Exploration of shame and disclosure in chronic drug dependence

This thesis explores levels of shame in 31 chronic poly-drug users, in an out-patient methadone prescription program, compared to 31 non-drug users closely matched on gender, ethnicity, and socio-economic and employment status. In addition to this, this thesis looks at the relationship between shame and disclosure. All participants completed the Experience of Shame Scale (ESS; Andrews et al., 2002) as well as standard measures of depression, aggression and dissociation. Chronic drug users scored significantly higher on levels of characterological and behavioural shame, but not on bodily shame. However, when controlling for levels of depression, only the group difference on characterological shame remained. Within the chronic drug user group, the level of shame about drug use was significantly higher than characterological, behavioural and bodily shame. Thirty-two percent of the chronic drug users were identified as non-disclosers. Non-disclosure was associated with increased levels of depression and shame on all three standard shame sub-scales on the ESS, but not with shame about drug use. This study replicates previous findings, based on shame measures more susceptible to mood-state effects, that drug dependence is associated with increased shame. It extends the existing literature in terms of suggesting possible sources of shame particular to drug dependence and their relationship to non-disclosure. Implications for treatment and future research are discussed

Health and function assessments in two adjacent Danish birth cohorts of centenarians: Impact of design and methodology

International audienceUsing the results from measures of functional ability, cognitive and physical performance from two adjacent birth cohorts of 100-year-old adults, we aimed to elucidate the possible impact of difference in participation rates, design, and interviewer mode. Participants were birth cohort members born in 1910 (DK-1910) and 1911-12 (DK-1911). Both surveys used the same assessment instruments, but the design was different, and data collection was carried out by trained survey agency interviewers in DK-1910 and trained nurses in DK-1911. Participation rate in DK-1911 (49.8 % (251/504)) was lower than in DK-1910 (66.9 % (273/408)) (p < 0.001). The proportion of interviews with the participant answering alone or mainly alone was significantly higher in DK-1911 (77 %) than in DK-1910 (56 %), and the proportion living in nursing home was significantly lower (44 vs. 54 %, respectively). Higher proportions of DK-1911 independently performed all activities of daily living (ADL) compared to DK-1910, but only significantly for toileting, bathing, and feeding (all p < 0.01). Mini-mental state examination (MMSE) score was higher in DK-1911 than in DK-1910 (23.5 vs. 21.0; p < 0.001). Handgrip strength, gait speed, and chair stand were almost similar. DK-1911 participants had significantly better one-year survival than DK-1911 non-participants and DK-1910 participants and non-participants (p = 0.001). These results suggest that lower participation rate entails selection towards healthier participants in terms of ADL and cognitive functioning. Caution is warranted when comparing studies of centenarians with different participation rates, design, and interviewer mode, and further studies of these methodological issues are required

Post-Stroke Mortality, Stroke Severity, and Preadmission Antipsychotic Medicine Use – A Population-Based Cohort Study

<div><p>Background and Purpose</p><p>It has been suggested that antipsychotic medication may be neuroprotective and may reduce post-stroke mortality, but studies are few and ambiguous. We aimed to investigate the post-stroke effects of preadmission antipsychotic use.</p><p>Methods</p><p>We conducted a nationwide, population-based cohort study of 81,143 persons admitted with stroke in Denmark from 2003–2010. Using Danish health care databases, we extracted data on preadmission use of antipsychotics and confounding factors. We examined the association between current, former, and never use of antipsychotics and stroke severity, length of hospital stay, and 30-day post-stroke mortality using logistic regression analysis, survival analysis, and propensity score matching.</p><p>Results</p><p>Current users of antipsychotics had a higher risk of severe or very severe stroke on The Scandinavian Stroke Scale than never users of antipsychotics (adjusted odds ratios, 1.43; 95% CI, 1.29–1.58). Current users were less likely to be discharged from hospital within 30 days of admission than never users (probability of non-discharge, 27.0% vs. 21.9%). Antipsychotics was associated with an increased 30-day post-stroke mortality among current users (adjusted mortality rate ratios, 1.42; 95% CI, 1.29–1.55), but not among former users (adjusted mortality rate ratios, 1.05; 95% CI, 0.98–1.14).</p><p>Conclusions</p><p>Preadmission use of antipsychotics was associated with a higher risk of severe stroke, a longer duration of hospital stay, and a higher post-stroke mortality, even after adjustment for known confounders. Antipsychotics play an important role in the treatment of many psychiatric conditions, but our findings do not support the hypothesis that they reduce stroke severity or post-stroke mortality.</p></div

Association between preadmission antipsychotic medication use and 30-day mortality in acute stroke patients in various adjusted models.

<p>Model 1: adjusted for age group and calendar period. Overall estimates adjusted for gender in all models.</p><p>†Model 2: further adjusted for type of stroke, former stroke, pre-stroke drug use (lipid-lowering drugs, antihypertensive drugs, antidiabetic drugs, platelet inhibitors) and education level.</p><p>‡Model 3: further adjusted for year of admission, severity of stroke, and modified Charlson’s index (cerebrovascular disorders excluded). No interaction between genders in model 3 (<i>p</i> = 0.79).</p