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COMORBIDITY

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PSYCHIATRIC COMORBIDITY

Menezes, P.R., Johnson, S., Thornicroft, G., et al (1996) Drug and Alcohol Problems among individuals with Severe Mental Illness in South London. British Journal of Psychiatry, 168, 612-619.

Conclusions The prevalence of substance use problems among people suffering from severe mental disorders is high, and seems to be associated with greater use of in-patient services. This is a significant clinical problem, with cost implications. Further investigation is needed for adequate service provision.

 

Welch, S.L., Fairburn, C. (1996) Impulsivity or Comorbidity in Bulimia Nervosa A controlled Study of Deliberate Self-Harm and Alcohol and Drug Misuse in a Community Sample. British Journal of Psychiatry, 169, 451-458.

Conclusion Sampling bias is present in clinic-based studies of comorbidity in bulimia nervosa. Those with comorbid substance use and deliberate self-harm are probably heterogeneous in character , and their classification as a subgroup would therefore be premature.

 

Kendler, K.S., Davis, C.G., Kessler, R.C. (1997) The familial aggregation of common psychiatric and substance use disorders in the National Comorbidity Survey: a family history study. British Journal of Psychiatry, 170, 541-548.

Conclusions Familial aggregation of common psychiatric and substance use disorders is substantial in epidemiologic samples. The examined environmental adversities account for little of the observed parent-offspring transmission of these conditions.

 

Hall, W., Farrell, M. (1997) Comorbidity of substance misuse and mental disorders – Editorial. British Journal of Psychiatry, 171, 4-5.

 

Marsden, J., Gossop, M., Stewart, D., et al (2000) Psychiatric symptoms among clients seeking treatment for drug dependence. British Journal of Psychiatry, 176, 285-289.

Conclusions Addictions service providers should be vigilant to psychiatric problems among their clients at intake to treatment. Psychiatric symptoms are linked more closely to polydrug use than to opiate use in this population.

 

Soyka, M (2000) Substance misuse, psychiatric disorder and violent and disturbed behaviour. British Journal of Psychiatry, 176, 345-350.

Conclusion Substance misuse has been shown consistently to be a significant risk factor for violence and disturbed behaviour. Future research should try to evaluate possible pharmacological treatment approaches.

 

SUICIDE

Ohberg, A., Vuori, E., Ojanpera, I., et al (1996) Alcohol and Drugs in Suicides. British Journal of Psychiatry, 169, 75-80.

Conclusions Undertreatment of depression is a challenge for suicide prevention. Those who commit suicide by antidepressants use their own drugs. Relative suicide risk for a drug should be considered when choosing treatment for depressive patients.

 

Vassilas, C.A.., Morgan, H.G. (1997) Suicide in Avon Life stress, alcohol misuse and use of services. British Journal of Psychiatry, 170, 453-455.

Conclusions Various subgroups of suicide behave differently in the way they seek and utilise help. The implications of these findings for suicide prevention and service strategy are discussed.

 

Neelman, J., Farrell, M. (1997) Suicide and substance misuse - Editorial. British Journal of Psychiatry, 171, 303-304.

 

Inskip, H.M., Harris, C.E., Barraclough, B. (1998) Lifetime risk of suicide for affective disorder, alcoholism and schizophrenia. British Journal of Psychiatry, 172, 35-37.

Conclusions The lifetime suicide risk figures often quoted in the literature appear to be too high.  

 

Oyefeso, A., Ghodse, H., Clancy, C., et al (1999) Suicide among drug addicts in the UK. British Journal of Psychiatry, 175, 277-282.

Conclusions The findings confirm that addicts are still at higher risk of suicide than the general population and that prescribed drugs, notably antidepressants and methadone, influence this heightened risk.

 

McCloud, A., Barnaby, B., Omu, N., et al (2004) Relationship between alcohol use disorders and suicidality in a psychiatric population In-patient prevalence study. British Journal of Psychiatry, 184, 439-445.

Conclusions The AUDIT questionnaire should be incorporated into psychiatric assessments when risk of self-harm is being evaluated. Further research is warranted to examine the impact of interventions for alcohol use disorders in psychiatric settings on self-harm and suicidal ideation.

 

PSYCHOSIS

Cantwell, R., Brewin, J., Glazebrook C., et al (1999) Prevalence of substance misuse in first episode psychosis. British Journal of Psychiatry, 174, 150-153.

Conclusions This study confirms high rates of substance misuse at onset of psychosis. There is evidence for an increase in diagnosis of substance-related psychotic disorders over time. Those most at risk of substance misuse are young males.

 

Curran, C., Byrappa, N., McBride, A. (2004) Stimulant psychosis: systematic review. British Journal of Psychiatry, 185, 196-204.

Conclusions Compliance with antipsychotic medication by someone with schizophrenia will not prevent a relapse or worsening of psychotic symptoms if stimulants are used. Low-dose antipsychotic treatment may be beneficial in stimulant users, to prevent sensitisation.

 

RCPsych  Literature Search COMORBIDITY 2005

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Substance Misuse and Mental Health Comorbidity HAS 2001

Mental Health Policy Implementation Guide - Dual Diagnosis Good Practice Guide

Mental Health Policy Implementation Guide Developing Positive Practice to Support the

Safe and Therapeutic Management of Aggression and Violence in Mental Health In-patient Settings

Dual diagnosis in mental health inpatient and day hospital settings

Guidance on the assessment and management of patients in mental health inpatient and day hospital

settings who have mental ill-health and substance use problems

Personality Disorder, no longer a diagnosis of exclusion NIMHE, 2003

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