Littérature scientifique sur le sujet « Psychiatry, Dual diagnosis, co-occurring disorders, drugs and alcohol »

SummaryWe have studied the occurrence of dual diagnoses (psychoses as well as abuse of either amphetamine, cannabis or opiates) during a 15-year period, among patients treated at Huddinge Hospital, Stockholm, Sweden. The purpose of the study is to evaluate if the different drugs were coupled to different rates of psychiatric co-morbidity. During the period in question, 461, 425 and 371 different patients respectively had been admitted at least once due to dependency on amphetamine, cannabis and opiates. Approximately 30% of the patients with a pure abuse of amphetamine or cannabis and less than 6% of the opiate abusers had been diagnosed at least once with any of the psychoses studied. Comparing the frequency of psychoses among mixed and pure abusers of illegal drugs, with and without a concomitant abuse of alcohol, we found that the co-morbidity rate for mixed opiate abusers increased significantly from 7.2 to 20.2% when alcohol abuse was also present. For abusers of amphetamine and cannabis (both pure and mixed), no differences in co-morbidity rates were seen when an abuse of alcohol was added to that of the drugs. It is difficult to find an explanation for the significant difference between the co-morbidity of pure abuse of amphetamine or cannabis on the one hand and opiates on the other. In conclusion, our findings show that the distribution of psychotic illness is high among abusers of amphetamine and cannabis, in contrast to the generally lower co-morbidity among abusers of opiates. Although these findings are consistent with earlier studies that have shown a propensity for developing psychoses among abusers of amphetamine and cannabis, one should bear in mind that this study is based on inpatients, and is not necessarily representative for all abusers of the drugs in question.

Over the past decade, the importance of co-occurring posttraumatic disorders in patients with substance dependence has become increasingly apparent. In clinical populations of addicted patients, about 25 to 50 percent receive a lifetime diagnosis of Posttraumatic Stress Disorder (PTSD). The talk will give an overview of the prevalence of PTSD and other trauma related disorders in European samples of patients with substance dependence. Moreover, data on experiences with the German version of an integrated treatment program for PTSD and substance abuse („Seeking Safety”, Najavits 2002) in N = 38 female outpatients with alcohol dependence will be reported. The results suggest that participants’ satisfaction with the content of the treatment, its structure and the session handouts was high. “Seeking Safety” therefore seems to be a promising treatment also for European patients with the dual diagnosis of PTSD and substance abuse.

Addiction medicine/psychiatry, a medical subspecialty founded on October 1991 by the American Board of Psychiatry and Neurology, was granted as subspecialty within psychiatry. It mainly deals with medical assessment, diagnosis and treatment of subjects who suffer from an addiction (i.e. drug and/or alcohol addiction; gambling; sexual addiction; game addiction; and so on). Addiction psychiatry also deals with subjects in dual diagnosis, i.e. individuals with addiction issues along with co-occurring psychiatric disorders. However, despite its well established “dignity” to be part of psychiatry, most mental health's professionals believe that it is not a primarily psychiatric field due to the frequent co-occurrence of internistic/medical issues. In addition, the situation of psychiatric training specifically addressed to addiction is widely diversified across the European countries. Therefore, most psychiatrists do not possess specific qualifications and formation on this increasing field of psychiatry. The present lecture aims at providing an insight into the issues related to the diatribe between psychiatry and medicine on addiction medicine/psychiatry, specifically focusing on differences across European countries.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Purpose To improve outcomes for people with co-occurring mental health and substance use disorders, the Eastern Health Mental Health Service implemented an integrated treatment model known as the dual diagnosis clinician shared care model. This study aims to provide evidence for a relatively unexplored model in clinical mental health services within the state of Victoria, Australia. Design/methodology/approach Dual diagnosis clinicians were placed into community mental health clinics in a shared-care, modified case management role, to provide primary and secondary consultations to select consumers and/or their carers, as well as to provide capacity-building training to the mental health staff facing real world clinical challenges in dual diagnosis service delivery. Findings Since the commencement of this service, more than 800 consumers of the adult mental health service have been supported to concurrently address their harmful substance use, while receiving recovery-focused community mental health care. Preliminary findings include previously unknown figures on the prevalence for co-occurring substance use at the point of referral and a demonstrated preference by consumers for treatment of both disorders at the same time by the same service (in-house treatment). Originality/value The establishment of a dedicated, integrated dual diagnosis team has significantly increased the capacity of a community-based clinical mental health service to engage with and treat consumers with dual diagnosis disorders. This model is beginning to produce evidence challenging traditional siloed approaches to mental health and alcohol and drug treatment.

Recognition and management of mood symptoms in individuals using alcohol and/or other drugs represent a daily challenge for clinicians in both inpatient and outpatient treatment settings. Diagnosis of underlying mood disorders in the context of ongoing substance abuse requires careful collection of psychiatric history, and is often critical for optimal treatment planning and outcomes. Failure to recognize major depression or bipolar disorders in these patients can result in increased relapse rates, recurrence of mood episodes, and elevated risk of completed suicide. Over the past decade, epidemiologic research has clarified the prevalence of comorbid mood disorders in substance-dependent individuals, overturning previous assumptions that depression in these patients is simply an artifact of intoxication and/or withdrawal, therefore requiring no treatment. However, our understanding of the bidirectional relationships between mood and substance use disorders in terms of their course(s) of illness and prognoses remains limited. Like-wise, strikingly little treatment research exists to guide clinical decision making in co-occurring mood and substance use disorders, given their high prevalence and public health burden. Here we overview what is known and the salient gaps of knowledge where data might enhance diagnosis and treatment of these complicated patients.

Lo studio è in primo luogo la descrizione delle caratteristiche sociodemografiche e cliniche della popolazione che afferisce al Servizio Psichiatrico di Diagnosi e Cura dell’Azienda Ospedaliera “San Gerardo” di Monza. Il secondo punto di interesse è l’individuazione di indicatori di tipo sociodemografico, clinico e di carico assistenziale che caratterizzino e differenzino la popolazione con Doppia diagnosi. Il campione dello studio è costituito da tutti i pazienti afferenti nel corso del triennio 2010, 2011 e 2012 al Servizio Psichiatrico di Diagnosi e Cura (SPDC). Dai risultati emerge che la presenza della doppia diagnosi nei soggetti afferenti all’SPDC riguarda il 25% dei pazienti ricoverati nei tre anni dello studio. Il paziente con doppia diagnosi è di solito di sesso maschile, abusa spesso di alcol e soffre di un disturbo di personalità, di un disturbo dell’adattamento o di una sindrome affettiva. Sul piano sociodemografico è un soggetto giovane/adulto, celibe, disoccupato e con un basso titolo di studio. La doppia diagnosi rende più precoce e complessa la richiesta di aiuto presso il servizio psichiatrico. La valutazione longitudinale indica che la percentuale di casi di doppia diagnosi in reparto sia in aumento, essendo passata da circa il 20% a quasi il 30% del totale dei soggetti afferenti al servizio, e che il loro numero assoluto è pressoché raddoppiato negli ultimi tre anni.
The study is primarily a description of the socio-demographic and clinical characteristics of the population belonging to the Psychiatric Diagnosis and Treatment Service of the "San Gerardo" Hospital in Monza. The second point of interest is the identification of socio-demographic, clinical and care-load indicators that characterize and differentiate the population with Dual Diagnosis. The study sample was made up of all patients from the Psychiatric Service of Diagnosis and Treatment (SPDC) during the three-year period 2010, 2011 and 2012. The results show that the presence of double diagnosis in subjects belonging to the SPDC concerns 25% of patients hospitalized in the three years of the study. The patient with a double diagnosis is usually male, often abuses alcohol and suffers from a personality disorder, an adaptation disorder or an affective syndrome. On the socio-demographic level it is a young / adult, unmarried, unemployed and with a low educational qualification. The double diagnosis makes the request for help from the psychiatric service earlier and more complex. The longitudinal evaluation indicates that the percentage of cases of double diagnosis in the ward is increasing, having gone from about 20% to almost 30% of the total number of subjects belonging to the service, and that their absolute number has almost doubled in the last three years.