Antisocial personality disorder, conduct disorder, and substance abuse in schizophrenia.

The validity of subtypes based on antisocial personality disorder (APD) or childhood conduct disorder without adult APD (CD only) in patients with schizophrenia (or schizoaffective disorder) and a substance use disorder (abuse or dependence) was examined. APD patients scored lower on personality measures related to socialization and higher on antisocial bebavior, psychopathy, and aggression. APD patients also reported higher rates of aggression and legal problems. APD, and to a lesser extent CD only, was associated with more severe psychiatric symptoms, an earlier age of onset of substance abuse, more severe symptoms of substance abuse, and a stronger family history of substance abuse and psychiatric hospitalization. The findings suggest that schizophrenia patients with APD represent a high-risk subgroup vulnerable to more severe substance abuse, psychiatric impairment, aggression, and legal problems. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Women's mental health in primary care. Depression, anxiety, somatization, eating disorders, and substance abuse

Primary care physicians can improve the care of women patients by applying new concepts of women's physiology and psychosocial development. New developmental models that emphasize the importance of relationships in women's self-concept and well-being have led to effective psychotherapies for depression, eating disorders, anxiety and substance abuse. Many of these therapies can be offered in brief formats suitable to primary care settings. New biological treatments including the use of estrogen, thyroid hormone and bright light for depression and refeeding to increase metabolic rate in eating disorders also promise to expand the range of mental health problems that generalist physicians can treat successfully.     

Use of psychoactive substances in three medical specialties: anaesthesia, medicine and surgery

In order to determine the prevalence of psychoactive substance use in three specialty groupings, 1,624 questionnaires were sent to physicians in medicine, surgery and anaesthesia; all had trained at the same academic institution. A response rate of 57.8% was achieved. Comparison of prevalence of impairment rates showed no differences between Surgery (14.4%), Medicine (19.9%) and Anaesthesia (16.8%). Substance abuse was clearly associated with a family history of abuse; 32.1% of the abusers had a family history of such abuse compared with 11.7% of the non-abusers. Increased stress at various career stages did not appear to increase substance abuse; problem areas during medical life times were similar for each specialty. Substances most frequently used were marijuana (54.7%), amphetamines (32.9%); and benzodiazepines (25.1%). Seventy-three used psychoactive drugs which were non-prescribed. Drug counselling programmes were judged inadequate by most. Use of alcohol and drugs by faculty members was reported by a number of respondents.     

Should patients' religiosity influence clinicians' referral to 12-step self-help groups? Evidence from a study of 3,018 male substance abuse patients.

Twelve-step self-help organizations maintain that anyone, regardless of his or her religious beliefs, can benefit from participation in their groups. Yet many addiction professionals have reservations about referring nonreligious patients to 12-step groups. The present study examined the influence of patients' religiosity on whether they were referred to and benefited from 12-step groups. Participants were 3,018 male substance abuse inpatients. Individuals who engaged in fewer religious behaviors in the past year were referred to 12-step groups less frequently by clinicians. However, referrals to 12-step groups were effective at increasing meeting attendance, irrespective of patients' religious background, and all experienced significantly better substance abuse outcomes when they participated in 12-step groups. The viewpoint that less religious patients are unlikely to attend or benefit from 12-step groups may therefore be overstated. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Computer model of a bovine type I collagen microfibril

It has been found that > 60% of bipolar I and almost 50% of bipolar II patients have a history of substance abuse (Regier et al., 1990). While previous studies have examined comorbidity of bipolar disorder and substance abuse, little has been done to examine the effect of substance abuse on the course of bipolar disorder. There has also been little distinction made between bipolar disorder occurring prior to substance abuse and that occurring after the onset of substance abuse. Given the high prevalence of substance abuse in bipolar patients, it would be useful to determine more about the effect of substance abuse on demographic and clinical features and on the course of illness. We attempted to do this with a retrospective chart review of 188 bipolar patients seen by D.L. Dunner between January 1992 and December 1993. Demographic and clinical information as well as information about course of illness were systematically extracted from the charts. We compared the means and percentages of these variables and analysed them for significance. Preliminary results show differences in demographics, clinical features and course of illness between patient groups. These differences may illustrate the clinical effects of substance abuse on the course of bipolar disorder. Our results also indicate that there are differences between patients whose bipolar disorder began prior to and those whose disorder began after the onset of substance abuse.     

Managed care and technical efficiency in outpatient substance abuse treatment units

This article examines (1) the extent to which managed care participation is associated with technical efficiency in outpatient substance abuse treatment (OSAT) organizations and (2) the contributions of specific managed care practices as well as other organizational, financial, and environmental attributes to technical efficiency in these organizations. Data are from a nationally representative sample survey of OSAT organizations conducted in 1995. Technical efficiency is modeled using data envelopment analysis. Overall, there were few significant associations between managed care dimensions and technical efficiency in outpatient treatment organizations. Only one managed care oversight procedure, the imposition of sanctions by managed care firms, was significantly associated with relative efficiency of these provider organizations. However, several organizational factors were associated with the relative level of efficiency including hospital affiliation, mental health center affiliation, JCAHO accreditation, receipt of lump sum revenues, methadone treatment modality, percentage clients unemployed, and percentage clients who abuse multiple drugs.     

Sensation seeking, substance abuse, and psychopathology in treatment-seeking and community cocaine abusers.

Sensation seeking, substance abuse severity, and psychiatric disorders were systematically assessed in a clinical and a community sample of 335 cocaine abusers. In contrast to low-sensation-seeking cocaine abusers, high-sensation seekers exhibited more severe symptoms of substance abuse, exhibited more severe psychosocial impairment, were more likely to be polysubstance abusers, and had an earlier age of onset for substance use and abuse. High-sensation seekers were more likely to report both a lifetime history and family history of antisocial personality, attention deficit disorders and conduct disorder. Sensation seeking was related to several dimensions that are important for defining subtypes of substance abusers and was consistent with other features of a Type II classification. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Restructuring public mental health and substance abuse service systems

The authors originally circulated the concepts in this proposal during May 1995. The purpose was to support an open, public dialogue regarding the restructuring of the mental health and substance abuse services in Illinois in anticipation of Medicaid funding changes. Restructuring mental health and substance abuse service systems should follow certain key principles. These principles are applicable to other states, particularly those large in territory and population. The authors propose the temporary use of multiple managed care companies serving as administrative services only (ASO) organizations, each of whom would have responsibility for a given geographic portion of a state. The role of the ASOs would be to organize providers into networks on a regional basis and transfer managed care expertise in financing and clinical management to the relevant state departments and provider groups. Changes in the service delivery system would be phased in over time with reorganization of key components of the system during each phase. Where the provision of mental health, substance abuse, and social services is split among multiple state agencies, these agencies would be merged to achieve unified funding and administrative efficiency. Patients and advocacy organizations would play a key role in overseeing and shaping system restructuring at all levels, including a governmental board reporting to the governor, overseeing ASO organizations' operations and assuring quality and access at the provider level. The authors propose funding of public behavioral health services through use of a tiered, integrated funding model.     

Integrative treatment of symptomatic disorders.

Symptomatic disorders such as substance abuse, eating disorders, depression, and anxiety states can cause significant life impairment in patients. The author proposed that an optimally responsive, analytically oriented treatment for an individual with symptomatic distress may involve the use of active symptom-focused techniques. Reduction of symptomatic problems strengthens the self and facilitates deeper levels of self-exploration and therapeutic involvement. Techniques originating in behavioral and cognitive-behavioral orientations may be implemented in an analytically informed treatment and adapted accordingly. Current psychoanalytic models such as self psychology and some other relational approaches that emphasize the importance of empathic appreciation of a patient's perspective and optimal responsiveness to the individual can encompass such an integrative approach. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Ability of counselors to detect cognitive impairment among substance-abusing patients: An examination of diagnostic efficiency.

Counselors (N?=?12) in 1 of 2 substance abuse treatment facilities were asked to identify which of their patients (N ?=?97) had general neurocognitive impairment. Counselors were required to base their judgements on information collected from patients during psychosocial history gathering, clinical interviews, physical examinations, brief cognitive screening tests, and substance abuse severity evaluations, but not on neuropsychological test results. All patients were subsequently administered a neuropsychological test battery. Diagnostic agreement between counselors' impressions of patients' cognitive status and patients' actual neuropsychological test performance was poor. Subsequent analyses revealed counselors' impressions about patients' neuropsychological functioning were based on information that did not reliably discriminate between cognitively impaired and intact patients (e.g., years of education and self-reported symptoms of cognitive dysfunction). (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Effect of neurocognitive status and personality functioning on length of stay in residential substance abuse treatment: An integrative study.

Administered a battery of neuropsychological tests and the Millon Clinical Multiaxial Inventory-II (MCMI-II) to 246 patients (aged 17–53 yrs) admitted to a long-term residential substance abuse treatment facility. Ss who displayed general cognitive impairment scored higher on the Avoidant, Antisocial, Paranoid, and Thought Disorder scales than those who did not have such impairment. Cognitive status and personality functioning, particularly an antisocial personality style, were independently and interactively related to program participation. Ss with elevations on the MCMI-II scale measuring antisocial personality style and who had cognitive impairment stayed in the program a shorter amount of time, were rated as less positively participatory by clinical staff, and were removed more frequently from treatment for rule violations than other residents. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Elder abuse: a call to action

An estimated 2 million people a year are victims of elder abuse, which ranges from neglect and mistreatment to physical abuse. By the year 2020, a full 22% of the population will be aged 65 or older. This demographic explosion demands that we identify and protect those at risk. To investigate the incidence of elder abuse or neglect (EAN) and to determine clinician awareness of associated risk factors, we conducted a 1-year retrospective review of thermally injured patients aged 60 or older. Data included age, total body surface area burned, mechanism of injury, length of hospital stay, mortality, abuse or neglect risk factors, and referral to the appropriate social agency. We found that our elderly patients (n = 28) were poorly screened for EAN. While 64% to 96% of patients were screened for cognitive impairment, overall health, and financial resources, none were screened for risk factors of emotional isolation. None of the patient's caregivers, including any spouses, roommates, or guardians, were screened for risk factors of substance abuse, familial violence, dependency needs, or external stresses. With the use of available data, we were able to place 11 patients on the following levels of abuse or neglect: 1) low risk for abuse; 2) self-neglect; 3) neglect; and 4) abuse. By this scale, 7 patients (64%) were victims of self-neglect, 3 patients (27%) were victims of neglect, and 1 patient (9%) was a victim of abuse. Adult Protective Services intervened in 2 cases. Recognizing that all cases of EAN should be preventable, we cannot accept the socioeconomic impact of this entity. The 11 patients identified as victims of neglect, self-neglect, or abuse accounted for 135 hospital days and 8 fatalities. Before we can address EAN, health care personnel must be made aware of the problem and routine screening for risk factors must be implemented. The true incidence of EAN is likely underestimated because health care providers have difficulty recognizing its features. A standard assessment tool to screen for neglect or abuse should be used for each older adult admission.     

Substance abuse issues in cancer patients. Part 1: Prevalence and diagnosis

Although rare, drug abuse problems present a complex set of physical and psychosocial issues that complicate cancer treatment and pain/ symptom management. Most oncologists are not be well versed in either the conceptual or practical issues related to addiction. As a result, they often struggle in their attempts to effectively treat patients who are or have been substance abusers, and they find it difficult to understand issues of addiction in patients with pain who have no history of substance abuse. In the first installment of a two-part series, the authors explore the epidemiology of substance abuse. An examination of the distinctions between abuse and dependence leads to definitions of these terms appropriate for the oncology setting. Guidelines for assessing aberrant drug-taking behavior are also offered. Part 2, which will appear in the next issue of ONCOLOGY, will discuss the clinical management of cancer patients with a history of substance abuse.     

Immunolocalization of BMP-6, a novel TGF-beta-related cytokine, in normal and atherosclerotic smooth muscle cells

OBJECTIVES: The study replicated methods used in an earlier study to determine the prevalence of dissociative disorders among patients with substance use disorders and to examine demographic characteristics and history of childhood abuse among patients with and without dissociative comorbidity. METHODS: A total of 100 inpatients who were completing a substance abuse treatment program at a VA medical center were interviewed using the Dissociative Disorders Interview Schedule, which diagnoses dissociative disorders. Two additional screening measures of dissociative symptoms were used, as well as an instrument to measure IQ. RESULTS: Fifteen percent of the sample were diagnosed as having a dissociative disorder. Compared with patients without a dissociative disorder, the patients with a dissociative disorder had significantly higher median scores on the two screening measures, indicating more dissociative experiences and the presence of five distinct symptom clusters. The two groups did not differ in history of childhood abuse or IQ. CONCLUSIONS: The results support earlier findings suggesting that patients with substance abuse disorder should be routinely screened for dissociative symptoms and disorders.     

Adolescent growth, development, and psychosocial aspects of sports participation: an overview

This chapter examines sports participation in the context of adolescent growth and development. Because the nature of sports participation is highly organized and competitive, it is imperative that parents, coaches, physicians, and other clinicians remember that they may be placing increased pressures on the adolescent to perform and practice. The authors review the impact of physical growth and psychosocial development and also describe how substance abuse, depression, and aggressive behavior may or may not be influenced by sports participation.     

Apoptosis detection: an overview

As with women in general, the vicissitudes of the female physician who suffers from a substance use disorder have been understudied, and such persons remain underrepresented in treatment. The purpose of the present study is to describe the similarities and differences between female and male physicians presenting for assessment; 108 physicians in total were included in the study, 10 of whom were female. Demographically, we found that the female physicians were more likely to be single and younger than their male counterparts. On clinical indices, females showed less impairment on legal and medical functioning, and better capability in sustaining abstinence and eliminating environmental cues to relapse. Of the women with substance use disorders, higher rates of comorbidity were found than with males. Although there were no significant differences in overall severity, males were more likely to be recommended to more intensive levels of care for either substance use or psychiatric disorders. The female physicians were recommended to a level of care of a lower intensity, but more often to a treatment with a dual-diagnosis focus. These findings are discussed in terms of the vulnerabilities of the female physician, barriers to treatment, tailoring treatment to female needs, and opportunities for prevention and further research.     

Childhood abuse and parental disorders reported by Navy outpatient mental health patients

OBJECTIVE: To ascertain the number of Navy outpatient mental health patients reporting a history of childhood abuse. To explore the relationships among abuse history, parental/step-parental substance abuse, mental illness, and divorce. METHOD: Review of 134 clinical data forms completed by patients when first seen. RESULTS: Twenty-six percent reported at least one type of childhood abuse (physical, sexual, verbal, emotional). Proportionally more females reported any one type of abuse. Assailants were predominantly males, typically fathers or stepfathers. Verbal abuse significantly affected childhood happiness. Parental substance abuse, mental illness, or divorce before age 19 reduced childhood happiness, and abuse further reduced it. CONCLUSION: Childhood abuse is commonly reported by Navy mental health patients and may affect their adjustment to military life.     

Self-report and observer measures of substance abuse among homeless mentally ill persons in the cross-section and over time

The comparability of self-report and observer measures of substance abuse among 118 homeless mentally ill persons was assessed using cross-sectional and longitudinal measures. Possible correlates of nondisclosure were identified from demographic variables and clinical indicators. Lifetime abuse reported at baseline was a sensitive predictor of subsequent abuse behavior in the project, but cross-sectional measures based only on self-report or observer ratings failed to identify many abusers. A total of 17% of the subjects never disclosed abuse that was observed during the project. The level of substance abuse is likely to be severely underestimated among homeless mentally ill persons when only one self-report measure is used at just one point in time. This problem can, however, largely be-overcome by incorporating information from observers and from multiple follow-ups or by focusing on lifetime rather than current abuse. We also conclude that underreporting may bias estimates of some correlates of substance abuse.     

Physicians disciplined by a state medical board

CONTEXT: State medical boards discipline several thousand physicians each year. Although certain subgroups, such as those disciplined for malpractice, substance use, or sexual abuse, have been studied, little is known about disciplined physicians as a group. OBJECTIVE: To assess the offenses, contributing factors, and type of discipline of a consecutive series of disciplined physicians. DESIGN: Case-control study on publicly available data matching 375 disciplined physicians with 2 groups of control physicians, one matched solely by locale, and a second matched for sex, type of practice, and locale. SUBJECTS: All disciplined physicians publicly reported by the Medical Board of California from October 1995 through April 1997. MAIN OUTCOME MEASURES: Characteristics of disciplined physicians, offenses leading to discipline, and type of discipline. RESULTS: A total of 375 physicians licensed by the Medical Board of California (approximately 0.24% per year) were disciplined for 465 offenses. The most frequent causes for discipline were negligence or incompetence (34%), abuse of alcohol or other drugs (14%), inappropriate prescribing practices (11%), inappropriate contact with patients (10%), and fraud (9%). Discipline imposed was revocation of medical license (21%), actual suspension of license (13%), stayed suspension of license (45%), and reprimand (21%). Type of offense was significantly associated with severity of discipline (P=.03). In logistic regression models comparing disciplined physicians with controls matched by locale, board discipline was significantly associated with physicians' sex (odds ratio [OR] for women, 0.44; 95% confidence interval [CI], 0.28-0.70) and involvement in direct patient care (OR, 2.56; 95% CI, 1.75-3.75). In the regression model with additional matching criteria, disciplinary action was negatively associated with specialty board certification (OR, 0.42; 95% CI, 0.29-0.60) and positively associated with being in practice more than 20 years (OR, 2.02; 95% CI, 1.39-2.92). CONCLUSIONS: A small but substantial proportion of physicians is disciplined each year for a variety of offenses. Further study of disciplined physicians is necessary to identify physicians at high risk for offenses leading to disciplinary action and to develop effective interventions to prevent these offenses.     

Outcomes of the treatment climate in psychiatric and substance abuse programs

This study examines how key aspects of the treatment climate are related to program differences in the aggregate behaviors of patients residing in 89 psychiatric or substance abuse facilities. More active support, personal expression, and practical orientation were related to better patient functioning, more patient activity in the facility and in the community, and more use by patients of the program's health-treatment services and social-recreational activities. These results held for both patients' and staff members' consensual perceptions of the treatment climate. On the whole, these aspects of the treatment milieu were especially beneficial for groups of patients with greater psychiatric impairment.