Substance use and abuse among patients with comorbid dysthymia and substance disorder

This study determines the substance use and abuse patterns among patients with comorbid substance-related disorder (SRD) and dysthymia in SRD-dysthymia as compared with patients with SRD only. Differences in use and abuse patterns could be useful for (a) understanding motivations for use, such as self-treatment, and (b) assisting clinicians to identify cases of dysthymia among SRD patients. Retrospective and current data were obtained regarding history of substance use and current SRD diagnoses. Two university medical centers with alcohol-drug programs located within departments of psychiatry were the settings. A total of 642 patients was assessed. of whom 39 had SRD-dysthymia and 308 had SRD only. Data on past usc were collected by a research associate using a questionnaire. Current SRD and dysthymia diagnoses were made by psychiatrists specializing in addiction. The patients with SRD-dysthymia and SRD only did not differ with regard to use of alcohol, tobacco, and benzodiazepines. The patients with SRD-dysthymia started caffeine use at an earlier age, had shorter "use careers" of cocaine, amphetamines, and opiates, and had fewer days of cocaine and cannabis use in the last year. They also had a lower rate of cannabis abuse/dependence. This study indicated that patients with dysthymia and SRD have exposure to most substances of abuse that is comparable to patients with SRD only. However, they selectively use certain substances less often than patients with SRD only. Early use of caffeine may reflect self-treatment for depressive symptoms among patients with SRD-dysthymia.     

Comorbid substance use disorder: prevalence, patterns of use, and course

Research on the prevalence, patterns, and course of substance use disorders in severe mental illness gives key insights into the complex interaction of substance use and mental disorder. Understanding the literature on comorbidity has implications for the design of clinical services and for the direction of future research in the field.     

Comorbid psychopathology in binge eating disorder: Relation to eating disorder severity at baseline and following treatment.

Individuals with binge eating disorder (BED) have high rates of comorbid psychopathology, yet little is known about the relation of comorbidity to eating disorder features or response to treatment. These issues were examined among 162 BED patients participating in a psychotherapy trial. Axis I psychopathology was not significantly related to baseline eating disorder severity, as measured by the Structured Clinical Interview for DSM-III-R (SCID-I and SCID-II) and the Eating Disorder Examination. However, presence of Axis II psychopathology was significantly related to more severe binge eating and eating disorder psychopathology at baseline. Although overall presence of Axis II psychopathology did not predict treatment outcome, presence of Cluster B personality disorders predicted significantly higher levels of binge eating at 1 year following treatment. Results suggest the need to consider Cluster B disorders when designing treatments for BED. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Attention-deficit hyperactivity disorder and substance abuse: relationships and implications for treatment

Attention-deficit hyperactivity disorder (ADHD) and substance-use disorders are related to each other in a variety of ways. Although within the child-psychiatry literature earlier investigations were inconsistent regarding such a link, recent prospective studies that followed hyperactive children and normal controls into adulthood have found that hyperactive adults with a history of ADHD are more likely than controls to have substance-use disorders. The substance-abuse literature is less consistent regarding the potential association between ADHD and substance abuse. However, recent studies suggest that persons with a substance-use disorder, and particularly those with a cocaine-use disorder, may be more likely than the general population to have a childhood history of ADHD. Some of the inconsistency regarding this association is due to differences in diagnostic criteria, type of assessments used, and reliability of information obtained. Each of the potential relationships that may exist between ADHD and substance abuse has treatment implications for the clinician. Pharmacological as well as nonpharmacological approaches deserve further investigation. Because pharmacotherapy is a central component in the treatment of childhood ADHD, clinicians designing a strategy to treat both a substance-use disorder and ADHD need to consider pharmacological interventions. At present, the literature on pharmacological treatment for childhood ADHD is extensive and that for adult ADHD is growing; information regarding the treatment of cocaine abuse and concomitant ADHD symptoms remains limited.     

Comorbid panic disorder and major depression: implications for cognitive-behavioral therapy

The Fourier transform infrared spectrum of H3SiI has been recorded in the nu1/nu4 region from 2075 to 2315 cm-1 at an optical resolution of 2.3 x 10(-3) cm-1. The nu1/nu4 fundamental bands and the (nu1 + nu3) - nu3/(nu4 + nu3) - nu3 hot bands have been rotationally investigated. Numerous local perturbations have been observed in the nu1 and nu4 bands and in the hot bands. Without the lines involved in perturbations, more than 2900 transitions of the nu1/nu4 bands were used to determine the band origins and the vibration-rotation parameters of the nu1 = 1 and nuv4 = 1 states. A least-squares fit of 766 apparently unperturbed transitions of the hot bands gave the parameters of the nu1 = nu3 = 1 and nu4 = nu3 = 1 states. The l(2, 2) resonance in nu4 and the A1-E Coriolis coupling between nu1 and nu4 have been investigated. Most of the local perturbations have been studied individually using a simple model by which the main perturber for each resonance was identified. Copyright 1998 Academic Press.     

Dental fear treatment outcomes for substance use disorder patients

In order to examine the clinical treatment outcome for dental fears, we compared the records of 18 phobics who had co-morbid substance use disorder (SUD) with those of 27 subjects who were phobic without concomitant SUD. Outcomes were determined by calculation of changes in the Dental Fear Survey (DFS) score. Subjects were classified by the Structured Clinical Interview for DSM-III-R. All subjects received exposure-based behavioral therapy with or without pharmacological adjuncts. All 27 subjects in the non-SUD group and 15 of 18 (83.3%) of subjects in the SUD group improved. Non-SUD subjects improved more than SUD's on the avoidance and specific fear, but not on the physiological upset, dimensions of the DFS.     

Comorbid panic disorder and major depression: Implications for cognitive–behavioral therapy.

Panic disorder and major depression frequently coexist, yet the implications of comorbidity for psychological treatments have rarely been studied. The objective of this study was to evaluate whether pretreatment comorbidity of major depression affects the outcome of cognitive–behavioral treatment (CBT) of panic disorder. Thirty-seven clients who met diagnostic criteria for both panic and major depression participated in 10 sessions of individual CBT for panic. Treatment outcome was contrasted with the outcome of 53 clients having only panic disorder who received the same treatment. The cooccurrence of depression did not adversely affect CBT for panic. These results have implications for clinical practice and theoretical implications for the nature of the relationship between panic and depression. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Implementing evidence-based psychosocial treatment in specialty substance use disorder care.

Implementing evidence-based psychosocial or behavioral treatments for clients with substance use disorders (SUDs) presents significant challenges. In this article, we first identify the treatments for which there is some consensus that sufficient empirical support exists to designate them as “evidence-based,” and then briefly consider the nature of that evidence. Following that, we review data from a Substance Abuse and Mental Health Services Administration survey on the extent to which these evidence-based treatments (EBTs) are used in SUD treatment in the United States. The main focus of the article is a review of 21 studies attempting to implement EBTs from which we glean information on factors associated with more and less successful implementation. We conclude that more conceptually driven, organizationally focused (not just individual-provider-focused) approaches to implementation are needed and that, at least with some providers in some organizational contexts, it may be more effective to implement evidence-based practices or processes (EBPs) rather than EBTs. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Comorbid mental disorders: Implications for treatment and sample selection.

Disorders from the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., rev.; American Psychiatric Association, 1987) were assessed in a birth cohort of 961 young adults. Comorbid cases exceeded single-disordered cases in chronic history of mental illness, use of treatments, physical health problems, functional interference in daily life, and impaired adaptation across domains such as work, education, health, and social-support networks. Single-disorder cases were also more impaired than nondisordered cases, but comorbid cases were the most severely impaired. Our findings suggest that (a) samples that underrepresent comorbidity (pure single-disorder cases or student samples) will underestimate effect sizes for relations between a disorder and its correlates, whereas samples that overrepresent comorbidity (clinical or adjudicated samples) will overestimate effect sizes, (b) comorbidity is accompanied by complications that challenge treatment planning, compliance, and coordination of service delivery, and (c) comorbidity is associated with physical, educational, and economic problems that make it a broad societal concern. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Assertive community treatment for patients with co-occurring severe mental illness and substance use disorder: a clinical trial

Neural correlates of saccade planning in 6-month-old infants were investigated by high-density event-related potentials. Subjects made saccades to a target stimulus following a time gap from fixation stimulus offset (gap trials) or with the fixation stimulus still present (overlap trials). Like adults, infants were slower to make a saccade to the target when the fixation stimulus was still present. Strikingly, infants did not show clear evidence of the pre-saccadic components observed in adults which are thought to reflect cortical saccade planning processes. They did, however, show a left frontal positivity, which we suggest reflects cortical disinhibition of the colliculus initiated by fixation stimulus offset, and clear post-saccadic lambda waves. These results indicate that the frontal cortex already plays a role in action control by 6 months of age, while other aspects of cortical action planning may not yet be present in certain task situations.     

Temperament and antisocial behavior in preadolescent boys with or without a family history of a substance use disorder.

The goals of this study were to determine the relations between different dimensions of temperament, and their interactions, with antisocial behavior (ASB) in 351 preadolescent boys with (n?=?175) or without (n?=?176) a family history of a substance use disorder (SUD) and to determine whether these relations are moderated by a family history of SUD. Participants were administered the Revised Dimensions of Temperament Survey (DOTS-R) and multiple measures of ASB. Factor analysis reduced the DOTS-R subscales into three factors: Rhythmicity, Behavioral Regulation, and Positive Affectivity. Results indicated that above and beyond the effects of age and socioeconomic status, low rhythmicity, low behavioral regulation, and low positive affectivity, as well as some of their higher order interactive effects, are important indicators of different types of ASB and, in some cases, only in boys with a family history of SUD. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Predictors of initiation and engagement in VA substance use disorder (SUD) treatment.

We examined if patient or setting characteristics predict subsequent addiction treatment involvement in a sample of 270,877 Veteran Administration (VA) patients identified with substance use disorders (SUD). Patient characteristics (e.g., gender, age, marital status) and treatment specialty of the unit where the SUD was identified (SUD, Psychiatric, or Other) were used to predict two aspects of treatment involvement, specifically the HEDIS Initiation and Engagement quality indicators (National Committee for Quality Assurance, 2006). Overall, patients who were female, not married, younger, and had their SUDs identified in SUD or Psychiatric treatment units initiated and engaged in treatment at significantly higher rates. For example, a younger, single patient who was identified with an SUD in an SUD specialty unit had a predicted probability of meeting the Initiation criteria of 0.54 compared to 0.14 for an older married patient identified in a general medical setting. This research facilitates the identification of patients with lower likelihoods of initiation and engagement in treatment and may inform intervention efforts to improve rates of initiation and engagement in targeted groups and settings. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Treating obsessive-compulsive disorder among substance abusers: A guide.

Explores psychotherapeutic and pharmacologic approaches for the treatment of obsessive–compulsive disorder (OCD), and explains how these interventions can be integrated into a substance abuse treatment plan. Behavior therapy is the most effective treatment for OCD, using an exposure and response prevention paradigm. Five steps are recommended for treating substance abusers with OCD: (1) psychodiagnostic assessment, (2) assessment of symptom type and severity, (3) psychoeducational therapy, (4) developing a hierarchy of anxiety-evoking stimuli, and (5) treating OCD patients with exposure and response prevention. Four heterocyclic drugs with potent serotonin-reuptake inhibitor properties (clomipramine, fluoxetine, fluvoxamine, and sertraline) have also shown consistent effectiveness in reducing OCD symptoms. A case example is provided of a 37-yr-old male substance abuser seeking therapy for contamination fears and washing rituals. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Exposure therapy for posttraumatic stress disorder in a residential substance use treatment facility.

Clinical lore abounds when discussing the issue of treating trauma-related symptoms in substance-dependent clients. Historically, clinicians have wondered whether they should wait until the client has gained substantial abstinence from abused substances before initiating trauma treatment or if trauma treatment should be conducted during substance use treatment. Furthermore, questions arise with regard to exactly how trauma-related symptoms should be addressed and how trauma treatment should be incorporated into the recovery process. In this article, the growing literature suggesting that posttraumatic stress disorder (PTSD) can be treated concurrently with substance use disorders is reviewed. In addition, the unique challenges of implementing treatment for PTSD with substance-dependent clients seeking treatment in a residential treatment facility are discussed. Specifically, we provide concrete suggestions about how to utilize prolonged exposure, a very effective treatment for PTSD, with clients in a residential substance use treatment facility, including use of the internet to facilitate exposure therapy. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

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)     

Comparison of the effect of amisulpride and viloxazine in the treatment of dysthymia

An evaluation of the therapeutic efficacy of Amisulpride as compared with Viloxazine in a group of patients diagnosed as dysthymic, according to the DSM-III-R criteria is presented. Study was a double-blind, randomized controlled trial: Subjects were assessed during an initial examination with informed consent, then entering a 4-week treatment trial. The Hamilton Depression Scale, the Widlocher Psychomotor Retardation Scale, and the Andreasen Negative Symptoms Scale were used for evaluating cases. Both the efficacy and safety of drugs were assessed. An analysis of results suggests a better therapeutic response among the Amisulpride group subjects.     

Natural history of adhesional small bowel obstruction: counting the cost

BACKGROUND: The aim of this study was to identify patients admitted with adhesional obstruction to determine if there was an identifiable pattern to the type of initial operation, the type of treatment used for the obstructive episode and the subsequent need for further treatment. METHODS: Patients with adhesional obstruction were identified retrospectively in a cross-sectional study using ICD codes relating to admissions in the years 1990 to 1996. The case notes were used to assess their outcome. RESULTS: Fifty-nine case notes from a total of 175 identified initially satisfied the inclusion criteria. These patients had a mean age at presentation of 51 (range 16-88) years and had undergone a total of 122 operations. Thirty-one patients (53 per cent) had a single previous operation with a median time to presentation with obstruction of 5.5 years (range 11 days to 34.7 years); 33 patients (56 per cent) were treated conservatively on their first admission. There was no statistically significant difference in the outcome in patients who received either conservative or surgical treatment. The length of stay in patients treated surgically (median 11 (range 2-47) days) was significantly longer than that for those treated conservatively (median 6 (range 1-39) days) (P< 0.001). A flow chart was constructed demonstrating the eventual outcome of the patients in the study, enabling the cost of adhesional obstruction to be calculated. CONCLUSION: This type of approach could be used to assess the potential effect of different treatment strategies for adhesional obstruction.     

The treatment history of patients with borderline personality disorder in the Republic of Germany

The present study was undertaken to explore the treatment history of women with borderline personality disorder and to provide an estimation of the treatment costs. Using a semi-structured interview, forty-five carefully diagnosed patients were interrogated about their lifetime treatment history with respect to every inpatient and outpatient treatment received for any psychical symptoms, including physical treatment after self-injurious behaviour. Results demonstrate an extensive and protracted use of psychiatric, psychotherapeutic and physical help, and a chaotic course of treatment with discontinuance of treatments as a characteristic feature. Treatment costs were estimated at a minimum of 24,000 DM per year and patient; 22,000 DM due to hospitalisations. The unsatisfactory treatment situation for these patients in the public health system and the socioeconomic advantages of a specified treatment programme are discussed.     

Introduction to the special section on substance use disorder and posttraumatic stress disorder comorbidity.

A body of 2 complementary, albeit independent, research literatures has emerged that documents a strong relationship between substance use disorders (SUDs) and posttraumatic stress disorder (PTSD) in both community and clinical samples. Research on the concomitants and consequences of PTSD has found that substance abuse is a frequent comorbid problem among individuals diagnosed with PTSD. Researchers from the substance abuse field are now investigating the interrelationship between PTSD and SUDs and finding that PTSD has a notable effect on SUD course and treatment response. Here, a brief summary of the prevalence of SUD-PTSD comorbidity is provided and the 5 articles of the special section are introduced. (PsycINFO Database Record (c) 2010 APA, all rights reserved)