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Dual Diagnosis (dual + diagnosis)

Distribution by Scientific Domains

Medical Sciences	92%
2 Other Domains	8%

Distribution within Medical Sciences

Nursing General	41%
Intellectual Disability	11%

Selected Abstracts

Book and Media Reviews

ADDICTION BIOLOGY, Issue 4 2000
David Ball
Books reviewed in this article: Book reviews in this column will primarily be of titles focusing completely, or in part, on biological aspects of addiction. However, significant titles of general relevance to the addictions field will also be included, even if they are not "biological", as will titles of general methodological and clinical relevance, even if they are not on "addictions". Similar considerations will apply to other media (software, audio tapes and CDs, videos, etc). However, specific "addictions" software applications seem to be relatively uncommon and, as these items are rarely reviewed elsewhere, we will endeavour to include reviews of some of the older programmes that are still useful, as well as new titles that appear. I would appreciate suggesti ons of any items suitable for reviews, but especially software and other media of specifi c relevance to the addictions. Please contact: Dr David Ball, National Addiction Centre, 4 Windsor Walk, London SE5 8AF, UK. Dual Diagnosis and Treatment: substance abuse and co-morbid medical and psychiatric disorders HENRY R. KRANZLER & BRUCE J. ROUNSAVILLE (Eds) Improving the Care of People in Substance Misuse Ser vices: clinical audit project examples KIRSTY MACLEAN STEEL & CLAIRE PALMER Software European Legal Texts on Drugs (CD-Rom) [source]

Dual Diagnosis , Substance Misuse and Psychiatric Disorders

JOURNAL OF ADVANCED NURSING, Issue 5 2005
Rod Thomson MEd MSc DipAdEd DipHV RMN RGN RHV HonMFPH FRCN
No abstract is available for this article. [source]

Dual Diagnosis: Prevalence, Risk Factors, and Relationship With Suicide Risk in a Nationwide Sample of French Prisoners

ALCOHOLISM, Issue 1 2009
Michael Lukasiewicz
Background:, Axis I psychiatric disorders (PD) and substance use disorders (SUD) are common in prison, but only few studies have focused on their association in this setting. Dual diagnosis (DD) (the co-occurrence of a SUD and any axis I disorder) is known to have a poorer prognosis and to require more intense supportive care. Objectives:, The objectives of this study were (1) to describe prisoners with DD (prevalence and characteristics); (2) to compare DD prisoners with 3 other groups of prisoners: no diagnosis (ND), SUD alone, or other isolated PD; and (3) to evaluate the impact of DD on suicide risk in prison. Method:, A random stratified strategy was used to select 23 various types of prisons and 998 prisoners. Diagnoses were assessed using a unique procedure, each prisoner being evaluated by 2 psychiatrists, 1 junior, using a structured interview (MINI 5 plus), and 1 senior, using an open clinical interview. Following interviews, clinicians met to establish a list of diagnoses. Cloninger's temperament and character inventory was also used. Results:, Of the prisoners, 26.3% had a DD. DD prevalence was almost 80% in prisoners with SUD, while only one-third of the prisoners with an axis I PD had co-morbid SUD. No significant differences were observed in drug use patterns between DD and SUD without co-morbid PDs. DD showed the strongest association with suicide risk [OR = 5.7 (1.7,4.6)]. Conclusion:, DD is very frequent in prison and is a major risk factor for suicide. Systematic psychiatric/SUD screening of prisoners with either a SUD or an axis I PD should be encouraged. [source]

Treatments for Patients With Dual Diagnosis: A Review

ALCOHOLISM, Issue 4 2007
Quyen Q. Tiet
Background: Comorbid substance use and mental illness is prevalent and often results in serious consequences. However, little is known about the efficacy of treatments for patients with dual diagnosis. Methods: This paper reviews both the psychosocial and medication treatments for those diagnosed with a substance-related disorder and one of the following disorders: (a) depression, (b) anxiety disorder, (c) schizophrenia, (d) bipolar disorder, (e) severe mental illness, and (f) nonspecific mental illness. We made no restriction of study design to include all published studies, due to the dearth of studies on treatments of patients with dual diagnosis. Results: Fifty-nine studies were identified (36 randomized-controlled trials; RCT). Limited number of studies, especially RCTs, have been conducted within each comorbid category. This review did not find treatments that had been replicated and consistently showed clear advantages over comparison condition for both substance-related and other psychiatric outcomes. Conclusions: Although no treatment was identified as efficacious for both psychiatric disorders and substance-related disorder, this review finds: (1) existing efficacious treatments for reducing psychiatric symptoms also tend to work in dual-diagnosis patients, (2) existing efficacious treatments for reducing substance use also decrease substance use in dually diagnosed patients, and (3) the efficacy of integrated treatment is still unclear. This review provides a critique of the current state of the literature, identifies the directions for future research on treatment of dual-diagnosis individuals, and calls for urgent attention by researchers and funding agencies to conduct more and more methodologically rigorous research in this area. [source]

Dual Diagnosis,Policy and Practice in Italy

THE AMERICAN JOURNAL ON ADDICTIONS, Issue 2 2006
Giuseppe Carrà MD
In Italy, dual diagnosis issues are affected by distinctive historical pathways. Since the end of the 1970s, the addiction field has been starved of psychiatric contribution, with the emphasis being on a pedagogical model of substance-related disorders and a bio-psycho-social model for mental health. As such, dual diagnosis treatment, service models, and research have only been developed in the last fifteen years. Substantial training needs with regard to dual diagnosis are identified in addiction and mental health professionals, and new graduate and undergraduate programs are required. Further research is needed as well as an evidence-based health policy from national and regional government. [source]

Caring for clients with dual diagnosis in rural communities in Australia: the experience of mental health professionals

JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 3 2005
C. DEANS rmn, hv cert
This paper identifies and describes the experiences of 13 rural mental health professionals who care for clients diagnosed with a mental illness and a coexisting alcohol and other drug disorder (dual diagnosis). Dual diagnosis is a common problem which is often poorly understood and managed by mental health professionals. The effect of excessive substance use on a person's mental well-being can present as a diagnostic challenge as each condition may mask symptoms of the other. The authors utilized a phenomenological approach to discover the experiences of a group of mental health professionals working in rural communities in Victoria, Australia. Caring for clients diagnosed with dual diagnosis was found to be a complex and stressful role that involved high levels of skill and knowledge. Despite the fact that health professionals in rural areas are expected to deliver the most appropriate care to individuals with a dual diagnosis, a number of these rural health professionals have limited preparation and experience in dealing with arising clinical diagnosis issues. Clinicians experience frustration, resentment and powerlessness in their attempt to understand their clients' drug misuse whilst simultaneously endeavouring to provide a quality mental health service. [source]

Dual Diagnosis: Prevalence, Risk Factors, and Relationship With Suicide Risk in a Nationwide Sample of French Prisoners

Birth-cohort and dual diagnosis effects on age-at-onset in Brazilian patients with bipolar I disorder

ACTA PSYCHIATRICA SCANDINAVICA, Issue 6 2009
P. V. Da Silva Magalhães
Objective:, Substance use disorders and birth-cohort have been associated with an earlier onset in bipolar disorder (BD). This study aimed at evaluating the inter-relations of these factors in age-at-onset in bipolar illness. Method:, Two-hundred and thirty patients with bipolar I disorder were cross-sectionally evaluated. Patients were categorized into four age groups for analysis. Lifetime comorbidity and age-at-onset were derived from the Structured Clinical Interview for DSM-IV. Results:, There was a strong linear association between age group and age-at-onset. Lifetime alcohol and drug use disorders were also associated with age-at-onset. Illicit drug and alcohol use disorders and age group remained significant in the multivariate model. No interactions appeared. Conclusion:, Both age group and dual diagnoses had strong and independent impacts on age-at-onset in out-patients with BD. Substance abuse may be partly accountable for earlier symptom onset, but other features of BD in younger generations are still in need to be accounted for. [source]

Traumatic spinal cord injury and concomitant brain injury: a cohort study

ACTA NEUROLOGICA SCANDINAVICA, Issue 2010
E. M. Hagen
Hagen EM, Eide GE, Rekand T, Gilhus NE, Gronning M. Traumatic spinal cord injury and concomitant brain injury: a cohort study. Acta Neurol Scand: 2010: 122 (Suppl. 190): 51,57. © 2010 John Wiley & Sons A/S. Objective,,, To assess the temporal trends in the incidence and demographic characteristics of traumatic spinal cord injury (TSCI) with clinical concomitant traumatic brain injury (TBI), in an unselected, geographically defined cohort, 1952,2001. Material and methods,,, The patients were identified from hospital records. TBI was classified as none, mild, moderate, and severe. Results,,, Of 336 patients, 157 (46.7%) patients had a clinical concomitant TBI. Clinical TBI was classified as mild in 30.1%, moderate in 11.0% and severe in 5.7%. The average annual incidence increased from 3.3 per million in the first decade to 10.7 per million in the last. Alcohol was the strongest risk factor of clinical TBI (OR = 3.69) followed by completeness of TSCI (OR = 2.18). Conclusions,,, The incidence of TSCI with concomitant TBI has increased during the last 50 years. Alcohol and completeness of injury are strong risk factors. Increased awareness of dual diagnoses is necessary. [source]

The role of alcohol and drugs in homicides in England and Wales

ADDICTION, Issue 8 2006
Jenny Shaw
SUMMARY Background The annual number of homicide convictions in England and Wales is increasing. Previous studies have highlighted the aetiological role of alcohol and drugs in homicide. Aims To examine rates of alcohol and drug misuse and dependence in people convicted of homicide; the role of alcohol and drugs in the offence; the social and clinical characteristics of alcohol- and drug-related homicides; and the social and clinical characteristics of patients with dual diagnosis who commit homicide. Methods A national clinical survey based on a 3-year (1996,9) consecutive sample of people convicted of homicide in England and Wales. Information on rates of alcohol and drug misuse/dependence, the role of alcohol and drugs in the offence and social and clinical characteristics of perpetrators were collected from psychiatric reports prepared for the court in homicide convictions. Detailed clinical information was gathered from questionnaires completed by mental health teams for those in contact with mental health services. Results Of the 1594 homicide perpetrators, more than one-third (42%) occurred in people with a history of alcohol misuse or dependence and 40% in people with a history of drug misuse or dependence. Alcohol or drug misuse played a contributory role in two-fifths of homicides. Alcohol played a major role in 52 (6%) and a minor role in 364 (39%) homicides. Drugs played a major role in six (1%) and a minor role in 138 (14%) homicides. Forty-two homicides (17%) were committed by patients with severe mental illness and substance misuse. Alcohol- and drug-related homicides were generally associated with male perpetrators who had a history of violence, personality disorders, mental health service contact and with stranger victims. Conclusions Substance misuse contributes to the majority of homicides in England and Wales. A public health approach to homicide would highlight alcohol and drugs before severe mental illness. [source]

Psychosocial treatments for people with co-occurring severe mental illness and substance misuse: systematic review

JOURNAL OF ADVANCED NURSING, Issue 2 2009
Michelle Cleary
Abstract Title.,Psychosocial treatments for people with co-occurring severe mental illness and substance misuse: systematic review. Aim., This study is a report of a systematic review to assess current evidence for the efficacy of psychosocial interventions for reducing substance use, as well as improving mental state and encouraging treatment retention, among people with dual diagnosis. Background., Substance misuse by people with a severe mental illness is common and of concern because of its many adverse consequences and lack of evidence for effective psychosocial interventions. Data sources., Several electronic databases were searched to identify studies published between January 1990 and February 2008. Additional searches were conducted by means of reference lists and contact with authors. Review methods., Results from studies using meta-analysis, randomized and non-randomized trials assessing any psychosocial intervention for people with a severe mental illness and substance misuse were included. Results., Fifty-four studies were included: one systematic review with meta-analysis, 30 randomized controlled trials and 23 non-experimental studies. Although some inconsistencies were apparent, results showed that motivational interviewing had the most quality evidence for reducing substance use over the short term and, when combined with cognitive behavioural therapy, improvements in mental state were also apparent. Cognitive behavioural therapy alone showed little consistent support. Support was found for long-term integrated residential programmes; however, the evidence is of lesser quality. Contingency management shows promise, but there were few studies assessing this intervention. Conclusion., These results indicate the importance of motivational interviewing in psychiatric settings for the reduction of substance use, at least in the short term. Further quality research should target particular diagnoses and substance use, as some interventions may work better for some subgroups. [source]

Quality of life is not only for people served , it is also for staff: the Multi-Focal Approach

JOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 10 2005
N. Baum
Abstract Background To date, little attention has been given to the concept of quality of life around human resources employment programmes for staff working with persons with a dual diagnosis. Method This article describes the implementation of quality of life principles to service provision for people with dual diagnosis and its application to staff training. Results This type of experiential training facilitated change in staff's attitude to, and treatment of, the people served. Conclusion Human resources development programmes should be based on the same core quality of life principles and domains that guide service delivery on the individual level. [source]

Cerebral dominance and schizophrenia-spectrum disorders in adults with intellectual disability

JOURNAL OF INTELLECTUAL DISABILITY RESEARCH, Issue 6 2000
D. Rowe
Abstract Studies of the general population without intellectual disability have suggested an association between atypical handedness and schizophrenia-spectrum disorders (SSDs). Mixed handedness is taken as an index of diminished cerebral dominance or laterality. The present study addressed the question of whether such findings extend to the neurodevelopmentally ,at risk' population of adults with intellectual disability and SSDs compared with appropriate controls. Fourteen patients with a dual diagnosis of intellectual disability and SSD were compared with 14 controls with intellectual disability alone. Assessments of self-reported hand preference and relative hand skill were completed. Self-report of hand preference revealed highly significantly greater mixed-handedness in the SSD group. Furthermore, relative hand skill performance was significantly diminished for the dominant hand. The discrepancy between dominant and non-dominant hand functioning was lower in the SSD group and this association was highly significant. The results of the present study support the usefulness of such detailed laterality assessment in this population. Mixed laterality, over and above that of the population with general intellectual disability and developmental disorder, was associated with SSD. These results are consistent with the neurodevelopmental hypothesis of schizophrenia and its cognitive neuropsychiatric/neuropsychological sequelae. [source]

Trisomy 21 and Rett syndrome: A double burden

JOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 7 2004
H Leonard
Abstract: Rett syndrome is a severe neurodevelopmental disorder generally affecting girls. Affected individuals are apparently normal at birth but later pass through a period of regression with loss of hand and communication skills and the development of hand stereotypies and dyspraxia. Mutations in the methyl-CpG binding protein 2 (MECP2) gene, have now been found to cause Rett syndrome in up to 80% of classical cases. We report a girl with Down syndrome, one of three children with birth defects in a family of five. From the age of 18 months she developed symptomatology considered by her primary physician to be very characteristic of Rett syndrome. However, this remained a clinical diagnosis till the age of 12 years. Laboratory confirmation of the dual diagnosis, which includes a R168X mutation in the MECP2 gene in addition to trisomy 21, has now been possible. The presence of one neurological or developmental disorder does not necessarily preclude a diagnosis of Rett syndrome. [source]

Psychosocial Factors Affecting Adults With Intellectual Disabilities With Psychiatric Disorders in Cali, Colombia

JOURNAL OF POLICY AND PRACTICE IN INTELLECTUAL DISABILITIES, Issue 3 2009
Miguel Ángel Verdugo
Abstract Increases in life expectancy have heightened concerns for people with intellectual disability (ID) who are growing old and who have be designated as "dually diagnosed",that is, who have, apart from their ID, a psychiatric disorder, and who because of this conjoint condition, are subjected to social exclusion due to three factors: old age, cognitive limitation, and mental illness. The objective of this study was to describe the psychosocial factors associated with the comorbidity between ID and psychiatric disorder of adults in the city of Cali, Colombia. Subjects were 50 dyads consisting of a carer and a person with ID. The Caregivers Questionnaire and the Integral Quality of Life Scale were adapted for use in the study. The analysis of information was based on three factors: person, family, and society. In the case of the personal factor, an adequate level of physical well-being and a good level of self-care were found in more than 60% of the adults with dual diagnosis, good adherence to treatment in 82%, and medium satisfaction in the individual-context relationship in 54%. With regard to the family factor, a high level of satisfaction of needs (84%) was found. Good family functioning was observed in 86%, while family participation in rehabilitation was reported to be between moderate and deficient in 60% of the cases. With respect to the social factor, cases of support between moderate and deficient were found in 68%, and a regular inclusion was observed in 48%. The authors conclude that the family functioning aspect appeared as the major protective factor, while the inclusion and social support were shown as the main risk factors. [source]

The Matrix Model of dual diagnosis service delivery

JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 3 2009
B. GEORGESON bsc(hons)
The Matrix Model is essentially a strategy for managing dual diagnosis across a range of agencies. It is a way of implementing partnership working across services and commissioning structures. The Matrix Model was born out of hard experience at the coalface of dual diagnosis treatment at a tier four service in Bristol. A very common experience, which many may recognize, was that clients with complex mental health and addiction needs were being sent from ,pillar to post' in their treatment. Things needed to change. Here is a method of how things can change. Briefly, professionals in the drug/alcohol and mental health fields co-locate, working with clients in each other's workspaces. In doing this, they create nodes of integration. These nodes of integration link through parallel-working to create a matrix. Outcome and key recommendation is that professionals in the drug/alcohol and mental health fields co-locate in each other's agencies, adopting an assertive outreach approach to working with dual diagnosis/complex-needs clients. [source]

How reliable is the current evidence looking at the efficacy of harm reduction and motivational interviewing interventions in the treatment of patients with a dual diagnosis?

JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 8 2007
C. J. LAKER ba bsc rmn
Current policy from the Department of Health advocates for an integrated approach to treating patients with a dual diagnosis. However, pragmatic and clinically effective brief interventions that can be delivered by nurses across mental health settings remain underdeveloped. Motivational interviewing has had some successful exposure in the field of dual diagnosis; however, harm reduction remains unexplored both conceptually and in terms of clinical intervention. This literature review examines the notion of harm reduction as a method of identifying and reducing the harm associated with the misuse of drugs and alcohol in relation to mental health problems. Currently there is a paucity of good quality evidence for integrated interventions in the treatment of dually diagnosed patients. Therefore, the papers are analysed in respect of their methodological quality and contribution to the evidence base to inform both future research and mental health nursing practice. [source]

Caring for clients with dual diagnosis in rural communities in Australia: the experience of mental health professionals

Evaluation of a postgraduate training programme for community mental health practitioners

JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 2 2005
A. N. GAUNTLETT rmn bsc msc
Government guidelines on mental health care in England have considerable implications for the level of competency required by the mental health workforce. Implementing these changes requires the widespread introduction of training initiatives whose effectiveness in improving staff performance need to be demonstrated through programme evaluation. This exploratory study evaluates the impact of a 2-year mental health training programme by measuring skill acquisition and skill application, by identifying the key ingredients for facilitating the transfer of learning into practice, and by examining differences in outcome between the academic and the non-academic students. High skill acquisition and application was reported in the majority of interventions, however, low skill application was reported for some key interventions (assertive outreach, dual diagnosis). Statistically significant differences were found between student cohorts in one intervention for skill acquisition (crisis intervention) and two interventions for skill application (client strengths model; medication management). The main ingredients for facilitating transfer were found to be the credibility of the trainers and training alongside colleagues from their own workplace. Some of the possible explanatory factors for these findings are discussed. [source]

Substance misuse, offending and mental illness: a review

JOURNAL OF PSYCHIATRIC & MENTAL HEALTH NURSING, Issue 6 2000
P. Phillips MSc RMN
The literature concerning the associations between violence, mental disorder, comorbidity and substance misuse are discussed in this review, which focuses on the findings of several international studies that demonstrate significantly higher rates of violence in substance misuse and dual diagnosis (when compared with ,single' diagnosis groups). The need for the development of an effective psychiatric nursing response in terms of assessment, liaison and joint clinical management approaches to those with a dual diagnosis is discussed in the context of United Kingdom Government legislation and policy in both forensic mental health services, and in statutory substance misuse services. [source]

Treatments for Patients With Dual Diagnosis: A Review

Reevaluating the Self-Medication Hypothesis among the Dually Diagnosed

THE AMERICAN JOURNAL ON ADDICTIONS, Issue 3 2007
Benjamin Henwood LMSW
The self-medication hypothesis (SMH) is an intuitively appealing explanation for substance use. Conceptually, however, it is not always clear what the hypothesis entails, particularly when applied to persons with mental and substance use disorders. This makes empirical support for SMH difficult to evaluate. By classifying the self-reported reasons for substance use from 33 participants in a NIMH-funded qualitative study of dual diagnosis and homelessness, this study aims to evaluate the applicability of SMH. How one conceptualizes SMH will determine whether SMH is empirically supported. When SMH refers to using substances strictly to cope with symptoms of mental disorders, only 11 out of 72 attributions support it. When SMH refers to using substances to cope with painful feelings in general, more than half of all attributions support SMH. The significance of accurately understanding the various reasons people give for why they use substances is discussed. [source]

Dual Diagnosis,Policy and Practice in Italy

Differentiating Premenstrual Dysphoric Disorder From Premenstrual Exacerbations of Other Disorders: A Methods Dilemma

CLINICAL PSYCHOLOGY: SCIENCE AND PRACTICE, Issue 2 2001
Shirley Ann Hartlage
Premenstrual dysphoric disorder (PMDD) and premenstrual exacerbations of other disorders are difficult to distinguish. Previous methods, such as excluding women with other disorders from a PMDD diagnosis, do not enable a dual diagnosis. Our objective is to advance conceptual and clinical thinking and stimulate dialogue regarding this methods dilemma. The discussion sheds light on comorbidity in general, regardless of the disorders. Considering fundamental criteria for severe premenstrual disorders helps distinguish the phenomena of interest. A proposed method allows identification of PMDD co-occurring with other disorders. PMDD symptoms can be differentiated by their nature and timing (e.g., cyclic depressed mood could be a PMDD symptom, but cyclic binge eating or depressed mood all month long could not be). Impairment must increase premenstrually for a PMDD diagnosis. The proposed method is an advance, but specified unanswered questions remain. [source]