Understanding substance misuse amongst the mentally ill: an investigation of the context of, and motivations for, drug and alcohol use in an in-patient sample of individuals with psychotic illness

Background: Dual diagnosis (substance misuse and mental illness) is recognised as a significant clinical problem. However there is little evidence contributing to the understanding of what motivates people with psychotic illnesses to use drugs and alcohol, and in what social context. There is still less evidence concerning the correlates of dual diagnosis in in-patient settings including the relationship between mental health service settings and the initiation and maintenance of substance misuse. This study reports the prevalence, social context of, and motivations for substance use in a sample of in-patients with psychotic illnesses.;Methods and measures: Staff on 9 acute mental health wards and 2 psychiatric intensive care units in North London used a Clinician Drug and Alcohol Use Rating Scale to assess whether working age in-patients with psychotic illness also met the criteria for harmful alcohol or drug use, or dependence during the preceding six months. Those meeting the criteria for harmful use or dependence were then approached to participate in the study. Participants were interviewed and asked to report on the nature, extent, social context and attributions of their substance use, and whether they had continued to use whilst an in-patient. Measures used included an Inventory of Alcohol and Drug Use Situations, a Self-Medication Questionnaire, a demographic schedule and a structured set of questions concerning substance use history and it's relationship to mental health service settings.;Results: All working age adult in-patients (264) were screened for a current or recent substance use disorder. One hundred and twenty nine individuals met the study criteria (48.9%), whilst a further 39 (15%) had a substance use history, but no associated impairment of these, 102 agreed to take part in the study (response rate 79%). Those with dual diagnosis were younger on average and more likely to be male, than those with psychosis alone. The majority (76%) suffered from schizophrenia and were detained under the Mental Health Act (1983), with 19% being street homeless. A wide range of substances including opiates, stimulant substances and khat were used by participants, but alcohol, cannabis and cocaine (respectively) were the most frequently used substances. Eighty one percent of the participants reported using on the ward during their current admission, with almost half of the participants buying substances from other in-patients. Methods of using reflected the wide range of substance use reported, and included intravenous injection, chasing, and smoking. A third of participants reported feeling pressurised to buy, or use substances with other in-patients. For the majority substance use was clearly a social activity with three quarters of the participants reporting that they typically used or drank with others. Sixteen percent of the participants reported typically using with other mental health service users. Two principal components analyses of use situations and self medication data each revealed three factors, explaining 68% and 66% of the variance respectively. All factors had high mean scores, and elicited motivations for substance use. They were (use related to): negative personal and social states (48% variance), pleasant social conditions (13% variance), reward (7% variance), social interaction and boredom (41%) social acceptance (14% variance), and medication side effects (9% variance). An exploratory cluster analysis aimed at identifying sub-groups with distinctive patterns of motivations for use. Scores within clusters varied, with the membership of one cluster scoring highly on all factor items while other cluster members scored low on several items, clearly influencing their motivations for use. This exploratory analysis gives some indication that there are a number of distinctive patterns of use, including people who use in a wide range of situations with a variety of motivations, those who primarily use for relief of unpleasant feelings and social anxiety, and those whose use is predominantly social.;Conclusions: Substance misuse is a common problem in users of adult mental health services, and innovative solutions to understand and address these problems are needed. Although it was uncommon for individuals to directly medicate the symptoms of their illness with substances, their motivations for use reflected a range of social difficulties, isolation and other affective problems. Further investigation of demographic variables and substance use motivations in a larger sample may be an effective way of delineating sub groups with distinct motivations and of developing treatment strategies which take these motivations into account

um cuidado especializado do enfermeiro obstetra

Observa-se, hoje em dia, que algumas práticas na maternidade tendem a ignorar as preferências das mulheres em trabalho de parto, uniformizando os cuidados com prejuízo para o bem-estar e a qualidade de vida das famílias. As práticas em Obstetrícia têm vindo a tornar-se cada vez mais repletas de intervenção, focando-se apenas nos resultados físicos (mortalidade e morbilidade) e descurando as vivências das parturientes e família, assim como as consequências psicossociais de um parto traumático. O presente Relatório de Estágio pretende refletir os cuidados em maternidade na perspetiva EEESMOG, que se visa holística, centrada no cliente e baseada na evidência. Da mesma forma, espelha as aprendizagens efetuadas em contexto do Estágio com Relatório inserido no 6º CMESMO da ESEL. Foram escolhidos como referenciais teóricos norteadores os modelos de Nola Pender – Modelo de Promoção da Saúde, e a Teoria de Empowerment em Saúde de Nelma Shearer. Foi também realizada uma Revisão Sistemática da Literatura que visou responder à seguinte questão de investigação: “Quais os cuidados do EEESMOG promotores do empowerment das mulheres direcionado para uma tomada de decisão informada relativa ao trabalho de parto?”. Adicionalmente, foi efetuado um registo da interação durante a prestação de cuidados no decorrer do estágio, sobre os quais foi efetuada uma reflexão e confrontação com os resultados da RSL. Concluiu-se que os cuidados que o EEESMOG presta que são promotores de uma tomada de decisão informada para o trabalho de parto se inserem dentro de três grandes temas, nomeadamente Competências da esfera relacional, Competências da esfera da prática clínica e Competências da esfera científica, com especial referência para os cuidados que se relacionam com o Estabelecimento de Relação Terapêutica, a Educação para a Saúde, o Cuidado da Mulher em trabalho de parto, a Promoção do exercício do Consentimento Informado e a Prática baseada na Evidência

Additional file 7: Table S3. of Whole-genome bisulfite sequencing of cell-free DNA identifies signature associated with metastatic breast cancer

Summary of percent methylation values for WGBS and MiSeq for 36 CpGs within GP5, HTR1B, PCDH10, and UNC13A. (TIFF 367 kb

Additional file 2: Table S1. of Whole-genome bisulfite sequencing of cell-free DNA identifies signature associated with metastatic breast cancer

Summary of clinical patient demographics. (TIFF 335 kb

Additional file 8: Table S4A. of Whole-genome bisulfite sequencing of cell-free DNA identifies signature associated with metastatic breast cancer

Ingenuity pathway analysis for 21 gene signature. Table S4B. Detailed view of 17 Genes in cancer as shown in Additional file 8: Table S4A. (TIFF 2363 kb

Patients’ characteristics at inclusion.

<p>Patients’ characteristics at inclusion.</p

Screening strategy for cardiovascular disease before transplantation.

<p>Screening strategy for cardiovascular disease before transplantation.</p

Analysis of factors associated with early cardiovascular events after kidney transplantation in univariate analysis.

<p>Immunosuppressive regimen: <b>LIR = Low immunological risk</b> = Immunosuppressive therapy, included a combination of anti-CD25 (Basiliximab) 20mg at day 0 and 4, steroids 500mg at day 0, 125mg at day 1 then rapidly tapered to 10mg per day, calcineurin inhibitors (cyclosporine or tacrolimus) and antimetabolites; <b>HIR = High immunological risk</b> (immunized patients) = immunosuppressive therapy included induction with thymoglobulin (1.5mg/kg/day for five days), steroids 500mg at day 0, 125mg at day 1 then rapidly tapered to 10mg per day, calcineurin inhibitors (cyclosporine or tacrolimus), antimetabolites, intravenous immunoglobulin (four courses of 2g/kg).</p><p>^aFor an increase of 5 units</p><p>^bFor an increase of 1 unit</p><p>^cFor an increase of 10 units</p><p>Analysis of factors associated with early cardiovascular events after kidney transplantation in univariate analysis.</p

Pre-transplant cardiovascular evaluation and results.

<p>All renal transplant recipients underwent electrocardiography, echocardiography and non-invasive testing.</p><p>Pre-transplant cardiovascular evaluation and results.</p

Characteristics of the study population.

*<p>Two-tailed Mann-Whitney test; † Mean±SEM (range); ND: Not Documented; ^#Fisher's exact test.</p>‡<p>All patients received Steroids, Cyclosporin, Tacrolimus and/or Mycophenolate Mofetil; one patient received both Basiliximab and anti-thymocyte globulins.</p