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Article
Publication date: 15 May 2017

Yasmina Frem, Marta Torrens, Antonia Domingo-Salvany and Gail Gilchrist

The purpose of this paper is to examine gender differences in lifetime substance use and non-substance use (non-SUD) psychiatric disorders among illicit drug users and

Abstract

Purpose

The purpose of this paper is to examine gender differences in lifetime substance use and non-substance use (non-SUD) psychiatric disorders among illicit drug users and determine factors associated with non-SUD psychiatric disorders independently for males and for females.

Design/methodology/approach

Secondary analysis of five cross-sectional studies conducted in Barcelona, Spain during 2000-2006. Lifetime DSM-IV substance use and non-SUD psychiatric diagnoses were assessed using the Spanish Psychiatric Research Interview for Substance and Mental disorders (PRISM) among 629 people who use substances (68 per cent male) recruited from treatment (n=304) and out of treatment (n=325) settings. Odds ratios (OR) and 95% confidence intervals (CI) were calculated using binary logistic regression.

Findings

The prevalence of any lifetime psychiatric (non-SUD) disorder was 41.8 per cent, with major depression (17 per cent) and antisocial personality disorder (17 per cent) being the most prevalent disorders. After adjusting for age and study, the odds of having any lifetime non-SUD (OR 2.10; 95%CI 1.48, 2.96); any mood disorder (OR 2.13; 95%CI 1.46, 3.11); any anxiety disorder (OR 1.86; 95%CI 1.19; 2.92); any eating disorder (OR 3.09; 95%CI 1.47, 6.47); or borderline personality disorder (OR 2.30; 95%CI 1.36, 3.84) were greater for females than males. Females were less likely than males to meet criteria for antisocial personality disorder (OR 0.59; 95%CI 0.36, 0.96) and attention deficit disorder (OR 0.37; 95%CI 0.17, 0.78).

Research limitations/implications

Psychiatric disorders are common among people who use substances, with gender differences reported for specific disorders. Gender-sensitive integrated treatment approaches are required to prevent and to address comorbidity psychiatric disorders among this population.

Originality/value

This secondary analysis of five cross-sectional studies included a large sample size allowing sufficient power to examine the differences between men and women. An additional strength of the methodology is the use of the gold standard PRISM which was used to assess disorders.

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Article
Publication date: 18 May 2012

Gail Gilchrist, Alicia Blázquez and Marta Torrens

This paper's aim is to examine the relationship between intimate partner violence, childhood abuse and psychiatric disorders among 118 female drug users in treatment in…

Abstract

Purpose

This paper's aim is to examine the relationship between intimate partner violence, childhood abuse and psychiatric disorders among 118 female drug users in treatment in Barcelona, Spain.

Design/methodology/approach

Secondary analysis of a cross‐sectional study of the psychiatric, behavioural and social risk factors for HIV. DSM‐IV disorders were assessed using the Spanish Psychiatric Research Interview for Substance and Mental Disorders; the Composite Abuse Scale assessed intimate partner violence and the Child Maltreatment History Self‐Report assessed childhood physical and sexual abuse.

Findings

The odds of experiencing intimate partner violence were 2.42 times greater among those with any depressive disorder (95 per cent CI 1.13, 5.20), over three times greater for those who reported ever attempting suicide (OR 3.20; 95 per cent CI 1.29, 7.94), met criteria for borderline personality disorder (OR 3.05; 95 per cent CI 1.31, 7.11), had been abused in childhood (OR 3.38; 95 per cent CI 1.45, 7.85) or currently lived with a substance user (OR 3.74; 95 per cent CI 1.29, 10.84). In multiple logistic regression, only living with a substance user (OR 3.42; 95 per cent CI 1.08, 10.86) and a history of childhood abuse (OR 2.87; 95 per cent CI 1.05, 7.86) remained significant in the model examining intimate partner violence victimisation.

Research limitations/implications

The small sample size, together with the fact that the study was not originally powered to examine differences in intimate partner violence may have increased the possibility of type II errors.

Originality/value

Histories of psychiatric disorders, intimate partner violence and childhood abuse are common in female substance users in treatment. Research suggests that such histories result in poorer treatment outcomes. Histories of intimate partner violence and childhood abuse should be identified and addressed in substance abuse treatment to enhance treatment outcomes.

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Article
Publication date: 12 March 2010

Morten Hesse

Assessment of personality disorders in substance abusing patients may produce important insights. Little is known about the value of routine personality disorder

Abstract

Assessment of personality disorders in substance abusing patients may produce important insights. Little is known about the value of routine personality disorder assessment in a clinical context. Adults with past‐year substance dependence seeking treatment at a centralised intake unit for substance abusers in the City of Copenhagen were randomised to assessment of personality disorders and individual psychoeducation vs. attention placebo (n=75). All patients received psychoeducation for attention deficit hyperactive disorder (ADHD) and anxiety/depression when indicated. Patients were followed at three and six months post‐treatment. The psychoeducation for personality disorder did not result in improved functioning. Significant differences indicated a larger drop in substance use in the experimental group. Assessing personality disorders and providing psychoeducation is a promising treatment in a clinical context. There is a need for relevant treatment options to improve functioning and quality of life for this group of patients.

Details

Drugs and Alcohol Today, vol. 10 no. 1
Type: Research Article
ISSN: 1745-9265

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Article
Publication date: 10 August 2012

Jaime Delgadillo

This study aims to describe and to compare the reliability and accuracy of different methods of measuring psychiatric symptom changes in the context of substance use.

Abstract

Purpose

This study aims to describe and to compare the reliability and accuracy of different methods of measuring psychiatric symptom changes in the context of substance use.

Design/methodology/approach

A group of 60 patients in routine methadone treatment were followed‐up during a “watchful wait” period of four to six weeks. Diagnoses of common mental disorders meeting International Classification of Diseases (ICD‐10) criteria were established using the CIS‐R structured diagnostic interview. Brief questionnaires for depression (PHQ‐9) and anxiety (GAD‐7) were used to measure symptom changes between test and retest. It was hypothesised that the accuracy of symptom changes measured using brief questionnaires may be compromised by methodological artefacts such as poor specificity, regression to the mean and measurement error. These assumptions were tested empirically.

Findings

It was demonstrated that measuring change using conventional cut‐offs in brief symptom questionnaires tends to overestimate the prevalence of common mental disorders and the rates of improvement. Using higher cut‐off scores calibrated in samples of alcohol and drug users, in combination with a reliable change index results in more conservative and reliable estimates of symptom change.

Originality/value

This paper presents a considered discussion on the relative merits and limitations of alternative psychiatric symptom measurement methods. These methodological recommendations may be of interest to research and clinical practice concerned with evaluating changes in comorbid depression and anxiety. Important questions are also raised about the modest degree of symptom changes typically observed during a watchful wait period.

Details

Advances in Dual Diagnosis, vol. 5 no. 3
Type: Research Article
ISSN: 1757-0972

Keywords

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Article
Publication date: 21 February 2011

Mischa Gwaspari, Sanita Hochhauser and Matt Bruce

The main objective of the study is to investigate unmet needs of Black African and Caribbean Heritage (BAH) patients with and without a concurrent diagnosis of antisocial…

Abstract

Purpose

The main objective of the study is to investigate unmet needs of Black African and Caribbean Heritage (BAH) patients with and without a concurrent diagnosis of antisocial personality disorder (ASPD).

Design/methodology/approach

A total of 79 participants were recruited from ten psychiatric inpatient wards across two hospital sites in South London. Personality disorder was assessed using the SCID‐II for DSM‐IV, the prevalence of unmet needs was assessed by The Camberwell Assessment of Need Short Assessment Schedule and substance misuse problems measured using well validated drug and alcohol use disorder identification tools.

Findings

The presence of a concurrent ASPD was independently associated with a greater number of unmet needs. ASPD was associated with lower qualifications and a greater risk of homelessness and substance misuse. Unmet need was associated with lower qualifications and substance misuse. In a stepwise linear regression model alcohol dependence and drug misuse were the most significant predictors of unmet need.

Research limitations/implications

Further research is required to identify the reasons why these needs are not being met and establish reasons for these patients' high‐dropout rates from treatment.

Practical implications

The present findings suggest BAH psychiatric inpatients with ASPD are at greater risk of alcohol dependence and drug misuse and report a greater number of unmet needs thus requiring a greater volume of services; however, current services are not meeting these needs. Mental health teams should ensure thorough needs assessment procedures are incorporated into general psychiatric service practice ensuring effective treatment packages are tailored to these patients needs.

Originality/value

The research identifies a previously under‐researched sub‐group of psychiatric inpatients with a high proportion of unmet health and social needs and suggests further research to develop service improvements supporting their management.

Details

Ethnicity and Inequalities in Health and Social Care, vol. 4 no. 1
Type: Research Article
ISSN: 1757-0980

Keywords

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Book part
Publication date: 4 July 2016

Russell K. Schutt

Reexamination and reinterpretation of the process of deinstitutionalization of public mental hospital inpatients.

Abstract

Purpose

Reexamination and reinterpretation of the process of deinstitutionalization of public mental hospital inpatients.

Methodology/approach

A comprehensive review of related research is presented and lessons learned for the sociology of mental health are identified.

Findings

The processes of both institutionalization and deinstitutionalization were motivated by belief in the influence of the social environment on the course of mental illness, but while in the early 19th century the social environment of the mental hospital was seen as therapeutic, later in the 20th century the now primarily custodial social environment of large state mental hospitals was seen as iatrogenic. Nonetheless, research in both periods indicated the benefit of socially supportive environments in the hospital, while research on programs for deinstitutionalized patients and for homeless persons indicated the value of comparable features in community programs.

Research limitations/implications

While the process of deinstitutionalization is largely concluded, research should focus on identifying features of the social environment that can maximize rehabilitation.

Practical implications

The debate over the merits of hospital-based and community-based mental health services is misplaced; policies should instead focus on the alternatives for providing socially supportive environments. Deinstitutionalization in the absence of socially supportive programs has been associated with increased rates of homelessness and incarceration among those most chronically ill.

Originality/value

A comprehensive analysis of deinstitutionalization that highlights flaws in prior sociological perspectives and charts a new direction for scholarship.

Details

50 Years After Deinstitutionalization: Mental Illness in Contemporary Communities
Type: Book
ISBN: 978-1-78560-403-4

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Article
Publication date: 12 August 2014

Ian Hamilton

It is more than 30 years since attention turned to the issue of the relationship between substance use and mental health. The purpose of this paper is to reflect on the…

Abstract

Purpose

It is more than 30 years since attention turned to the issue of the relationship between substance use and mental health. The purpose of this paper is to reflect on the progress to date that has been made in advancing the knowledge and understanding.

Design/methodology/approach

The author has drawn on the available literature, identifying key contributions from a variety of fields which have helped to shape the understanding of the issues in relation to dual diagnosis. The ten themes are not presented in order of importance.

Findings

Achievements have been made in attracting the attention of clinicians, researchers, policy makers and commissioners to this issue. Overall the author is left with a clearer understanding of what treatments are not effective and the challenges of determining what is.

Originality/value

This paper seeks to instigate a discussion about where the collective knowledge stands on this important and challenging area of practice and research.

Details

Advances in Dual Diagnosis, vol. 7 no. 3
Type: Research Article
ISSN: 1757-0972

Keywords

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Article
Publication date: 13 May 2009

Apu Chakraborty, Kwame McKenzie and Michael King

Background: the increased incidence of psychosis in African‐Caribbeans in the UK compared to the white British population has been frequently reported. The cause for this…

Abstract

Background: the increased incidence of psychosis in African‐Caribbeans in the UK compared to the white British population has been frequently reported. The cause for this is unclear; social factors are said to account for this increase and one factor that is often cited is discrimination.Aims and method: we have looked at two groups of psychotic patients, blacks of Caribbean origin and white British, and present a qualitative comparison of the individual's experience of unfair treatment and its perceived cause.Results: the African‐Caribbean patients did not describe more perceived discrimination than their white counterparts but were more likely to claim that their distress was due to racial discrimination perpetrated by the psychiatric services and society in general. The white patients were more likely to attribute perceived discrimination to their mental illness.Conclusion: this mismatch of explanatory models between black patients and their doctors may account for some inequalities in their treatment, their relative non‐engagement and adverse outcome.Declaration of interest: none.

Details

Ethnicity and Inequalities in Health and Social Care, vol. 2 no. 1
Type: Research Article
ISSN: 1757-0980

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Book part
Publication date: 15 July 2015

Joseph Calvin Gagnon and Brian R. Barber

Alternative education settings (AES; i.e., self-contained alternative schools, therapeutic day treatment and residential schools, and juvenile corrections schools) serve…

Abstract

Alternative education settings (AES; i.e., self-contained alternative schools, therapeutic day treatment and residential schools, and juvenile corrections schools) serve youth with complicated and often serious academic and behavioral needs. The use of evidence-based practices (EBPs) and practices with Best Available Evidence are necessary to increase the likelihood of long-term success for these youth. In this chapter, we define three primary categories of AES and review what we know about the characteristics of youth in these schools. Next, we discuss the current emphasis on identifying and implementing EBPs with regard to both academic interventions (i.e., reading and mathematics) and interventions addressing student behavior. In particular, we consider implementation in AES, where there are often high percentages of youth requiring special education services and who have a significant need for EBPs to succeed academically, behaviorally, and in their transition to adulthood. We focus our discussion on: (a) examining approaches to identifying EBPs; (b) providing a brief review of EBPs and Best Available Evidence in the areas of mathematics, reading, and interventions addressing student behavior for youth in AES; (c) delineating key implementation challenges in AES; and (d) providing recommendations for how to facilitate the use of EBPs in AES.

Details

Transition of Youth and Young Adults
Type: Book
ISBN: 978-1-78441-933-2

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Article
Publication date: 8 February 2016

Ian Cummins and David Edmondson

In his recent report, Lord Adebowale (2013) described mental health issues as “core police business”. The recent retrenchment in mental health and wider public services…

Abstract

Purpose

In his recent report, Lord Adebowale (2013) described mental health issues as “core police business”. The recent retrenchment in mental health and wider public services mean that the demands on the police in this area are likely to increase. Mental health triage is a concept that has been adapted from general and mental health nursing for use in a policing context. The overall aim of triage is to ensure more effective health outcomes and the more effective use of resources. The purpose of this paper is to examine the current policy and practice in this area. It then goes on to explore the models of mental health triage that have been developed to try and improve working between mental health services and the police.

Design/methodology/approach

The paper outlines the main themes in the research literature regarding mental illness and policing, including a brief overview of section 136 MHA. It then examines recently developed models of triage as applied in these settings.

Findings

The models of triage that have been examined here have developed in response to local organisational, demographic and other factors. The approaches have two key features – the improved training for officers and improved liaison with mental health services.

Practical implications

Wider mental health training for officers and improved liaison with community-based services are the key to improving police contacts.

Social implications

The current pressure on mental health services has increased the role that the police have in responding to these sorts of emergencies. This situation is unlikely to change in the short term.

Originality/value

This paper contributes to the wider debate about policing and mental illness. It highlights the fact that section 136 MHA use has tended to dominate debates in this area to the detriment of a broader discussion of the police role.

Details

The Journal of Adult Protection, vol. 18 no. 1
Type: Research Article
ISSN: 1466-8203

Keywords

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