Prevalence of psychoactive substance use among psychiatric in-patients in Harare, Zimbabwe

OBJECTIVE: To determine the prevalence of psychoactive substance use among psychiatric in-patients in Harare. DESIGN: A cross sectional study that was conducted in 1994. SETTING: Harare Central Hospital Psychiatric Unit. SUBJECTS: A total of 194 consecutively admitted patients to Harare Central Hospital Psychiatric Unit, aged from 16 to 55 years with a mean (SD) age of 33.5 (11.4) years. MAIN OUTCOME MEASURES: The psychiatric diagnoses were made according to the ICD10 diagnostic criteria, while the substance abuse was evaluated by the modified WHO AUDIT core questionnaire, which was translated into the Shona language. RESULTS: The point prevalence rate of psychoactive substance abuse among the psychiatric in-patients were alcohol 28.4% (95% CI = 22.1, 34.7), tobacco 27.6% (95% CI = 18.7, 36.5) and cannabis 14.3% (95% CI = 7.4, 21.2). CONCLUSION: The data have provided scientific evidence on the moderate prevalence and pattern of substance abuse among psychiatric patients in Zimbabwe.     

The reliability of psychiatric diagnosis: a new look.

"Each of 426 state hospital patients was diagnosed independently by pairs of psychiatrists using official psychiatric nomenclature. Reliability of the schizophrenic diagnosis was indicated by values of γ between .73 and .95, depending on the range of discrimination required. Classification of the diagnosis into 3 major categories—organic, psychotic, and characterological—showed that about four-fifths of such classifications of one psychiatrist were confirmed by another. Agreement with respect to diagnoses of the specific subtype occurred in about only half the cases and was almost absent in cases involving personality pattern-and-trait disorders and the psychoneuroses." (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The Timeline Followback reports of psychoactive substance use by drug-abusing patients: Psychometric properties.

The Timeline Followback (TLFB; L. C. Sobell and M. B. Sobell, 1996) interview, which uses a calendar method developed to evaluate daily patterns and frequency of drinking behavior over a specified time period, has well-established reliability and validity for assessing alcohol consumption. Although several investigators have used the TLFB to evaluate drug-using behavior, few studies have examined the psychometric properties of the interview for this purpose. The authors conducted TLFB interviews with a sample of adult drug-abusing patients seeking treatment for substance abuse (n?=?113) at baseline, posttreatment, and quarterly thereafter for 12 months. It was found that the patients' reports about their drug consumption using this method generally had high (a) retest reliability, (b) convergent and discriminant validity with other measures, (c) agreement with collateral informants' reports of patients' substance use, and (d) agreement with results from patients' urine assays. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Clinical implications of the co-occurrence of substance use and other psychiatric disorders.

The co-occurrence of substance use and psychiatric disorders is the rule rather than the exception in mental health and substance use treatment settings across the United States. Such co-occurrence may call for special assessment and evaluation procedures, modified treatment plans, and specialized follow-up. Treatment of co-occurrence of substance abuse and psychiatric disorders requires more cross-disciplinary collaboration; greater integration of substance use, mental health, and social services treatment approaches; and modifications in the training of care providers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The ability of individuals with psychoactive substance use disorders to escape detection by the Personality Assessment Inventory.

The ability of individuals with psychoactive substance use disorders to dissimulate successfully on the Personality Assessment Inventory (PAI; L. C. Morey, 1991) was evaluated. Patients receiving treatment for drug abuse who were instructed to respond honestly (n?=?59) had significantly higher scores on the PAI scales measuring problems with alcohol and other drug use than (a) patients instructed to respond defensively (n?=?59), (b) respondents suspected of abusing psychoactive substances who were referred for an evaluation by the criminal justice system and who had reasons to conceal their drug use (n?=?59), and (c) respondents from a nonclinical control group (n?=?9). However, a PAI validity scale designed to measure positive dissimulation was prone to making false positive and false negative errors, depending on the cutoff employed. (PsycINFO Database Record (c) 2011 APA, all rights reserved)     

Gender differences in psychiatric comorbidity among adolescents with substance use disorders.

The authors examined gender differences in rates of comorbid psychiatric disorders among adolescents with 1 or more psychoactive substance use disorders. Baseline diagnostic data were obtained from 135 adolescents, ages 12 to 19, and their parents-guardians, who participated in a study to develop and efficacy test Integrated Family and Cognitive-Behavioral Therapy. Rates of attention-deficit/hyperactivity disorder and conduct disorder were higher among drug-abusing male adolescents compared with drug-abusing female adolescents. However, high rates of disruptive behavior disorders also characterized drug-abusing female adolescents. Similarly, drug-abusing female adolescents exhibited a higher rate of major depression compared with drug-abusing male adolescents. However, rates of dysthymia, double depression (i.e., major depression and dysthymia), and bipolar disorder were equivalent between genders. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Community studies on adolescent substance use, abuse, or dependence and psychiatric comorbidity.

A literature review on community studies of adolescent substance use, abuse, or dependence (SU/A/D) and psychiatric comorbidity yielded 22 articles from 15 studies with information on rates, specificity, timing, and differential patterns of comorbidity by gender, race/ethnicity, and other factors. Results revealed that 60% of youths with SU/A/D had a comorbid diagnosis, and conduct disorder (CD) and oppositional defiant disorder (not attention-deficit/hyperactivity disorder) were most commonly associated with SU/A/D, followed by depression. Child psychopathology (particularly CD) was associated with early onset of substance use and abuse in later adolescence. The authors suggest that available data relevant to SU/A/D and psychiatric comorbidity can be used to better address such questions. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Students' evaluations of their psychoactive drug use.

Obtained evaluations with the same questionnaire item in 1968, 1969, 1970, and 1972 at Carnegie-Mellon University. The evaluations of marihuana and LSD experiences reported in 1968 were very similar to those at California Institute of Technology in 1967. Evaluations varied by drug but were predominantly "beneficial and helpful" (marihuana, hallucinogens, tranquilizers and barbiturates) or had "no particular effect" (amphetamines, beer, liquor, tobacco, and narcotics). In the class of 1972, evaluations were positively related to number of usage experiences and remained steady over time for all drugs except hallucinogens; these were seen less positively in later surveys. More negative experiences resulted from hallucinogen use than from any other drug. Statements about drug effects are evaluated against personal and peer experience and expectations; thus counselors and educators need to know that most experiences are seen as beneficial or neutral. (23 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Applying behavioral theories of choice to substance use in a sample of psychiatric outpatients.

The current study tests the utility of the contextual view of reinforcement in predicting substance use among a sample of 34 psychiatric outpatients enrolled at a public psychiatric facility. Participants reported substance use, as well as the frequency and enjoyability of a variety of potential reinforcers, for the previous 30 days. A series of regression analyses revealed that a ratio of reinforcement from substance use relative to total reinforcement was more predictive of substance use days than was reinforcement for substance use taken alone. The results demonstrate importance of viewing behaviors within their broader environmental context and support predictions derived from the behavioral choice perspective. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Associations between ADHD and psychoactive substance use disorders. Findings from a longitudinal study of high-risk siblings of ADHD children

This article investigates the relationship between attention-deficit/hyperactivity disorder (ADHD) and psychoactive substance use disorders (PSUD) in siblings of ADHD and normal-control probands and addresses issues of psychiatric comorbidity and gender. Using DSM-III-R structured diagnostic interviews and blind raters, the authors conducted a 4-year follow-up of siblings. ADHD and male gender predicted higher rates and an earlier onset of PSUD after adjusting for high-risk status, other psychiatric disorders, and age. Risk was particularly high if the siblings had ADHD plus conduct disorder. This study's findings confirms the authors' prior report high-lighting the importance of drug and alcohol prevention and cessation programs aimed at ADHD youth and their siblings, particularly those with comorbid conduct disorder.     

Physical and mental comorbidity of substance use disorders in psychiatric consultations. European Consultation-Liaison Workgroup

Comorbidity of substance use disorders with physical and mental disorders was investigated among 1249 consecutive psychiatric consultation patients admitted to six general hospitals in Finland. Of the patients 354 (28%) were diagnosed with substance use disorders (ICD-10), of which 22% were due to use of at least two different types of psychoactive substances. Alcohol dependence (117/226) in male patients and acute drug intoxication (49/128) at a similar rate as alcohol dependence (44/128) in female patients were the most common clinical conditions. With few exceptions, all substance use disorders were comorbid and in 63% of affected patients comprised a "triple diagnosis" (i.e., physical, mental, and substance use diagnoses concurrently). Poisonings and personality disorders in both sexes, digestive system diseases in men, and injuries in women were related to substance use disorders. Conclusions for service provision were: (1) the high level of co-occurrence of physical and mental disorders with substance use disorders calls for comprehensive, multi-disciplinary assessment of any substance use problems ascertained in psychiatric consultations; (2) poisoning with substance use involvement and mental comorbidity was the most common combined clinical condition justifying provision of addiction psychiatric emergency consultations in general hospitals; (3) polydrug use indicating severe problems and complex treatment needs should be identified; and (4) psychiatric referrals of patients with physical alcohol-related disorders should be ensured in general hospitals.     

Intelligence and substance use.

Why do some individuals choose to drink alcohol, smoke cigarettes, and use illegal drugs while others do not? The origin of individual preferences and values is one of the remaining theoretical questions in social and behavioral sciences. The Savanna-IQ Interaction Hypothesis suggests that more intelligent individuals may be more likely to acquire and espouse evolutionarily novel values than less intelligent individuals. Consumption of alcohol, tobacco, and drugs is evolutionarily novel, so the Savanna-IQ Interaction Hypothesis would predict that more intelligent individuals are more likely to consume these substances. Analyses of two large, nationally representative, and prospectively longitudinal data from the United Kingdom and the United States partly support the prediction. More intelligent children, both in the United Kingdom and the United States, are more likely to grow up to consume more alcohol. More intelligent American children are more likely to grow up to consume more tobacco, while more intelligent British children are more likely to grow up to consume more illegal drugs. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Some current studies of psychoactive and hallucinogenic drug use.

Describes a study of a hippie subculture showing extensive, indiscriminant nonnarcotic drug use among hippies, and indifference to harmful drug effects. Among high-school students studied, alcohol and tobacco are still the most popular drugs, but marihuana, LSD, and psychoactive drugs are used by substantial numbers. Drug use relates to sex, grade level, and parental use of alcohol and tobacco. Social contact with other users, imitation of parental drug-use patterns, and the psychological disturbances of users are partial explanations for drug use among young people. Progress in research is inhibited by tendencies to (a)define all nonalcoholic drug use as abuse, (b) classify drugs as good or bad, and (c) study users without reference to their total drug use. (French summary) (19 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Parents and families as contexts for the development of substance use and substance use disorders.

Parenting and familial influences on substance use and substance use disorders (SUDs) are important areas of study both for theories of etiology and for the development of preventive and treatment interventions. The articles in this special section illustrate both the value and the challenges of studying parenting and familial influences. Noteworthy issues include the need for mediational and moderational models examining the processes by which familial influences operate in a longitudinal framework to consider outcomes in a developmental context. Future directions include a multidisciplinary expansion of these studies. (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

Impact of assertive community treatment on homeless persons with co-occurring severe psychiatric and substance use disorders

To investigate the possibility of engrafting fetal liver hematopoietic cells by in utero intraperitoneal transplantation, we transplanted donor cells obtained from mouse fetuses at 13, 15 and 17 days of gestation to mouse fetuses at 15, 16 and 17 days of gestation. Engraftment was assessed by Sry gene amplification of DNA extracted from peripheral blood samples of transplanted mice six weeks after birth. In comparison, we performed an in vitro colony-assay of fetal liver cells at 13, 15, and 17 days of gestation. The incidence of engraftment was significantly higher in cells of 15 days of gestation than in cells of 13 or 17 days of gestation, whereas the colony forming activity decreased gradually from 13 to 15 days of gestation. From these results, we suggest that the 15 day liver contains hematopoietic progenitors which have the specific characteristics required for engraftment by intraperitoneal transplantation.     

Social competence and psychiatric diagnosis.

It was hypothesized that symptoms reflect a patient's social competence or maturity level and that this level is related to the diagnosis he receives. Symptom scales based on empirical relations between symptoms and competence levels were constructed for 3 spheres of functioning: thought, affect, and action. Results obtained with 504 psychiatric patients showed that: (1) placement on each symptom scale was significantly related to diagnosis, and (2) patients who could be rated on all 3 scales showed consistent placement across scales. The latter finding was interpreted as indicating that the maturity dimension is a pervasive one, thus lending further support to the view that maturity plays an important role in the process of diagnosis. (17 ref.) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The contextual nature of psychiatric diagnosis.

Replies to criticisms of the author's 1973 report on the diagnosis of pseudo psychiatric patients by R. L. Spitzer, B. Weiner, and T. Millon (see PA, Vol 54:Issue 6). It is argued that psychiatric diagnoses are powerfully influenced by the contexts in which patients are found and the expectations of diagnosticians and that many of the comments by Millon, Spitzer, and Weiner underscore these facts. Their observations are examined for the implications they hold for the meanings of sanity and insanity, the "wastebasket" nature of the schizophrenia diagnosis, as well as for the role of professionally sanctioned justification of diagnostic error. Substantive criticisms of design and interpretation are answered. Finally, guidelines for producing and evaluating any new diagnostic systems are offered. (24 ref) (PsycINFO Database Record (c) 2010 APA, all rights reserved)     

The influence of peers on young adult substance use.

Data collected from 294 young adults, ages 19 to 25, and both a same- and an opposite-gender best friend or mate across 3 annual assessments were analyzed to examine the similarity to and influence of the peer on the young adult's substance use. The authors found similarity across time between both peers and the young adult in cigarette use, alcohol use, binge drinking, and, in most cases, marijuana use. In prospective analyses, peer use predicted young adult cigarette use, binge drinking, and problem use by the young adults. Results were generally consistent across gender and for both same- and opposite-gender peers. Findings emphasize peer influence contribution to young adult substance use and suggest the design of interventions that involve both young adults and their peers. (PsycINFO Database Record (c) 2010 APA, all rights reserved)