Comorbid mental disorders in substance users from a single catchment area - a clinical study

<p>Abstract</p> <p>Background</p> <p>The optimal treatment of patients with substance use disorders (SUDs) requires an awareness of their comorbid mental disorders and vice versa. The prevalence of comorbidity in first-time-admitted SUD patients has been insufficiently studied. Diagnosing comorbidity in substance users is complicated by symptom overlap, symptom fluctuations, and the limitations of the assessment methods. The aim of this study was to diagnose all mental disorders in substance users living in a single catchment area, without any history of treatment for addiction or psychiatric disorders, admitted consecutively to the specialist health services. The prevalence of substance-induced versus substance-independent disorders according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV), in SUD patients will be described.</p> <p>Methods</p> <p>First-time consecutively admitted patients from a single catchment area, aged 16 years or older, admitted to addiction clinics or departments of psychiatry as outpatients or inpatients will be screened for substance-related problems using the Alcohol Use Disorder Identification Test and the Drug Use Disorder Identification Test. All patients with scores above the cutoff value will be asked to participate in the study. The patients included will be diagnosed for SUD and other axis I disorders by a psychiatrist using the Psychiatric Research Interview for Substance and Mental Disorders. This interview was designed for the diagnosis of primary and substance-induced disorders in substance users. Personality disorders will be assessed according to the Structured Clinical Interview for DSM-IV axis II disorders. The Symptom Checklist-90-Revised, the Inventory of Depressive Symptoms, the Montgomery Asberg Depression Rating Scale, the Young Mania Rating Scale, and the Angst Hypomania Check List will be used for additional diagnostic assessments. The sociodemographic data will be recorded with the Stanley Foundation's Network Entry Questionnaire. Biochemical assessments will reveal somatic diseases that may contribute to the patient's symptoms.</p> <p>Discussion</p> <p>This study is unique because the material represents a complete sample of first-time-admitted treatment seekers with SUD from a single catchment area. Earlier studies have not focused on first-time-admitted patients, so chronically ill patients, may have been overrepresented in those samples. This study will contribute new knowledge about mental disorders in first-time-admitted SUD patients.</p

Contrasting Monosymptomatic Patients with Hallucinations and Delusions in First-Episode Psychosis Patients: A Five-Year Longitudinal Follow-Up Study

Objectives: This thesis explores different symptom profiles found in First Episode Psychosis (FEP) patients assessed at several points of time over a ten year period. Earlier studies have focused predominantly on groups of symptoms rather than individual symptoms when describing course of illness and outcome, and long-term studies of symptom development in epidemiological FEP samples assessed multiples times are lacking. By studying individual symptoms longitudinally from the onset of illness we aimed to gain more knowledge about symptom development and the relationship between symptoms and outcome variables that are known to be affected in psychotic disorders. The aim of the study was threefold: 1) to identify a group of patients with delusions only and a group with hallucinations only, and examine if the groups differed with regard to demographics, clinical variables and outcome measures, and in particular suicidality, 2) to assess the prevalence of apathy ten years after the first psychotic episode, and to explore the association between apathy and general functioning, and between apathy and quality of life, and 3) to identify different flat affect (FA) symptom profiles based on longitudinal symptom trajectories and assess the prevalence and correlates of these trajectories, to assess predictors of enduring FA, and to explore the longitudinal relationship between FA and social functioning. Methods: Three-hundred-and-one first episode, non organic psychosis patients were included in the TIPS Study (Early Treatment and Intervention in Psychosis) and followed over a ten year period. Patients were assessed at baseline, three months, and one, two, five and ten year follow-up with an extensive battery of instruments including measures of demographics, duration of untreated psychosis (DUP), premorbid function (PAS), diagnosis (SCID), symptom measures (PANSS, AES, CDSS), measures of functioning (GAF, SCLFS), suicidality and quality of life (L-QoLI). The relationship of the symptoms of interest, namely hallucinations and delusions (PANSS P1 and P3, respectively), apathy (AES-SApathy and PANSS N2+N4) and flat affect (PANSS N1), to the above measures were assessed with t-test, correlation and regression analyses. Results: Sub-groups of patients with hallucinations only and delusions only can be identified in a five year follow-up study, and the groups differed on multiple variables. Most importantly, the hallucination only group scored higher on measures of suicidality, and insight might be a possible mediator of suicidality in this group. Apathy was found to be a common symptom ten years after the first psychotic episode, affecting 30 % of the sample. Proxy-measures of apathy indicated that this symptom declined in the follow-up period. Clinical apathy was strongly related to poorer functioning and to poorer subjective quality of life in patients ten years after the first psychotic episode. Five different FA trajectory groups were identified. FA was more fluctuant than expected, and only 5 % of the sample experienced enduring FA. Furthermore, FA was related to poorer functional outcome measures, in particular to objective social functioning, both premorbidly and throughout the ten year follow-up period. Conclusions: By looking at individual symptoms rather than groups of symptoms it was possible to shed light on patients with symptom profiles that previously have received limited attention, and to learn more about the long-term development of the individual symptoms. Combined, the findings highlight the importance of looking at symptoms separately in order to both better understand the longitudinal association between symptoms, and to gain knowledge of how individual symptom profiles affect outcome measures including suicidality, quality of life, and social functioning