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substance related disorder [keywords]
- What factors are related to success on conditional release/discharge? Findings from the new orleans forensic aftercare clinic: 2002-2013. [Journal Article]
- Behav Sci Law 2014 Sep; 32(5):641-58.
The present study investigated the empirically based factors that predicted success on conditional release among a sample of individuals conditionally discharged in Louisiana. Not guilty by reason of insanity acquittees and individuals on conditional release/discharge for incompetency to stand trial were included in the study. Success on conditional release was defined as maintenance of conditional release during the study period. Recidivism (arrest on new charges) and incidents were empirically evaluated. Success on conditional release was maintained in over 70% of individuals. Recidivism was low, with only five arrests on new charges. Success on conditional release was predicted by financial resources, not having a personality disorder, and having fewer total incidents in the program. After controlling for the influence of other variables, having an incident on conditional release was predicted by a substance use diagnosis and being released from jail. Individuals conditionally released from jail showed fewer number of days to first incident (67 vs. 575 days) compared with individuals discharged from the hospital. These data provide support for the successful management of forensic patients in the community via conditional release, although they highlight specific factors that should be considered when developing community-based release programming. Conditional release programs should consider empirical factors in the development of risk assessment and risk management approaches to improve successful maintenance of community-based forensic treatment alternatives. Copyright © 2014 John Wiley & Sons, Ltd.
- It's time to change the default for tobacco treatment. [JOURNAL ARTICLE]
- Addiction 2014 Oct 16.
The World Health Organization estimates that 1 billion people will die from tobacco-related illnesses this century. Most health-care providers, however, fail to treat tobacco dependence. This may be due in part to the treatment 'default'. Guidelines in many countries recommend that health-care providers: (i) ask patients if they are 'ready' to quit using tobacco; and (ii) provide treatment only to those who state they are ready to quit. For other health conditions-diabetes, hypertension, asthma and even substance abuse-treatment guidelines direct health-care providers to identify the health condition and initiate evidence-based treatment. As with any medical care, patients are free to decline-they can 'opt out' from care. If patients do nothing, they will receive care. For tobacco users, however, the treatment default is often that they have to 'opt in' to treatment. This drastically limits the reach of tobacco treatment because, at any given encounter, a minority of tobacco users will say they are ready to quit. As a result, few are offered treatment. It is time to change the treatment default for tobacco dependence. All tobacco users should be offered evidence-based care, without being screened for readiness as a precondition for receiving treatment. Opt-out care for tobacco dependence is warranted because changing defaults has been shown to change choices and outcomes for numerous health behaviors, and most tobacco users want to quit; there is little to no evidence supporting the utility of assessing readiness to quit, and an opt-out default is more ethical.
- Personality disorders and physical comorbidities in adults from the United States: data from the National Epidemiologic Survey on Alcohol and Related Conditions. [JOURNAL ARTICLE]
- Soc Psychiatry Psychiatr Epidemiol 2014 Oct 15.
There is a paucity of research examining the relationship between personality disorders (PDs) and chronic physical comorbidities. Consequently, we investigated associations between individual PDs and PD Clusters, and various common disease groups [cardiovascular disease (CVD), diabetes, arthritis and gastrointestinal disease (GI)] in a nationally representative survey of adults from the United States.This study utilized pooled data (n = 34,653; ≥20 years) from Waves 1 and 2 of the National Epidemiologic Survey on Alcohol and Related Conditions. PDs were assessed using the Alcohol Use Disorder and Associated Disabilities Interview Schedule- Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. Physical conditions were based on self-reports of being diagnosed by a health professional. Unadjusted and adjusted logistic regressions examined the relationship between PDs and physical conditions.After adjustment (sociodemographic factors, past-year mood, anxiety and substance use disorders), Clusters A, B and C PDs were each associated with physical conditions (all p ≤ 0.01). Of the individual PDs, schizoid, schizotypal, narcissistic, borderline and obsessive-compulsive PDs were associated with CVD (all p ≤ 0.01) among younger adults. Paranoid, antisocial, borderline and avoidant PDs and younger adults with schizoid, schizotypal and obsessive-compulsive PDs were each associated with arthritis (all p ≤ 0.01). Significant associations were seen between paranoid, schizoid and schizotypal PDs and diabetes (all p ≤ 0.01). Finally, schizotypal, antisocial, borderline and narcissistic PDs were associated with GI conditions (all p ≤ 0.01).PDs were consistently associated with physical conditions. Investigation of PDs and their relationship with physical health outcomes warrant further research attention as these findings have important clinical implications.
- Beyond the diagnostic traits: A collaborative exploratory diagnostic process for dimensions and underpinnings of narcissistic personality disorder. [Journal Article]
- Personal Disord 2014 Oct; 5(4):434-8.
Narcissistic personality disorder has been challenging to diagnose in psychiatric and general clinical practice. Several circumstances and personality factors related to the nature of pathological narcissism and NPD contribute. NPD is usually a moderately impairing condition, often accompanied by specific capabilities and high level of functioning. Comorbidity of other urgent and recognizable psychiatric conditions, such as mood and substance use disorders or suicidality, can override even significant narcissistic personality functioning. Patients' limited ability to recognize own contribution to problems or impact on other people, their hypersensitivity and defensive reactivity, and compromised ability for self-disclosure, self-reflection, and emotional empathy can make initial evaluations difficult. The aim of this study is to integrate recent clinical and empirical knowledge on the underpinnings of pathological narcissism and narcissistic personality functioning, and distinguish narcissistic self-regulatory patterns that are affecting diagnostic traits. A more flexible, exploratory, and collaborative diagnostic process is proposed that integrates the patients subjective experiences and interpersonal functioning in terms of self-regulation, agency, and traits in a way that is informative and meaningful for both the patient and the clinician. (PsycINFO Database Record (c) 2014 APA, all rights reserved).
- Tobacco Smoking Among Male and Female Alcohol Treatment-seekers: Clinical Complexities, Treatment Length of Stay, and Goal Achievement. [JOURNAL ARTICLE]
- Subst Use Misuse 2014 Oct 14.
Background: Literature suggests that tobacco smoking among clients in alcohol treatment has important clinical implications, including poorer treatment outcome. Much of this literature, however, has been derived from research-based treatment samples that utilized stringent inclusion and exclusion criteria, limiting generalizability of findings. Objective: In order to further our understanding of the correlates of smoking among clients with alcohol problems, the present research examines tobacco smoking status at admission for 21,128 adult treatment seekers from 253 community outpatient substance abuse clinics across New York State. Methods: This sample includes tobacco smokers at admission (62%) and women (25%). Clinical complexities at admission (unemployment, lack of high school diploma/GED, criminal justice involvement, mental illness, polysubstance abuse) and length of treatment stay and alcohol-related goal achievement at discharge were assessed by clinic staff. Results: Mixed models revealed that tobacco smoking was significantly associated with all five clinical complexities; interactions with gender indicated that this association was stronger for women with regard to criminal justice involvement and polysubstance abuse. Also, these smokers evidenced shorter substance disorder treatment duration and were less likely to achieve alcohol-related treatment goals relative to their nonsmoking counterparts. Conclusions: Admission tobacco smoking status of alcohol treatment seekers is an important client characteristic with regard to clinical presentation and treatment outcome. Our findings underscore the need to further our understanding of the complexities associated with smoking and especially as it pertains to female smokers.
- Addressing the Health, Developmental and Social Outcomes of Children Exposed to Perinatal and Infectious Risks. [JOURNAL ARTICLE]
- Infect Disord Drug Targets 2014 Oct 14.
Objective: There is strong evidence of a link between parental substance use and/or mental health problems and adverse outcomes in children. We wanted to know the impact of these early childhood adversities on the health and social outcomes of children. We also wanted to determine whether early identification of these risks made a difference to the child's outcome and what effective strategies and interventions are available that will ensure the safety of children, provide support for them and improve their long-term outcomes. Method: This was a retrospective analysis of children attending a specialized Pediatric ("Branches") clinic in South West Sydney; set up for children exposed to perinatal risks including parental substance use and/or mental health problems. Total of 124 children attended the Branches clinic from January 2006 to December 2009. Data recorded included health, developmental and social outcomes. Result: Mean age of first presentation to the clinic was 3.95 years, majority (63%) were in foster care. Parental substance abuse was identified in 73% of the cases while parental mental health disorder was documented in 48% cases. A range of infection and other health related problems were identified, including the risk of hepatitis C transmission. Almost one third of children had incomplete immunization (29%) and over 90% of children needed referrals to services. We did not find any difference in outcomes or age of first presentation to the clinic between children identified in the perinatal period, compared to those not identified early. Conclusion: Our study found significant health problems in children exposed to perinatal risks. Early or perinatal identification of these risks did not affect outcomes in our setting. Better coordination between maternity, pediatrics, hospital and community services may improve child outcomes through earlier identification of health concerns.
- Agitation in cognitive disorders: International Psychogeriatric Association provisional consensus clinical and research definition. [JOURNAL ARTICLE]
- Int Psychogeriatr 2014 Oct 14.:1-11.
ABSTRACT Background: Agitation is common across neuropsychiatric disorders and contributes to disability, institutionalization, and diminished quality of life for patients and their caregivers. There is no consensus definition of agitation and no widespread agreement on what elements should be included in the syndrome. The International Psychogeriatric Association formed an Agitation Definition Work Group (ADWG) to develop a provisional consensus definition of agitation in patients with cognitive disorders that can be applied in epidemiologic, non-interventional clinical, pharmacologic, non-pharmacologic interventional, and neurobiological studies. A consensus definition will facilitate communication and cross-study comparison and may have regulatory applications in drug development programs. Methods: The ADWG developed a transparent process using a combination of electronic, face-to-face, and survey-based strategies to develop a consensus based on agreement of a majority of participants. Nine-hundred twenty-eight respondents participated in the different phases of the process. Results: Agitation was defined broadly as: (1) occurring in patients with a cognitive impairment or dementia syndrome; (2) exhibiting behavior consistent with emotional distress; (3) manifesting excessive motor activity, verbal aggression, or physical aggression; and (4) evidencing behaviors that cause excess disability and are not solely attributable to another disorder (psychiatric, medical, or substance-related). A majority of the respondents rated all surveyed elements of the definition as "strongly agree" or "somewhat agree" (68-88% across elements). A majority of the respondents agreed that the definition is appropriate for clinical and research applications. Conclusions: A provisional consensus definition of agitation has been developed. This definition can be used to advance interventional and non-interventional research of agitation in patients with cognitive impairment.
- Bias due to sample selection in propensity score matching for a supportive housing program evaluation in new york city. [Journal Article]
- PLoS One 2014; 9(10):e109112.
Little is known about influences of sample selection on estimation in propensity score matching. The purpose of the study was to assess potential selection bias using one-to-one greedy matching versus optimal full matching as part of an evaluation of supportive housing in New York City (NYC).Data came from administrative data for 2 groups of applicants who were eligible for an NYC supportive housing program in 2007-09, including chronically homeless adults with a substance use disorder and young adults aging out of foster care. We evaluated the 2 matching methods in their ability to balance covariates and represent the original population, and in how those methods affected outcomes related to Medicaid expenditures.In the population with a substance use disorder, only optimal full matching performed well in balancing covariates, whereas both methods created representative populations. In the young adult population, both methods balanced covariates effectively, but only optimal full matching created representative populations. In the young adult population, the impact of the program on Medicaid expenditures was attenuated when one-to-one greedy matching was used, compared with optimal full matching.Given covariate balancing with both methods, attenuated program impacts in the young adult population indicated that one-to-one greedy matching introduced selection bias.
- HCV treatment uptake in people who have injected drugs - observations in a large cohort that received addiction treatment 1970-1984. [JOURNAL ARTICLE]
- Scand J Gastroenterol 2014 Oct 13.:1-8.
Abstract Objectives. The aim of this study was to document antiviral treatment uptake among former or current people who inject drugs (PWID) with chronic hepatitis C and to explore a possible association between treatment and mortality. Material and methods. This is a longitudinal cohort study of PWID admitted for drug abuse treatment 1970-1984. The 245 hepatitis C virus (HCV) RNA-positive patients alive by the end of 1996 were followed 1997-2012 through linkage to several health registers. Treatment uptake was mainly documented by information on prescription of antiviral medication registered in the Norwegian Prescription Database from 2004. Cox regression, with a time-dependent covariate measuring end-of-treatment, was employed to evaluate mortality after treatment. Results. At the end of the follow-up, median time since HCV exposure was 36 years, and 19.2% (47/245) had been prescribed antiviral treatment for chronic HCV infection. No gender difference was observed. Among those alive at the end of the study period, 27.8% (44/158) had been treated. Relative hazard of death was 0.21 (95% confidence interval [CI] 0.07-0.68), comparing periods for patients after versus before or without treatment. Mortality rate after treatment was 0.8 per 100 person years (95% CI 0.3-2.4) compared to 2.8 (95% CI 2.2-3.5) in untreated patients and before treatment. The most important causes of death among the untreated were drug-related. Conclusions. Among PWID infected with HCV, approximately one-fourth of those still alive at a median of 36 years after exposure had received HCV treatment. Treatment was associated with increased survival, probably mainly due to selection bias.
- Measuring symptoms and diagnosing mental disorders in the elderly community: the test-retest reliability of the CIDI65+ [JOURNAL ARTICLE]
- Int J Methods Psychiatr Res 2014 Oct 13.
Prevalence findings for the elderly are artificially low, most likely due to insufficient consideration of age-related cognitive abilities in diagnostic interviews. Aims: (1) To describe the rationale for the development of an age-adapted Composite International Diagnostic Interview (CIDI65+) for use in a European project (MentDis_ICF65+). (2) To examine its test-retest reliability. Methods: Based on substantive pilot work the CIDI standard questions were shortened, broken down into shorter subsets and combined with sensitization questions and dimensional measures. Test-retest was determined in N = 68 subjects aged 60-79 years via two independent examinations by clinical interviewers using kappa (sensitivity, specificity) for categorical and intraclass correlation (ICC) coefficients for dimensional measures. Results: Test-retest reliability was good for any mental disorder (κ = 0.63), major depression (κ = 0.55), anxiety (κ = 0.62, range = 0.30-0.78), substance (κ = 0.77, range = 0.71-0.82), obsessive-compulsive disorder (κ = 1.00) and most core symptoms/syndromes (κ range = 0.48-1.00). Agreement for some disorders (i.e. somatoform/pain) attenuated, partly due to time lapse effects. ICC for age of onset, recency, quantity, frequency and duration questions ranged between κ = 0.60-0.90. Dimensional agreement measures were not consistently higher. Conclusion: The age-adapted CIDI65+ is reliable for assessing most mental disorders, distress, impairment and time-related information in the elderly, prompting the need to examine validity. Copyright © 2014 John Wiley & Sons, Ltd.