45 research outputs found
The Longitudinal Impact of Intrinsic Motivation on Substance Use Severity in Schizophrenia and its Patterns in Men and Women
Schizophrenia is a complex and disabling psychiatric disorder that results in significant burden and challenges to those who suffer from it, their families, and to our larger society. One of the most vexing problems facing individuals with schizophrenia today is the co-occurrence of substance use disorders (SUDs). Longitudinal evidence indicates that many individuals with schizophrenia and comorbid SUD exhibit severe patterns of substance use over the course of the disorder, such that few achieve sustained remission or recovery. Intrinsic motivation deficits are promising potential contributors to substance use severity in this population, and consequently might serve as effective treatment targets. There is also evidence to suggest that women show less deficit in intrinsic motivation than men. To date, measurement in this area has been limited, and no study has investigated the longitudinal relations between prospective changes in intrinsic motivation and changes in substance use severity among individuals with schizophrenia and comorbid SUD. This study makes use of baseline, 6-, and 12-month follow-up data from patients with schizophrenia and comorbid SUD (n = 535 at baseline; n = 219 at 6-months; n = 150 at 1-year) selected from the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) study to: (1) extend validation of a promising new measure of intrinsic motivation developed by Nakagami, Xie, Hoe, and Brekke (2008) for schizophrenia to schizophrenia and comorbid SUD; (2) elucidate its longitudinal relations with substance use severity among this population; (3) and examine whether such relations vary across genders. A comprehensive psychometric analysis was used to examine the factor structure, reliability, and retest reliability of the instrument in this population; and hierarchical linear regression and hierarchical linear modeling were among the analytic methods used to examine the cross-sectional and longitudinal relations between intrinsic motivation and substance use severity. Psychometric results supported the reliability and retest reliability of the intrinsic motivation measure when applied to schizophrenia and comorbid SUD, but also revealed a potential shift in the latent factor structure of the instrument. Cross-sectional findings revealed a significant negative prediction of intrinsic motivation by alcohol and drug use severity after adjusting for demographic and clinical confounds, neurocognition and negative symptoms. Longitudinal results with intrinsic motivation strengthened the findings garnered in the cross-sectional analyses. Evidence was found suggesting longitudinal intrinsic motivation change is a salient incremental predictor of reductions in patient’s alcohol/ drug use severity, above and beyond the effects of age, illness chronicity, overall psychopathology, comorbidity status, and phase 1 randomization medication effects. Analyses of relations with gender indicated little to no cross-sectional associations between intrinsic motivation and substance use severity, and gender did not moderate the longitudinal association between intrinsic motivation and substance use severity. These findings suggest that changes in intrinsic motivation may be uniquely associated with changes in substance use severity in schizophrenia and comorbid SUD. Future research will need to replicate these findings, while focusing on intervention efforts that seek to target the intrinsic motivation deficits of schizophrenia and comorbid SUD, to help offset the severe and destabilizing effects exacted by substance use severity in this population
Recommended from our members
Traumatic Brain Injury and Long-Term Risk of Stroke Among US Military Veterans.
BACKGROUND: Traumatic brain injury (TBI) is associated with significant morbidity, but the association of TBI with long-term stroke risk in diverse populations remains less clear. Our objective was to examine the long-term associations of TBI with stroke and to investigate potential differences by age, sex, race and ethnicity, and time since TBI diagnosis. METHODS: Retrospective cohort study of US military veterans aged 18+ years receiving healthcare in the Veterans Health Administration system between October 1, 2002 and September 30, 2019. Veterans with TBI were matched 1:1 to veterans without TBI on age, sex, race and ethnicity, and index date, yielding 306 796 veterans with TBI and 306 796 veterans without TBI included in the study. In primary analyses, Fine-Gray proportional hazards models adjusted for sociodemographics and medical/psychiatric comorbidities were used to estimate the association between TBI and stroke risk, accounting for the competing risk of mortality. RESULTS: Participants were a mean age of 50 years, 9% were female, and 25% were of non-White race and ethnicity. Overall, 4.7% of veterans developed a stroke over a median follow-up of 5.2 years. Veterans with TBI had 1.69 times (95% CI, 1.64-1.73) increased risk of any stroke (ischemic or hemorrhagic) compared to veterans without TBI. This increased risk was highest in the first-year post-TBI diagnosis (hazard ratio [HR], 2.16 [95% CI, 2.03-2.29]) but remained elevated for 10+ years. Similar patterns were observed for secondary outcomes, with associations of TBI with hemorrhagic stroke (HR, 3.92 [95% CI, 3.59-4.29]) being stronger than with ischemic stroke (HR, 1.56 [95% CI, 1.52-1.61]). Veterans with both mild (HR, 1.47 [95% CI, 1.43-1.52]) and moderate/severe/penetrating injury (HR, 2.02 [95% CI, 1.96-2.09]) had increased risk of stroke compared to veterans without TBI. Associations of TBI with stroke were stronger among older compared to younger individuals (P interaction-by-age<0.001) and were weaker among Black veterans compared to other race and ethnicities (P interaction-by-race<0.001). CONCLUSIONS: Veterans with prior TBI are at increased long-term risk for stroke, suggesting they may be an important population to target for primary stroke prevention measures
Atrial Fibrillation is Associated With Greater Risk of Dementia in Older Veterans
ObjectivesTo examine the association of atrial fibrillation (AF) with incident dementia in older veterans and the effect of anticoagulation on that association.MethodsAround 407,871 veterans aged ≥55 years receiving care from US Veterans Health Administration between August 2003 and September 2015 were included in our retrospective study. AF and incident dementia were determined according to ICD-9-CM codes. Logistic regressions with veterans grouped into high-dimensional propensity scores deciles were used, and a mediation analysis was employed to examine the extent of cardio/cerebrovascular diseases that may also account for that association.ResultsAF was associated with greater dementia risk (odds ratio = 1.14; 95% confidence interval 1.07-1.22), partially mediated by cardio/cerebrovascular disease. Among veterans with AF taking anticoagulants, the risk of dementia was 44% higher (odds ratio =1.44; 95% CI 1.27-1.63) compared to those without anticoagulants, likely related to AF severity.ConclusionOur findings underscore the importance of considering cognitive function in the management of AF patients