The role of mental disorders in the risk and speed of transition to alcohol use disorders among community youth

Background Among adolescents and young adults with DSM-IV alcohol use disorders (AUDs), there are inter-individual differences in the speed of transition from initial alcohol use (AU) to AUD. AUDs are highly co-morbid with other mental disorders. The factors associated with rapid transition from first AU to AUD remain unknown and the role of mental disorders in rapid transitions is unclear. Given this background we examined (1) whether prior anxiety, mood, externalizing and non-alcohol substance use disorders are related to the risk and speed of transition from first AU to DSM-IV alcohol abuse (AA) and alcohol dependence (AD) and (2) whether early age of onset of prior mental disorders (PMDs) is a promoter of rapid transition. Method A total of 3021 community subjects (97.7% lifetime AU) aged 14-24 years at baseline were followed up prospectively for up to 10 years. AU and mental disorders were assessed with the DSM-IV/M-CIDI. Results Among subjects with lifetime AU, several PMDs, such as specific phobia, bipolar disorder and nicotine dependence, were associated with an increased risk of AUD independent of externalizing disorders. Associations of PMDs with the speed of transition to AUDs were mostly weak and inconsistent. Only social phobia and externalizing disorders were associated with faster transitions to AD even after adjustment for other PMDs. Earlier age of onset of PMD was not associated with rapid transition. Conclusions Mental disorders are associated with the risk of AUD. With the possible exception of social phobia and externalizing disorders, they do not promote rapid transition, even if they occur particularly early. Future research needs to identify factors relevant to rapid transition to AU

First cannabis use: does onset shift to younger ages? Findings from 1988 tot 2003 from the Dutch National School Survey on Substance Use

Aims To investigate the hypothesis that changes in cannabis prevalence among Dutch secondary school students (aged 12-17 years) were paralleled by shifts in the age of Krst cannahis use. Design and participants Data were derived from five waves (1988. 1992. 1996.1999 and 2003) of the Dutch National School Survey on Substance Use. a nationally representative cross-sectional study, with a total of i2 777 respondents. Measurements Written questionnaires on cannabis. tobacco, alcohol, other drug use and soclo-dcmographic and behavioural variables were administered in classroom settings. Findings Survival analysis showed a strong increase in cumulative incidences hy age of lirsl cannabis use Troin 1988 to 1992, a further increase in 1996 and stabilization in 1999. continuing into 2003. From 1992 to 1996. age of onset shifted towards younger ages. Onset peaked at age 15 in 1992 and age 14 in 1996, The proportion of life-time cannabis users starting at age 1 3 or younger increased from 26% in 1992 to 41% in 1996. The overall trend was similar for boys and girls. Conclusions The study largely confirmed the expectation that the increase in cannabis use from 1988 to 1996 was paralleled by a decrease in the age of first cannabis use. From 1996 to 2003 age of first cannabis use and prevalence stabilized, possibly occasioned by a change in cannabis policy in the mid-1990s. KEYWORDS Age of onset, cannabis use. secondary school students. trends

Wie wirksam ist das Fortbildungsprogramm "Patientenseminar Angst"? Ein erster Erfahrungsbericht

Der folgende Beitrag schildert erste Ergebnisse einer Evaluationsstudie des Fortbildungsprogramms «Patientenseminar Angst» für Ärzte. 109 Teilnehmer der Veranstaltung I und 104 Teilnehmer der Veranstaltung II wurden vor und im Anschluβ an die Veranstaltungen sowie 3 Monate später bezüglich ihrer Beurteilung des Fortbildungsprogramms sowie zu ihren Einstellungen, Erfahrungen und Kenntnissen zu Angstpatienten befragt und mit einer Kontrollgruppe verglichen. Es zeigte sich, daβ Angstpatienten in der Allgemeinarztpraxis viel Zeitaufwand beanspruchen und sowohl die diagnostischen als auch die therapeutischen Kenntnisse nicht zufriedenstellend sind. Das Fortbildungsprogramm wurde von den Teilnehmern sehr gut beurteilt. Durch die Teilnahme wurde in Teilgruppen eine Verbesserung vor allem der Kenntnisse im Bereich «Angststörungen erkennen/Diagnostik» erreicht. Das Patientenseminar wurde vom Groβteil der Teilnehmer sowohl in Gruppen als auch bei einzelnen Patienten in der Praxis durchgeführt. Es wird deutlich, daβ trotz des hohen Aufwandes eine groβe Akzeptanz für den Einsatz solcher Patienten-seminare vorhanden ist und daβ insgesamt die bisher untersuchten Variablen für eine überraschend hohe Effektivität der Fortbildungsmaβnahmen sprechen.This artide describes preliminary results of an evaluation study of the patientseminar 'anxiety', an educational programme for physicians. Before and after the two seminar meetings, 109 participants of part land 104 participants of part II filled in a questionnaire about their opinion on the programme as weil as their attitudes, experience, and knowledge about anxiety patients. They were compared with a control group, which did not take part in the programme. It is found that anxiety patients call for a lot of attention at general practitioners' and that the physicians' diagnostic and therapeutic knowledge is not sufficient. The educational programme was highly rated by participants. The patientseminar was conducted, for the greater part of participants, by the physicians both in groups and for single patients. It became evident that in spite of high expenses there is a wide acceptance of such patientseminars and that the variables so far examined up to now indicate surprisingly high efficiency of the educational programme

Natural course of behavioral addictions: A 5-year longitudinal study

BACKGROUND: Resolving the theoretical controversy on the labeling of an increasing number of excessive behaviors as behavioral addictions may also be facilitated by more empirical data on these behavioral problems. For instance, an essential issue to the classification of psychiatric disorders is information on their natural course. However, longitudinal research on the chronic vs. episodic nature of behavioral addictions is scarce. The aim of the present study, therefore, was to provide data on prevalence, substance use comorbidity, and five-year trajectories of six excessive behaviors—namely exercising, sexual behavior, shopping, online chatting, video gaming, and eating. METHODS: Analyses were based on the data of the Quinte Longitudinal Study, where a cohort of 4,121 adults from Ontario, Canada was followed for 5 years (2006 to 2011). The response rate was 21.3%, while retention rate was 93.9%. To assess the occurrence of each problem behavior, a single self-diagnostic question asked people whether their over-involvement in the behavior had caused significant problems for them in the past 12 months. To assess the severity of each problem behavior reported, the Behavioral Addiction Measure was administered. A mixed design ANOVA was used to investigate symptom trajectories over time for each problem behavior and whether these symptom trajectories varied as a function of sex. RESULTS: The large majority of people reported having problematic over-involvement for just one of these behaviors and just in a single time period. A main effect of time was found for each problem behavior, indicating a moderately strong decrease in symptom severity across time. The time x sex interaction was insignificant in each model indicating that the decreasing trend is similar for males and females. The data also showed that help seeking was very low in the case of excessive sexual behavior, shopping, online chatting, and video gaming but substantially more prevalent in the case of excessive eating and exercising. CONCLUSIONS: The present results indicate that self-identified excessive exercising, sexual behavior, shopping, online chatting, video gaming, and/or eating tend to be fairly transient for most people. This aspect of the results is inconsistent with conceptualizations of addictions as progressive in nature, unless treated. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12888-015-0383-3) contains supplementary material, which is available to authorized users

Psychometric Properties of the German Version of the Child Post-Traumatic Cognitions Inventory (CPTCI-GER)

Dysfunctional trauma-related cognitions are associated with posttraumatic stress disorder (PTSD). The psychometric properties of the German version of the Child Post-Traumatic Cognitions Inventory (CPTCI-GER) were assessed in a sample of 223 children and adolescents (7–16 years) with a history of different traumatic events. Confirmatory factor analyses supported the original two-factor structure—permanent and disturbing change (CPTCI-PC) and fragile person in a scary world (CPTCI-SW). The total scale and both subscales showed good internal consistency. Participants with PTSD had significantly more dysfunctional trauma-related cognitions than those without PTSD. Dysfunctional posttraumatic cognitions correlated significantly with posttraumatic stress symptoms (PTSS; r = .62), depression (r = .71), and anxiety (r = .67). The CPTCI-GER has good psychometric properties and may facilitate evaluation of treatments and further research on the function of trauma-related cognitions in children and adolescents. (Partial) correlations provide empirical support for the combined DSM-5 symptom cluster negative alterations in cognitions and mood

The Course of Adjustment Disorder Following Involuntary Job Loss and Its Predictors of Latent Change

Adjustment disorders (AjDs) usually resolve after the precipitating life event and its consequences are terminated. However, they bear the risk for the development of severe mental illness. The present study investigates the natural course of AjD as defined for International Classification of Diseases, 11th version (ICD-11). A total of 303 individuals who involuntarily lost their jobs were assessed initially after the job loss and 6 months later. Latent class latent change analysis and multinomial logistic regression were performed. Two groups showed low (n = 149, 49.2%) and medium (n = 108, 35.6%) symptom severity at initial assessment that declined over time. The third group (n = 46, 15.2%) showed a high initial response and a small effect of worsening of symptoms. Female gender, higher age, first dismissal, impaired social functioning, dysfunctional disclosure, less social support, and less social acknowledgment were associated with belonging to the latter group. It might be beneficial to target individuals at high risk with interventions that aim at the improvement of skills relevant for stress management

Wie häufig sind Substanzmißbrauch und -abhängigkeit?: Ein methodenkritischer Überblick

Die Arbeit gibt einen methodenkritischen Überblick über die in Deutschland vorliegenden Ergebnisse zur Prävalenz sowie Risikofaktoren von Substanzmißbrauch und -abhängigkeit (SMA). Es wird gezeigt, daß die vorliegenden epidemiologischen Studien unvollständig und methodisch unbefriedigend sind. Vor allem die fehlende Erfassung spezifischer diagnostischer Kriterien zur Ableitung klinisch relevanter Mißbrauchs- und Abhängigkeitsstörungen erschwert eine Interpretation der Ergebnisse der vorliegenden Repräsentativerhebungen. Diese geben zwar aussagekräftige populationsbezogene Informationen über die Häufigkeit und Verteilungsmuster von legalen und illegalen Substanzen, klinisch relevante Beurteilungsaspekte wie z.B. zu Schweregrad, Toleranz und Abstinenzproblemen sowie zu Einstieg und Verlauf der "Sucht"-Problematik fehlen jedoch vollständig. Dies trifft auch für Untersuchungen zu Risikofaktoren zu. Als ein durchgängiger Mangel wird ferner die Erfassungsmethodologie angesehen, die sich bislang fast ausschließlich auf Fragebögen oder Interviews stützt, über deren Reliabilität und Validität nur unzureichende psychometrische Daten vorliegen.A critical review of prevalence and risk factor studies of substance abuse and dependence in Germany is presented. It is shown that currently available epidemiological data are incomplete due to the failure of instruments to allow for a detailed assessment of specific substance use disorders. The neglect of diagnostic criteria for clinically significant abuse and dependence disorders makes it especially difficult to draw conclusions about the results of representative surveys. Although the give clear population-related information about frequency and distribution patterns of legal and illegal substancees, relevant clinical data regarding aspects such as severity, tolerance, problems of abstinence, onset and course of abuse and dependence are completely lacking. This is also true of studies on risk factors. An additional problem is diagnostic assessment based almost exclusively on questionnaires and interviews whose reliability and validity have not been sufficiently established