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Addiction and personality disorders: towards integrated treatment. Implementation in an Axis II treatment team 成瘾与人格障碍:迈向综合治疗。在Axis II治疗团队中实现
Pub Date : 2010-09-15 DOI: 10.1080/17523281.2010.505174
A. V. Wamel, Hendrik Jansen, E. Kuijpers
Background: In the Netherlands, mental illness and addiction are treated separately. This has caused problems when treating dual disorders. There is growing consensus in the Netherlands that the integration of mental health care and addiction care may be the best way to treat dual disorder patients. The effectiveness of Integrated Dual Disorder Treatment (IDDT) has been researched for schizophrenia and mood disorders. However, can IDDT be used in the treatment of personality disorders? Aims: To determine whether the IDDT model can be applied to Axis II patients and to what effect. Method: A team dealing with AXIS II patients participated in an IDDT pilot implementation project. Results: An important question at the introduction of IDDT was what would remain of the model when applied to patients with personality disorders? The findings suggest the model has remained intact. Conclusions: Although working with motivational interviewing and especially stage-wise treatment seem to be of real value; to a greate...
背景:在荷兰,精神疾病和成瘾是分开治疗的。这在治疗双重障碍时造成了问题。在荷兰,越来越多的人认为,将精神卫生保健和成瘾护理结合起来可能是治疗双重障碍患者的最佳方法。综合双重障碍治疗(IDDT)对精神分裂症和心境障碍的疗效进行了研究。然而,IDDT可以用于治疗人格障碍吗?目的:确定IDDT模型是否可以应用于II轴患者,以及应用效果如何。方法:一个处理AXIS II患者的团队参与了IDDT试点实施项目。结果:引入IDDT的一个重要问题是,当该模型应用于人格障碍患者时,该模型将保留什么?研究结果表明,该模型仍然完好无损。结论:虽然动机性访谈的工作,特别是阶段明智的治疗似乎是真正的价值;敬一个伟大的……
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引用次数: 2
Does recent criminal involvement matter? A study of women with co-occurring disorders in a multisite national trial 最近是否有犯罪前科重要吗?在一项多地点国家试验中对女性并发疾病的研究
Pub Date : 2010-09-15 DOI: 10.1080/17523281.2010.503938
L. Brady, L. Najavits, D. Toussaint, Diane Bonavota, B. Veysey
Aims: To investigate criminal involvement in relation to treatment outcome in a multisite study. We compared 381 women with recent criminal involvement (RCI, n = 381; past 3 months) to 681 women with no lifetime history of criminal involvement (NCI, n = 681) at baseline and at 6 months from start of treatment (RCI 6 mos: n = 282; NCI 6 mos: n = 556). Methods: Outcome measures were alcohol severity, drug severity, general mental health, and PTSD symptoms. We compared RCI versus NCI women at baseline and compared RCI versus NCI women from baseline to 6 months by treatment condition. Treatment conditions were integrated care for co-occurring disorders versus treatment-as-usual. Age and baseline scores were covariates. Results: In the baseline comparison, RCI women were younger, had greater drug addiction severity but better mental health than NCI women. In the over-time analysis, RCI and NCI 6-month clinical outcome scores improved irrespective of intervention type.
目的:在一项多地点研究中调查犯罪参与与治疗结果的关系。我们比较了381名近期有犯罪前科的女性(RCI, n = 381;在基线和治疗开始后6个月(RCI 6大多数:n = 282;NCI 6 mos: n = 556)。方法:结局指标为酒精严重程度、药物严重程度、一般心理健康和PTSD症状。我们比较了RCI和NCI女性在基线时的差异,并比较了RCI和NCI女性从基线到6个月的治疗情况。治疗条件是对合并疾病的综合护理与常规治疗。年龄和基线评分为协变量。结果:在基线比较中,RCI女性比NCI女性更年轻,有更大的药物依赖严重程度,但心理健康状况更好。在长期分析中,无论干预类型如何,RCI和NCI 6个月临床结局评分均有所改善。
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引用次数: 3
DSM-IV Axis-I comorbidity among illicit drug users seeking treatment for substance use disorders: results from the Multi-centre Study of Psychiatric Comorbidity in Drug Addicts (MUPCDA) 寻求药物使用障碍治疗的非法吸毒者的轴i共病:来自吸毒成瘾者精神共病多中心研究(MUPCDA)的结果
Pub Date : 2010-09-15 DOI: 10.1080/17523281.2010.504643
R. Thomasius, P. Sack, K. Petersen
Background: To contribute to the discussion on Integrated Dual Disorders Treatment in persons seeking treatment for substance use disorders and carrying a substance dependence diagnosis. Aims: To capture current (4 weeks) DSM-IV Axis-I comorbidity in a sample of German in-treatment substance use disorders patients. Method: A clinical sample of n = 301 patients (75% male, 25% female; mean age 31 years, range 15–55 years) were interviewed face-to-face by 40 raters, using the Mini-DIPS (German version of the Anxiety Disorders Interview Schedule). In this multi-centre study, 19 German treatment centres participated. Results: Diagnoses for opioid dependence were given to 86% and for polydrug dependence to 75% of the patients. Socio-demographic data revealed high unemployment, indebtedness and crime rates. Most frequent diagnoses of comorbidity were: generalized anxiety disorder (28%) and dysthymia (26%). Women were more likely to be dually diagnosed and to report lifetime substance-induced visual hallucination...
背景:对寻求物质使用障碍治疗和进行物质依赖诊断的人进行综合双重障碍治疗的讨论。目的:捕捉当前(4周)DSM-IV轴- i共病在治疗中的德国物质使用障碍患者的样本。方法:临床样本n = 301例,其中男性75%,女性25%;平均年龄31岁,年龄范围15-55岁),由40名评分员使用Mini-DIPS(德语版焦虑障碍访谈表)进行面对面访谈。在这项多中心研究中,有19个德国治疗中心参与。结果:86%的患者被诊断为阿片类药物依赖,75%的患者被诊断为多种药物依赖。社会人口统计数据显示失业率、负债和犯罪率居高不下。最常见的共病诊断是:广泛性焦虑症(28%)和心境恶劣(26%)。女性更有可能被双重诊断,并报告终生物质引起的视幻觉。
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引用次数: 9
Administration of PRN medications: a descriptive study of concurrent disorder patients PRN药物的管理:并发疾病患者的描述性研究
Pub Date : 2010-09-15 DOI: 10.1080/17523281.2010.504644
E. Martin, Shaohua Lu, H. Robertson, S. Ganesan, M. Mckenna
Background: There is a paucity of research on the use of pro re nata (PRN) medications in psychiatry, and even more so, their use in patients diagnosed with concurrent disorder (CD). Aim: To provide an initial review and description of this population with respect to the administration of PRN medications. Method: A retrospective review of 135 charts was conducted on patients admitted to the University of British Columbia Concurrent Disorder Unit from 1 June 2008 to 31 December 2008. Results: A total of 133 (98.5%) of the 135 patients had at least one PRN order in their charts. The most frequently ordered medications for use as a PRN were Lorazepam (103 orders), Quetiapine (91 orders), and Loxapine (68 orders). The mean dosages delivered for all medications were in the low, sedative range. The most common reasons for prescribing across medications were for: sleep, agitation, anxiety, and withdrawal symptoms. With respect to the proportion of PRN orders to actual PRN medications administered, Quetiapine (83...
背景:在精神病学中使用天然(PRN)药物的研究很少,在诊断为并发疾病(CD)的患者中使用这些药物的研究更是如此。目的:提供一个关于PRN药物管理的初步回顾和描述。方法:回顾性分析2008年6月1日至2008年12月31日在英属哥伦比亚大学并发障碍科收治的135例患者的病历。结果:135例患者中,133例(98.5%)患者的病历中至少有一个PRN顺序。作为PRN最常用的药物是劳拉西泮(103张)、喹硫平(91张)和洛沙平(68张)。所有药物的平均剂量都在低镇静范围内。开出跨药处方的最常见原因是:睡眠、躁动、焦虑和戒断症状。关于PRN处方与实际PRN用药的比例,喹硫平(83…
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引用次数: 1
Key enhancing factors for integrating services for patients with mental and substance use disorders 加强为精神和物质使用障碍患者提供综合服务的关键因素
Pub Date : 2010-09-15 DOI: 10.1080/17523281.2010.505176
A. Brousselle, Lise Lamothe, C. Sylvain, A. Foro, M. Perreault
Background: Over the past decade, practice standards have recommended that people experiencing both mental and substance use disorders receive integrated treatment. Yet few institutions offer integrated services, and patients are too often turned away from psychiatric and rehabilitation services. Aim: To identify key enhancing elements for integrating services for patients with co-occurring disorders. Methods: A process evaluation was conducted, using case study research methodology, with the aim of identifying factors that enhance or impede service integration. First, we elaborated a sound conceptual framework of service integration. In-depth case studies analysis using socio-anthropological methods (interviews with managers and professionals, focus groups with patients, non-participant observation, document analysis) were then conducted. Two contrasted forms of services integration, a joint venture and a strategic alliance, were analysed separately, and then compared. Results: Although the forms of inte...
背景:在过去十年中,实践标准建议患有精神和物质使用障碍的人接受综合治疗。然而,很少有机构提供综合服务,患者往往被精神科和康复服务拒之门外。目的:确定对合并疾病患者整合服务的关键加强要素。方法:采用案例研究方法进行流程评估,旨在识别增强或阻碍服务集成的因素。首先,我们阐述了一个完善的服务集成概念框架。然后使用社会人类学方法进行深入的案例研究分析(与管理人员和专业人员进行访谈,与患者进行焦点小组讨论,非参与者观察,文献分析)。本文分别分析了合资企业和战略联盟两种不同的服务整合形式,并进行了比较。结果:虽然肠道的形式…
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引用次数: 15
Changes in attitude to, and confidence in, working with comorbidity after training in screening and brief intervention 在接受筛查和简短干预培训后,对共病患者工作态度和信心的改变
Pub Date : 2010-05-04 DOI: 10.1080/17523281003712674
Jacqueline Cameron, N. Lee, Angela Harney
Background: Attitude to, and confidence in, working with comorbidity is an important feature of effective engagement when working with clients with mental health and substance use issues. Substance use treatment clinicians continue to voice concerns about their own skill and abilities to work with this complex client group. PsyCheck is a package designed to support drug and alcohol workers to implement screening and brief intervention for common mental health problems. Aim: This study used a whole workforce approach to training using the PsyCheck package, and examined changes in clinicians' attitude, skill and confidence in working with comorbidity post training. Method: A pre-post test evaluation design was used. Thirteen national alcohol and drug services were offered a two day training program in the PsyCheck package. Clinicians' attitude to comorbidity was measured by the Comorbidity Problems Perceptions Questionnaire. Semi-structured interviews were also conducted. Results: Results indicate that invo...
背景:在与有精神健康和物质使用问题的客户合作时,对共病工作的态度和信心是有效参与的一个重要特征。药物使用治疗临床医生继续对他们自己的技能和能力表示担忧,以应对这一复杂的客户群体。PsyCheck是一个一揽子计划,旨在支持吸毒和酗酒工作人员对常见的精神健康问题进行筛查和短暂干预。目的:本研究使用PsyCheck软件包对全体员工进行培训,并检查临床医生在培训后处理合并症的态度、技能和信心的变化。方法:采用前后试验评价设计。13个国家酒精和毒品服务机构在心理检查一揽子计划中接受了为期两天的培训方案。临床医生对共病的态度通过共病问题认知问卷进行测量。还进行了半结构化访谈。结果:结果表明:
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引用次数: 12
Dual diagnosis: what does it mean? 双重诊断:这意味着什么?
Pub Date : 2010-05-04 DOI: 10.1080/17523281003702089
Glen Smith, P. Morris
Background: The term ‘dual diagnosis’, referring to co-existing mental health and substance use problems, has recently increased in importance as reflected by the establishment of three new journals. However, several authors have criticised the term and some have proposed alternative terms. Aims: In this article we provide an alternate viewpoint to an existing detailed criticism of the term by Velleman and Baker (2008). In order to highlight some difficulties with the term, we undertook a preliminary analysis of citations linked to the ‘dual diagnosis’ subject heading. Method: We searched Medline (1950–2009) using the ‘dual diagnosis’ subject heading and with ‘dual diagnosis’ as a text word. We limited this subset to reviews from 2008 to 2009 and combined it with randomised controlled trials (2008–2009) as a subject heading and notated the topic of each citation. Results: There were 2609 citations located from 1950 to 2009, increasing gradually until the last two years, during which there has been a decli...
背景:“双重诊断”一词指的是共存的精神健康和药物使用问题,其重要性最近有所增加,这反映在三种新期刊的建立上。然而,一些作者批评了这个术语,有些人提出了替代术语。目的:在本文中,我们为Velleman和Baker(2008)对该术语的现有详细批评提供了另一种观点。为了突出这个术语的一些困难,我们对与“双重诊断”主题标题相关的引文进行了初步分析。方法:以“双重诊断”为主题,以“双重诊断”为文本词检索Medline(1950-2009)。我们将这一子集限制在2008年至2009年的综述中,并将其与随机对照试验(2008 - 2009年)合并为主题标题,并标记了每次引用的主题。结果:1950 ~ 2009年共被引2609次,呈逐渐增加趋势,但近两年出现了下降趋势。
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引用次数: 0
Unrecognised dual diagnosis – a risk factor for dropout of addiction treatment 未被认可的双重诊断——退出成瘾治疗的一个危险因素
Pub Date : 2010-05-04 DOI: 10.1080/17523281003705199
Sabrina J Schulte, P. Meier, J. Stirling, Mike J. Berry
Background: While many studies have examined the prevalence of concurrent substance misuse and mental health problems across different treatment populations, we know little as to what extent such co-morbidity is identified in routine clinical practice. However, literature in the field has emphasised the importance of recognising co-morbidity early to avoid adverse treatment outcomes. Aims: To determine: (1) the degree to which co-morbidity is recognised and addressed in outpatient addiction services; and (2) whether unaddressed co-morbidity increases the risk of dropout. Method: Clients (n = 176) starting treatment at six UK-based drug and/or alcohol services and their 46 practitioners were followed for 3 months. Multiple assessments were carried out in order to obtain information about clients' mental health, 90-day retention rates, treatment perceptions and practitioners' expertise and training levels in the co-morbidity field. Services' assessment protocols and in-treatment case notes for each client w...
背景:虽然许多研究已经调查了不同治疗人群中同时存在的药物滥用和精神健康问题的患病率,但我们对常规临床实践中确定这种合并症的程度知之甚少。然而,该领域的文献强调了早期识别合并症以避免不良治疗结果的重要性。目的:确定:(1)在门诊成瘾服务中识别和处理合并症的程度;(2)未解决的合并症是否会增加辍学的风险。方法:在英国6家药物和/或酒精服务机构开始治疗的客户(n = 176)及其46名从业人员随访3个月。进行了多次评估,以获得有关客户心理健康、90天滞留率、治疗观念以及从业人员在共发病领域的专业知识和培训水平的信息。服务评估协议和每个客户的治疗病例记录…
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引用次数: 25
Health service systems and comorbidity: stepping up to the mark 卫生服务系统和合并症:加紧行动
Pub Date : 2010-05-04 DOI: 10.1080/17523281003733514
P. Staiger, Caroline Long, A. Baker
Clients with co-occurring substance use and mental health disorders are not well served in traditional health care systems where specialist services offer segregated interventions and the client is left to negotiate required treatment across both systems. In recent years, policy change guiding the treatment of dual diagnosis in the United States, United Kingdom, Australia and elsewhere has triggered the development of diverse models of treatment, each of which function at different points on a continuum from serial to fully integrated care. This paper outlines key models and provides examples, while considering their potential for appropriately addressing the needs of this client group. Consideration is given to the benefits of an interaction between stepped care and the chosen model, as a means of enhancing care efficiency while retaining the focus on positive outcomes.
在传统的卫生保健系统中,同时存在物质使用和精神健康障碍的客户得不到很好的服务,因为专业服务提供隔离的干预措施,客户需要在两个系统中协商所需的治疗。近年来,在美国、英国、澳大利亚和其他地方,指导双重诊断治疗的政策变化引发了多种治疗模式的发展,每种治疗模式在从系列到完全综合护理连续体的不同点上发挥作用。本文概述了关键模型并提供了示例,同时考虑了它们在适当地满足该客户群体需求方面的潜力。考虑到阶梯式护理和选择的模式之间的相互作用的好处,作为提高护理效率的一种手段,同时保持对积极结果的关注。
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引用次数: 20
A qualitative study of how individuals with severe mental illness assess smoking risks 一项关于严重精神疾病患者如何评估吸烟风险的定性研究
Pub Date : 2010-05-04 DOI: 10.1080/17523281003738745
Kristin E. Davis, M. Brunette, V. Vorhies, Joelle C Ferron, R. Whitley
Background: This qualitative paper describes perceptions of smoking risk and ways of thinking about risk for 31 persons with a Severe Mental Illness (SMI). Research has shown that many people with SMI want to quit smoking, and, like many other disadvantaged groups, make many quit attempts. Aim: The authors undertook a qualitative study to explore views and experiences about smoking and quitting, within a general context of what it means to them to live a healthy lifestyle. Method: A purposive sample of former smokers, current smokers, and individuals who had never smoked was chosen to participate in a semi-structured interview. Questions targeted various lifestyle domains, narrowing to focus more specifically on smoking habits, attempts to quit, and thoughts about the future in relation to health and smoking. Techniques of grounded theory were used to categorize and interpret themes. Results: The results indicate that many current smokers interpret and frame perceptions of health risks from smoking in rel...
背景:本定性研究描述了31名重度精神疾病(SMI)患者对吸烟风险的认知和对风险的思考方式。研究表明,许多重度精神障碍患者想要戒烟,并且像许多其他弱势群体一样,多次尝试戒烟。目的:作者进行了一项定性研究,探讨吸烟和戒烟的观点和经验,在一个健康的生活方式对他们意味着什么的大背景下。方法:有目的的抽取前吸烟者、现吸烟者和从未吸烟过的人进行半结构化访谈。问题针对不同的生活方式领域,缩小到更具体地关注吸烟习惯、戒烟尝试以及对与健康和吸烟有关的未来的看法。扎根理论的技巧被用来分类和解释主题。结果:结果表明,许多当前吸烟者在现实生活中解释和构建吸烟对健康风险的看法。
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引用次数: 13
期刊
Mental health and substance use : dual diagnosis
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