral disinhibition (BD), reported in adolescence, were analyzed as a count outcome. Predictor variables were drawn from several waves of data collection and included individual-, maternal-, and neighborhood-level measures. Cognitive ability was assessed with the Peabody Picture Vocabulary Test at two time points. Neighborhood characteristics were assessed using census data from 1970. RESULTS: Number of BD indicators was predicted by maternal characteristics at prenatal assessment (maternal age and alcohol consumption) and age-10 assessment (maternal smoking, education, and separation from father). Characteristics of the child that predicted BD included birth order and conduct problems in middle childhood. Neighborhood poverty did not predict BD. Regardless of initial cognitive ability score, movement to a higher quartile by adolescence was associated with lower BD, while movement to a lower quartile was associated with higher BD. CONCLUSION: Risk for adolescent BD exists prenatally and extends through middle childhood. Change in cognitive ability during pre-adolescence emerged as a potentially important factor that merits further investigation. A greater focus on the life course can aid in comprehensively understanding disruptive behavior emergence in adolescence.

目的:青春期的破坏性行为可能表明对解除抑制的广泛脆弱性，这种脆弱性始于童年，并在成人的外化精神病理中达到高潮。我们利用前瞻性出生队列数据来评估青少年去抑制的儿童预测因素。我们还研究了青春期前认知能力波动的影响。方法:数据来自1961-1963年出生的儿童健康与发展研究队列;我们使用了参与随访到青春期的子样本(n=1752)。行为去抑制(BD)的六个指标，报告在青春期，分析作为计数结果。预测变量是从几波数据收集中提取的，包括个人、母亲和社区水平的测量。在两个时间点用皮博迪图片词汇测试评估认知能力。使用1970年的人口普查数据评估社区特征。结果:通过产前评估(母亲年龄和饮酒)和10岁评估(母亲吸烟、受教育程度和与父亲分离)时的母亲特征来预测BD指标的数量。预测双相障碍的儿童特征包括出生顺序和儿童中期的行为问题。邻里贫困并不能预测双相障碍。无论最初的认知能力评分如何，到青春期时运动到较高的四分位数与较低的双相障碍相关，而运动到较低的四分位数与较高的双相障碍相关。结论:青春期双相障碍的风险存在于产前，并延伸到童年中期。青春期前认知能力的变化是一个潜在的重要因素，值得进一步研究。对生命历程的更多关注有助于全面理解青春期破坏性行为的出现。

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引用次数: 13

The community impact of RIOTT, a medically supervised injectable maintenance clinic in south London RIOTT的社区影响，这是一家位于伦敦南部的医学监督注射维持诊所

Mental health and substance use : dual diagnosis

Pub Date : 2010-09-15 DOI: 10.1080/17523281.2010.503937

Peter M. Miller, S. McKenzie, N. Lintzeris, Anthea Martin, J. Strang

Background: One of the major issues facing treatment services for alcohol and other drug users (current or ex-) around the world is community backlash, which has led to the closure of some much-needed drug treatment services. Aims: This study investigates the impact on the local community of a Medically Supervised Injectable Maintenance Clinic (MSIMC) implemented as part of the Randomised Injectable Opioid Treatment Trial (RIOTT), a trial into the effectiveness and efficacy of the provision of injectable opioids versus conventional oral methadone. The clinic model is based around a small number of the most entrenched and refractory patients (approx. 30) being treated by the service at any one time. Methods: The clinic and the trial were conceived primarily over 2002–2005, and the clinic began actual clinical operation in October 2005. The research was conducted between July 2005 and October 2007. Methods involved: pre-trial community key informant interviews; two-year follow-up key informant interviews; a...

背景:世界各地酗酒者和其他吸毒者(现在或以前)的治疗服务面临的主要问题之一是社区的强烈反对，这导致一些急需的药物治疗服务关闭。目的:本研究调查了作为随机注射阿片类药物治疗试验(RIOTT)的一部分实施的医学监督注射维持诊所(MSIMC)对当地社区的影响，该试验旨在研究提供注射阿片类药物与传统口服美沙酮的有效性和疗效。临床模式是基于少数最根深蒂固和难治性的患者(大约。30)随时接受服务。方法:2002-2005年初步建立临床和试验，2005年10月开始临床实际操作。这项研究是在2005年7月至2007年10月期间进行的。方法涉及:审前社区关键举报人访谈;两年随访的关键线人访谈;一个……

引用次数: 7

Group substance abuse treatment for women in secure services 在安全服务机构对妇女进行集体药物滥用治疗

Mental health and substance use : dual diagnosis

Pub Date : 2010-09-15 DOI: 10.1080/17523281.2010.506182

C. Long, Barbara Fulton, Kirsty-Ann Fitzgerald, C. Hollin

Background: The treatment of substance abuse in secure settings needs to be informed by gender specific considerations. Aim: To assess the effectiveness of a manualised CBT substance abuse treatment programme designed for women in medium security. Method: Assessment of pre–post changes following treatment using substance-specific and other outcome indicators. Results: Positive outcomes were identified for treatment completers (n = 23) in terms of improved substance-related self-efficacy, lower perceived costs and greater benefits of change. These differences, which were not evident in the non-completer group (n = 11), were paralleled by positive clinical changes on subscale of the BPRS, CANFOR needs and increased general self-efficacy. Conclusions: Treatment was successful in engaging two-thirds of patients to complete treatment in readiness for conditions of lower security and potential exposure to alcohol and other drugs. Differences between completers and non-completers raise issues about the timing an...

背景:在安全环境中治疗药物滥用需要考虑到具体的性别因素。目的:评估为中等安全级别妇女设计的手动CBT药物滥用治疗方案的有效性。方法:使用特定物质和其他结果指标评估治疗后的前后变化。结果:治疗完成者(n = 23)在改善物质相关自我效能、降低感知成本和更大的改变收益方面获得了积极的结果。这些差异在未完成组(n = 11)中不明显，与BPRS亚量表、CANFOR需求和一般自我效能感的积极临床变化相似。结论:治疗是成功的，使三分之二的患者在较低安全性和可能接触酒精和其他药物的情况下完成治疗。完成者和非完成者之间的差异引发了时间和……

引用次数: 19

Profiles of individuals seeking psychiatric help for psychotic symptoms linked to methamphetamine abuse – baseline results from the MAPS (methamphetamine and psychosis study) 寻求与甲基苯丙胺滥用有关的精神病症状的精神病帮助的个人概况——来自MAPS(甲基苯丙胺和精神病研究)的基线结果

Mental health and substance use : dual diagnosis

Pub Date : 2010-09-15 DOI: 10.1080/17523281.2010.504645

T. Lecomte, K. Mueser, W. Macewan, Marie-Christine Laferrière-Simard, A. Thornton, T. Buchanan, E. Goldner, J. Brink, T. Ehmann, D. Lang, Shimi Kang, A. Barr, W. Honer

Background: Methamphetamine psychosis (MAP) is commonly encountered in psychiatric emergency rooms (ERs) in North America, and little is known regarding the specific needs of this clientele. Aims: This study aimed at describing the psychiatric and socioeconomic profiles of individuals with co-occurring methamphetamine abuse and psychosis profiles. Method: Two hundred and ninety-five (295) individuals needing psychiatric help for MAP were assessed regarding their socioeconomic situation, their substance abuse patterns, family histories, past psychiatric diagnoses, childhood trauma, and co-occurring disorders of depression, PTSD and antisocial personality disorder. Results: Eighty-seven percent had a family history of mental illness or substance abuse and close to 70% had a previous diagnosis of a mental illness, although only 21% of a psychotic disorder. Antisocial personality disorder, depression, and post-traumatic stress disorder were highly prevalent in our sample. Cluster analyses on methamphetamine (...

背景:甲基苯丙胺精神病(MAP)是常见的精神科急诊室(er)在北美，很少知道关于这一客户的具体需求。目的:本研究旨在描述同时发生甲基苯丙胺滥用和精神病的个体的精神和社会经济概况。方法:对295名MAP患者的社会经济状况、药物滥用模式、家族史、既往精神病学诊断、童年创伤、抑郁症、创伤后应激障碍和反社会人格障碍共发生障碍进行评估。结果:87%的人有精神疾病或药物滥用的家族史，近70%的人以前有过精神疾病的诊断，尽管只有21%的人患有精神障碍。反社会人格障碍、抑郁症和创伤后应激障碍在我们的样本中非常普遍。甲基苯丙胺(…

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引用次数: 13

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