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Mental health and substance use : dual diagnosis最新文献

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Prevalence and impact of co-occurring psychiatric disorders on outcomes from a private hospital drug and alcohol treatment program 一家私立医院药物和酒精治疗项目中同时发生的精神疾病的患病率和影响
Pub Date : 2009-01-13 DOI: 10.1080/17523280802593319
G. Dingle, Pauline King
Aim: This naturalistic study was designed to assess the prevalence and impact of co-occurring mental disorders in 104 adults (52% male) admitted to a private hospital drug and alcohol treatment program in Brisbane, Australia. Method: Psychiatric diagnoses made by the participants' admitting psychiatrists were collected by chart audit. Measures of substance use, dependence and mood were obtained by a program psychologist on participants' admission to the hospital, and during a follow-up interview conducted by the second researcher an average of 8.5 months after participants' discharge. Results: Ninety-two per cent of the sample was diagnosed with at least one mental disorder; most commonly Major Depressive Disorder (57%), Generalised Anxiety Disorder (20%) and Borderline Personality Disorder (16%). Having a concurrent mood, anxiety or personality disorder was not significantly related to either program attendance or outcomes on substance related self-report measures. Only depression symptoms at follow-up w...
目的:本自然主义研究旨在评估在澳大利亚布里斯班一家私立医院接受药物和酒精治疗项目的104名成年人(52%为男性)共患精神障碍的患病率和影响。方法:采用图表审核的方法收集被试住院精神科医师的精神诊断。一名项目心理学家在参与者入院时获得了物质使用、依赖和情绪的测量数据,并在参与者出院后平均8.5个月由第二位研究人员进行了随访。结果:92%的样本被诊断患有至少一种精神障碍;最常见的是重度抑郁症(57%),广泛性焦虑症(20%)和边缘型人格障碍(16%)。同时存在情绪、焦虑或人格障碍与项目出勤率或物质相关自我报告测量结果均无显著相关。随访时只有抑郁症状…
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引用次数: 14
Experiences of alcohol and other drugs in individuals with severe mental illness and concomitant substance use disorders 患有严重精神疾病和伴随物质使用障碍的个体的酒精和其他药物的经历
Pub Date : 2008-09-20 DOI: 10.1080/17523280802317404
Gunilla Cruce, A. Öjehagen, M. Nordström
Background: It is well known that severe mental illness (SMI) with concurrent substance use disorders (SUD) commonly occurs. This comorbidity has distressing social, psychological, psychiatric and somatic consequences. Aim: To gain greater understanding of how individuals with SMI and SUD experience the roles of alcohol and other drugs for their health and life situation. Method: Eight individuals were interviewed on two occasions. The semi-structured interviews, which were based on an interview guide, were transcribed verbatim and analysed thematically. Results: Alcohol and drug use influenced the individuals' own experiences of their health and life situation both in a positive and negative way. Substance use had meaning for their: ‘experience of themselves’ – well-being and discomfort, energy and lack of energy, meaningfulness and disorientation, identity and personality change; ‘experiences of relationships’ – affiliation and alienation; ‘experiences of mental health’ – decreased and increased symptom...
背景:众所周知,重度精神疾病(SMI)并发物质使用障碍(SUD)是常见的。这种合并症具有令人痛苦的社会、心理、精神和躯体后果。目的:更深入地了解重度精神障碍患者和重度精神障碍患者如何体验酒精和其他药物对其健康和生活状况的影响。方法:分两次对8人进行访谈。根据访谈指南进行的半结构化访谈逐字记录,并按主题进行分析。结果:酒精和药物使用对个体自身健康和生活状况的体验既有积极影响,也有消极影响。物质使用对他们的“自我体验”有意义——幸福和不舒服、精力充沛和缺乏精力、有意义和迷失方向、身份和个性改变;“关系的经验”——从属和异化;"心理健康经历" -症状减少或增加…
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引用次数: 7
Long-term development of mood states and substance use in a Swiss cohort of youths at risk 瑞士一群处于危险中的青少年的情绪状态和物质使用的长期发展
Pub Date : 2008-09-20 DOI: 10.1080/17523280802317362
G. Hüsler, B. Plancherel
Background: Substance use and mental health disorders are strongly associated. The rates of co-morbidity vary according to the population and methodology used. However, it can be reasonably stated that co-morbidity is common and significant. Mental disorders, including depressive mood, anxiety and conduct disorders, are the most often mentioned predictors for substance use. Aims: The main topic of interest is the interrelationship between mood and substance used over time in a cohort of adolescents and young adults. Method: To explore the courses of mood and substance use in a cohort of 614 adolescents and young adults (aged 12–20) using grouping analysis. To determine empirical patterns of mood over time a cluster analysis (k-means) was performed. Four groups differing in their mood states over time (stable low; stable high; increaser; decreaser) were obtained. Conclusions: There is an important relationship between mood states and substance use. Adolescents with mood disorder constantly use more drugs t...
背景:物质使用与精神健康障碍密切相关。合并症的发生率因人群和使用的方法而异。然而,可以合理地指出,合并症是常见的和显著的。精神障碍,包括抑郁情绪、焦虑和行为障碍,是最常被提到的药物使用的预测因素。目的:主要感兴趣的话题是情绪和物质使用之间的相互关系,随着时间的推移在青少年和年轻人的队列。方法:采用分组分析方法对614名12-20岁青少年的情绪和物质使用过程进行分析。为了确定情绪随时间的经验模式,进行了聚类分析(k-means)。随着时间的推移,四组人的情绪状态不同(稳定的低状态;稳定的高;增加者;得到了减少剂。结论:情绪状态与药物使用之间存在重要关系。患有情绪障碍的青少年不断地使用更多的药物……
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引用次数: 1
Staff attitude towards cocaine/crack-cocaine use amongst individuals with severe mental health problems in an inner city area of the UK 工作人员对联合王国内城地区有严重精神健康问题的个人使用可卡因/快克可卡因的态度
Pub Date : 2008-09-19 DOI: 10.1080/17523280802244889
Ruth Clutterbuck, D. Tobin, J. Orford, A. Copello, M. Birchwood, E. Day, Hermine L. Graham, D. Mcgovern, E. Griffith
Background: Cocaine/crack-cocaine use is associated with a number of negative outcomes in people with mental health problems. Aims: To explore the extent of use in individuals with severe mental health problems and impact of client use on mental health service staff. Method: Following Graham et al. (2001), care coordinators within community mental health teams in Birmingham, UK completed a prevalence survey of cocaine/crack-cocaine use in clients on their current caseload to determine the extent of use. Findings were compared to those of Graham et al. Interviews with staff explored the impact of cocaine/crack-cocaine on client outcome and effects on staff within the teams under study. Results: An increase in cocaine/crack-cocaine use is reported (from 5.6% to 11.5% over 8 years). Interview data indicate that despite this increase, staff declare themselves more competent and confident in dealing with cocaine/crack-cocaine use. Conclusions: We propose that the integration of substance use treatment within m...
背景:可卡因/快克可卡因的使用与精神健康问题患者的一些负面后果有关。目的:探讨重度心理健康问题患者的药物使用情况及对心理卫生服务人员的影响。方法:根据Graham等人(2001)的研究,英国伯明翰社区精神卫生小组的护理协调员完成了一项针对客户当前病例量的可卡因/快克可卡因使用情况的流行调查,以确定使用程度。将研究结果与Graham等人的结果进行比较。与工作人员的访谈探讨了可卡因/快克可卡因对客户结果的影响以及对所研究小组内工作人员的影响。结果:可卡因/快克可卡因的使用增加(8年间从5.6%增加到11.5%)。访谈数据表明,尽管有所增加,但工作人员声称自己在处理可卡因/快克可卡因使用方面更有能力和信心。结论:我们建议将药物使用治疗纳入综合治疗方案。
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引用次数: 3
Use of health care services by patients with co-occurring severe mental illness and substance use disorders. 同时患有严重精神疾病和药物使用障碍的患者使用卫生保健服务的情况。
Pub Date : 2008-09-19 DOI: 10.1080/17523280802274886
Marius N Kêdoté, Astrid Brousselle, François Champagne

Background: To better respond to the health care needs of people with co-occurring mental illness and substance use disorders, it is vital to understand their itinerary through the health care system.

Aim: To describe the characteristics of service utilization among patients with co-occurring disorders in a large urban area.

Method: We used a sample (n = 5467) constituted from administrative and clinical databases. Those identified as having substance use disorders and psychoses were followed over 12 months with respect to their utilization of medical services. A descriptive analysis of the data and a two-step cluster analysis were undertaken.

Results: Our analyses revealed a relatively high utilization of emergency services, outpatient clinics, private practices and hospitalization among patients with co-occurring disorders of severe mental illness and substance use. The two-step cluster analysis produced four heterogeneous groups in terms of service utilization.

Conclusions: This study demonstrates the need to develop strategies for organizing health care and services that are adapted to various sites of service utilization and to diverse profiles of patients with co-occurring mental illness and substance use disorders.

背景:为了更好地应对精神疾病和物质使用障碍患者的卫生保健需求,通过卫生保健系统了解他们的行程至关重要。目的:了解某大城市共患疾病患者的服务利用特点。方法:从行政和临床数据库中选取5467例样本。对那些被确定患有药物使用障碍和精神病的人进行了为期12个月的跟踪调查,了解他们利用医疗服务的情况。对数据进行描述性分析和两步聚类分析。结果:我们的分析显示,在严重精神疾病和药物使用共存的患者中,急诊服务、门诊诊所、私人诊所和住院的使用率相对较高。两步聚类分析在服务利用率方面产生了四个异质组。结论:这项研究表明,有必要制定战略,组织卫生保健和服务,以适应不同的服务利用地点和同时发生精神疾病和物质使用障碍的患者的不同概况。
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引用次数: 18
Implementing mental health screening within a youth alcohol and other drugs service 在青少年酒精和其他药物服务机构内实施心理健康检查
Pub Date : 2008-09-19 DOI: 10.1080/17523280802275040
D. Lubman, L. Hides, A. Scaffidi, K. Elkins, M. Stevens, Richard Marks
Background: While clinical studies consistently demonstrate high rates of co-occurring mental health problems among young people with substance use disorders, mental health assessments are not routinely conducted within Alcohol and Other Drug (AOD) settings. Aims: To describe the implementation of a universal mental health screening program within a youth AOD service. We report on the adoption of screening by AOD staff over the subsequent 30 months, as well as rates of identified psychological problems. Method: Examination of service data that were collected following implementation of the screening program. Results: Between August 2005 and December 2007, AOD workers completed 383 screens (87.4%) from a total of 438 eligible young people. Two hundred and sixty-eight (70.0%) scored 17 or above on the K10, with the mean score of the sample being 23.4 (SD = 9.6). Twenty-seven per cent reported moderate to severe suicide risk, with 9.9% reporting self-harm in the past month. Conclusion: With appropriate level...
背景:虽然临床研究一致表明,在有物质使用障碍的年轻人中,同时发生精神健康问题的比率很高,但在酒精和其他药物(AOD)环境中,并没有常规进行精神健康评估。目的:描述在青少年AOD服务中实施的普遍心理健康筛查计划。我们报告在随后的30个月里,精神疾病中心的工作人员采用筛检的情况,以及发现心理问题的比率。方法:检查筛查项目实施后收集的服务数据。结果:2005年8月至2007年12月期间,AOD工作人员从438名符合条件的年轻人中完成了383次筛查(87.4%)。268人(70.0%)的K10得分在17分及以上,样本平均得分为23.4分(SD = 9.6)。27%的人有中度至重度自杀风险,9.9%的人在过去一个月有过自残行为。结论:以适当的水平…
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引用次数: 12
Defining dual diagnosis: a qualitative study of the views of health care workers 定义双重诊断:卫生保健工作者观点的定性研究
Pub Date : 2008-09-19 DOI: 10.1080/17523280802274985
P. Staiger, Caroline Long, M. McCabe, L. Ricciardelli
Background: 'Dual diagnosis' is the term of choice in many countries to describe clients with co-occurring mental health and alcohol and other drug (AOD) issues. However, it is not known if its meaning is consistently represented within and across health care services. This uncertainty has significant implications for referral, consultation and research. Aim: To obtain information about the way that different health care professionals understand the term 'dual diagnosis'. Method: Twenty-nine health care workers across five service types (medical, mental health, AOD, dual diagnosis and community health) in Victoria, Australia were interviewed about their understanding of the term 'dual diagnosis'. Results: The findings indicated that service providers working in AOD and Mental Health had a shared general understanding of what was meant by 'dual diagnosis', despite uncertainties about more specific inclusion criteria. In contrast, medical and community health staff lacked a similar shared understanding, and were more likely to recommend change, but offered no consensus on alternatives. Conclusion: The results indicate that while the term 'dual diagnosis' has value in efficiently directing attention to the complexity of treatment issues, health practitioners cannot assume it will convey the intended meaning outside mental health or AOD services. Clear articulation of the intended definition may be a necessary requirement in wider health care communication.
背景:“双重诊断”是许多国家用来描述同时出现精神健康和酒精及其他药物(AOD)问题的患者的术语。然而,尚不清楚其含义是否在卫生保健服务内部和各服务之间得到一致体现。这种不确定性对转诊、咨询和研究具有重大影响。目的:了解不同卫生保健专业人员对“双重诊断”的理解方式。方法:对澳大利亚维多利亚州五种服务类型(医学、心理健康、AOD、双重诊断和社区卫生)的29名卫生保健工作者进行了访谈,了解他们对“双重诊断”一词的理解。结果:研究结果表明,尽管对更具体的纳入标准存在不确定性,但在AOD和心理健康领域工作的服务提供者对“双重诊断”的含义有着共同的总体理解。相比之下,医疗和社区卫生工作人员缺乏类似的共同理解,更有可能建议改变,但在替代方案上没有达成共识。结论:结果表明,虽然“双重诊断”一词在有效地引导人们关注治疗问题的复杂性方面具有价值,但健康从业者不能假设它在精神健康或AOD服务之外会传达预期的含义。在更广泛的卫生保健沟通中,明确预期定义可能是必要的要求。
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引用次数: 6
Acceptability and applicability of Cue Exposure Therapy as a relapse prevention intervention for individuals who have substance misuse and mental health problems 提示暴露疗法作为药物滥用和精神健康问题个体复发预防干预的可接受性和适用性
Pub Date : 2008-05-12 DOI: 10.1080/17523280802020099
D. Manley
Background: Cue Exposure Therapy (CET) is regarded as a valuable intervention, helping individuals with substance misuse problems recognise cues and triggers to relapse and begin to reduce cravings. Guidelines suggest substance misuse skills should be adapted by mental health professionals working with clients with mental health and substance misuse problems (dual diagnosis). Aims: This study aimed to assess the acceptability of training in CET, its applicability in dual diagnosis work and the effect the training had on professional's confidence in delivering services. In addition, to explore how skills were adapted to meet the needs of individuals with a dual diagnosis. Method: CET training was given to psychiatric professionals working with dual diagnosis clients. The cross-sectional research comprised two stages: pre- and post-training confidence self-scores and a post-training questionnaire; and confidence self-scores and semi-structured interviews with a randomised sub-section of the original populat...
背景:线索暴露疗法(CET)被认为是一种有价值的干预手段,可以帮助有药物滥用问题的个体认识到复发的线索和触发因素,并开始减少对药物的渴望。指南建议,精神卫生专业人员在处理有精神健康和物质滥用问题(双重诊断)的客户时,应调整药物滥用技能。目的:本研究旨在评估大学英语培训的可接受性、在双重诊断工作中的适用性以及培训对专业人员提供服务信心的影响。此外,探讨如何适应技能,以满足个人的双重诊断的需要。方法:对处理双重诊断病人的精神科专业人员进行CET培训。横断面研究包括两个阶段:训练前和训练后自信自我评分和训练后问卷;自信自我评分和对原始人群随机分组的半结构化访谈……
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引用次数: 6
Characterizing intensive community-based care : Use, reliability and factor structure of a generic measure 社区重症监护的特征:通用测量的使用、可靠性和因素结构
Pub Date : 2008-05-12 DOI: 10.1080/17523280802020115
D. Roeg, L. V. D. Goor, H. Garretsen
Background: There is a need for a reliable measurement instrument to characterize intensive community-based care across different types of programs. Aims: The aim of the current study was to use and test the previously developed Intensive Community-Based Care Program Components (ICPC) Questionnaire. Method: This questionnaire was used in a census of programs throughout the Netherlands. Reliability of the a priori scales was assessed, and exploratory factor analysis was used to reduce the number of scales and to re-evaluate the structure of the questionnaire. Descriptive data were calculated to characterize Dutch programs. Of the programs, 58% responded to the questionnaire. Results: Of the a priori scales, 70% were internally consistent. With factor analysis the number of scales was considerably reduced (73%), but still explaining 58% of the total variance. Conclusions: This study shows that the ICPC can be used to improve future effect studies and for international comparisons of programs.
背景:需要一种可靠的测量工具来表征不同类型的社区重症监护项目。目的:当前研究的目的是使用和测试先前开发的社区强化护理计划组成部分(ICPC)问卷。方法:本问卷用于荷兰各地的项目普查。评估先验量表的信度,并采用探索性因子分析减少量表数量,重新评估问卷结构。描述性数据的计算是为了描述荷兰的项目。在这些项目中,58%的人回答了调查问卷。结果:70%的先验量表内部一致。通过因子分析,量表的数量大大减少(73%),但仍能解释总方差的58%。结论:本研究表明,ICPC可用于改进未来的效果研究和项目的国际比较。
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引用次数: 5
Mutual aid groups in psychiatry and substance misuse 精神病学和药物滥用互助小组
Pub Date : 2008-05-12 DOI: 10.1080/17523280802020172
A. Baldacchino, W. Caan, C. Munn-Giddings
Background: Mutuality is a feature of many ‘self-help groups’ for people with mental health and/or substance misuse needs. These groups are diverse in terms of membership, aims, organisation and resources. Collectively, in terms of the pathways for seeking help, support, social capital or simply validation as people, mutual aid groups figure at some time in the life story of many psychiatric and/or substance misuse patients. From the viewpoint of clinical services, relations with such groups range from formal collaboration, through incidental shared care, via indifference, to incomprehension, suspicion, or even hostility. How should mental health and substance misuse clinicians relate to this informal care sector, in practice? Aims: To synthesise knowledge about three aspects of the relationship between psychiatric/substance misuse services and mutual aid groups: profile groups' engagement of people with mental health and/or substance misuse needs at all stages of vulnerability, illness or recovery; chara...
背景:互动性是许多有精神健康和/或药物滥用需要的人的“自助团体”的一个特点。这些团体在成员、目标、组织和资源方面各不相同。总的来说,在寻求帮助、支持、社会资本或仅仅作为人的认可的途径方面,互助组织在许多精神疾病和/或药物滥用患者的生活故事中扮演着重要角色。从临床服务的角度来看,与这些群体的关系从正式的合作,到偶然的共同护理,再到冷漠,再到不理解,怀疑,甚至敌意。在实践中,精神卫生和药物滥用临床医生应如何与这一非正式护理部门联系起来?目的:综合有关精神科/药物滥用服务与互助团体之间关系的三个方面的知识:概况小组在脆弱、疾病或康复的各个阶段参与有精神健康和/或药物滥用需要的人;的性格……
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引用次数: 11
期刊
Mental health and substance use : dual diagnosis
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