Addictive and other mental disorders : a call for a standardized definition of dual disorders

The persistent difficulty in conceptualizing the relationship between addictive and other mental disorders stands out among the many challenges faced by the field of Psychiatry. The different philosophies and schools of thought about, and the sheer complexity of these highly prevalent clinical conditions make progress inherently difficult, not to mention the profusion of competing and sometimes contradictory terms that unnecessarily exacerbate the challenge. The lack of a standardized term adds confusion, fuels stigma, and contributes to a "wrong door syndrome" that captures the difficulty of not only diagnosing but also treating addictive and other mental disorders in an integrated manner. The World Association on Dual Disorders (WADD) proposes the adoption of the term "Dual Disorder" which, while still arbitrary, would help harmonize various clinical and research efforts by rallying around a single, more accurate, and less stigmatizing designation

Professionals’ perception on the management of patients with dual disorders

Carlos Roncero,1,2 Néstor Szerman,3 Antonio Terán,4 Carlos Pino,5 José María Vázquez,6 Elena Velasco,7 Marta García-Dorado,7 Miguel Casas1,2 1Addiction and Dual Diagnosis Unit, CIBERSAM, Hospital Vall Hebron, Barcelona Public Health Agency (ASPB), Barcelona, Spain; 2Department of Psychiatry, Autonomous University of Barcelona, Barcelona, Spain; 3Outpatient Mental Health Clinic El Retiro, Gregorio Marañón University Hospital, Madrid, Spain; 4Outpatient Drug Clinic, Hospital San Juan de Dios, Palencia, Spain; 5Pontevedra City Council Drug Dependence Service, Galician Health Service (Xunta de Galicia), Pontevedra, Spain; 6Outpatient Drug Clinic Sants, Barcelona Public Health Agency (ASPB), Barcelona, Spain; 7Medical Affairs Department, Janssen-Cilag S.A., Madrid, Spain Background: There is a need to evaluate the professionals’ perception about the consequences of the lack of therapeutic adherence in the evolution of patients with co-occurring disorders.Methods: An online survey, released on the Socidrogalcohol [Spanish Scientific Society for Research on Alcohol, Alcoholism and other Drug Addic­tions] and Sociedad Española de Patología Dual [the Spanish Society of Dual Pathology] web pages, was answered by 250 professionals who work in different types of Spanish health centers where dual diagnosis patients are assisted.Results: Most professionals perceived the existence of noncompliance among dual diagnosis patients. Almost all of these professionals (99%) perceived that noncompliance leads to a worsening of the progression of the patient’s disorder, in both the exacerbation of mental disorders and the consumption of addictive substances. Most of the professionals (69.2%) considered therapeutic alliance as the main aspect to take into account to improve the prognosis in this population. The primary purpose of treatment must be the improvement of psychotic-phase positive symptoms, followed by the control of behavior disorders, reduction of craving, improvement of social and personal performances, and reduction of psychotic-phase negative symptoms.Conclusion: Most professionals perceived low adherence among dual diagnosis patients. This lack of adherence is associated with a worsening of their disease evolution, which is reflected in exacerbations of the psychopathology and relapse in substance use. Therefore, we propose to identify strategies to improve adherence. Keywords: dual diagnosis, professionals’ perception, noncompliance, decompensation, relaps

Bauteilintegrierte Heiz- und Haustechnik fuer zukuenftige Baukonzepte (Hybride Heizsysteme). Phase 2 Abschlussbericht

The report describes heating systems (hybrid systems) for future building concepts: Thermal and energetic characteristics of hollow components (passive and active ceiling systems); Thermal and energetic characteristics of buildings with optimized hollow components; Development of low-cost air-filled collector systems integrated in the outer walls of a building; Thermal interactions between heating systems and hybrid systems; Economic criteria. (HW)Es wird berichtet ueber Heizsysteme (Hybridsysteme) fuer zukuenftige Baukonzepte: Thermisches und energetisches Verhalten der Hohlbauteile (passives und aktives Deckensystem); thermisches und energetisches Verhalten von Gebaeuden mit optischen Hohlbauteilen; Entwicklung einer preisguenstigen Fassadenluftkollektive; thermisches Zusammenspiel von Heizung und Hybridsystem; Wirtschaftlichkeitskriterien. (HW)Available from TIB Hannover: RO 5074(1994,114)+a+b / FIZ - Fachinformationszzentrum Karlsruhe / TIB - Technische InformationsbibliothekSIGLEBundesministerium fuer Forschung und Technologie (BMFT), Bonn (Germany)DEGerman

Comparison of health-related quality of life among men with different co-existing severe mental disorders in treatment for substance use

Abstract Background Patient-perceived health-related quality of life has become an important outcome in health care as an indicator of treatment effectiveness and recovery for patients with substance use disorder. As no study has assessed health-related quality of life among male patients with substance use disorder and co-existing severe mental illness, we compared health-related quality of life among patients with substance use disorder and the following severe mental illness diagnosis in Barcelona, Spain: schizophrenia, bipolar disorder, major depressive disorder, and examined the associations with clinically related variables. Additionally, we compared results for health-related quality of life in patients with substance use disorder and severe mental illness, with Spanish population norms. Methods We assessed 107 substance use disorder male patients using the 36-Item Short Form Health Survey comparing results across three groups with: comorbid schizophrenia (n = 37), comorbid bipolar disorder (n = 34), and comorbid major depressive disorder (n = 36). Multiple analyses of variance were performed to explore health-related quality of life by the type of co-existing SMI and linear regression analyses examined clinical correlates for the 36-Item Short Form Health Survey dimensions for each group. Results There were differences in Physical Functioning, Vitality and the Physical Composite Scale among groups. Poorer Physical Functioning was observed for patients with comorbid schizophrenia (80.13±3.27) and major depressive disorder (81.97±3.11) compared with comorbid bipolar disorder patients (94.26±1.93). Patients with substance use disorder and schizophrenia presented lower scores in Vitality (41.6±2.80) than those with co-existing bipolar disorder (55.68±3.66) and major depressive disorder (53.63±2.92). Finally, results in the Physical Composite Scale showed lower scores for patients with comorbid schizophrenia (51.06±1.41) and major depressive disorder (51.99±1.87) than for those with bipolar disorder (60.40±2.17). Moreover, all groups had poorer health-related quality of life, especially Social Functioning, Role-Emotional and Mental Health, compared with population norms. Different clinical variables (e.g. medical disease comorbidity, severity of addiction, psychiatric symptomatology, suicide attempts, drug relapses) were related to different health-related quality of life dimensions depending on the co-existing severe mental illness. Conclusions Among male patients with substance use disorder, co-existing severe mental illness may influence some health-related quality of life dimensions and clinically related variables. Such differences may require tailored therapeutic interventions