Psychiatric Symptoms in Mentally Ill Chemical Abusers

Carey, Michael P.; Carey, Kate B.; Meisler, Andrew W.

doi:10.1097/00005053-199103000-00004

Cited by 77 publications

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“…Consistent with previous research (Carey et al, 1991;Fowler et al, 1998;Ries et al, 1994), active substance abuse is associated with subjective distress. Contrary to expectations, however, participants with a SUD in remission for at least 6 months were also more symptomatic than the never group.…”

Section: Discussionsupporting

confidence: 91%

“…First, the Global Severity Index (GSI) from the Symptom Checklist Revised (Derogatis, 1983) was used to determine self-reported psychological distress. The GSI is reliable and has demonstrated convergent, discriminant, and construct validity in general (Derogatis & Cleary, 1977), and known groups validity in this population (Carey, Carey, & Meisler, 1991). Second, an indicator variable was created signifying presence of a schizophrenic spectrum diagnosis (i.e., schizophrenia or schizoaffective disorder) versus bipolar diagnosis.…”

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confidence: 99%

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Correlates of Substance Use Disorder Among Psychiatric Outpatients: Focus on Cognition, Social Role Functioning, and Psychiatric Status

Carey

Simons

2003

The Journal of Nervous and Mental Disease

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This study compared psychiatric outpatients who were never, former, and current substance abusers on psychiatric, social, and cognitive functioning. Fifty-six outpatients with schizophrenia-spectrum and bipolar disorders volunteered to complete diagnostic and social role function interviews, selfreport inventories, and neuropsychological tests. Multinomial logit regression analyses indicated that current and former abusers reported greater subjective feelings of distress than those who never abused. Contrary to expectations, however, both groups of substance abusers performed better on non-verbal cognitive tests compared to those who never abused. Differences in social functioning were also observed: former abusers demonstrated better instrumental role functioning than those who never abused. This pattern of findings challenges assumptions about additive effects of comorbid disorders on cognitive and social functioning. Keywords schizophrenia; substance abuse; psychiatric distress; cognitive function; social function Persons living with a severe and persistent mental illness (SPMI; e.g., schizophrenia, bipolar disorder) often abuse alcohol or other drugs. At least 20% of all persons diagnosed with a SPMI have a current substance use disorder (SUD), and approximately 50% meet criteria for a SUD during their life (Regier et al., 1990). This comorbidity warrants greater attention because both classes of disorders are associated with pervasive impairment.Persons living with a SPMI routinely experience impairment in cognitive and social domains. For example, schizophrenia is often associated with a generalized pattern of cognitive deficits, including impairments in attention, memory, abstract thinking, problem solving, and tasks involving effortful processing (e.g., Braff, 1993;Saykin et al., 1991). Such impairment predates experience with neuroleptic or other treatments; however, considerable variability exists among patients with schizophrenia on neuropsychological tests (Mohamed, Paulsen, O'Leary, Arndt, & Andreasen, 1999;Saykin et al., 1994). Similarly, bipolar patients also demonstrate deficits in attention, learning and memory, especially during manic phases of the illness (Martinez-Aran et al., 2000;Murphy & Sahakian, 2001). Social/occupational dysfunction is a necessary criterion for diagnosis of both schizophrenia and bipolar disorder (Diagnostic and Statistical Manual of Mental Disorders [DSM-IV], American Psychiatric Association [APA], 1994), and often includes impaired ability to perform expected role functions in the community. In particular, persons with schizophrenia experience stable and pervasive social skill deficits (e.g., Mueser, Bellack, Douglas, & Morrison, 1991 (Green, 1996;Liddle, 2000).Substance use disorders also engender cognitive, social, and psychiatric problems. Prolonged abuse of alcohol is associated with impairment in abstraction, problem solving, memory, and perceptual-motor tasks (Chelune & Parker, 1981;Evert & Oscar-Berman, 1995). Polydrug abuse, especially the use of opiat...

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Section: Discussionsupporting

confidence: 91%

mentioning

confidence: 99%

Correlates of Substance Use Disorder Among Psychiatric Outpatients: Focus on Cognition, Social Role Functioning, and Psychiatric Status

Carey

Simons

2003

The Journal of Nervous and Mental Disease

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“…Symptom exacerbation and psychiatric admissions have both been linked to acute drug use in outpatients with a severe and persistent mental illness (SPMI), such as schizophrenia (Haywood et al, 1995;Shaner et al, 1995). Individuals enrolled in outpatient treatment and "dually diagnosed" with psychiatric and substance use disorders exhibit poor (Keck, McElroy, Strakowski, Bourne, & West, 1997;Owen, Fischer, Booth, & Cuffel, 1996;Pristach & Smith, 1990), report more severe psychiatric symptoms (Carey, Carey, & Meisler, 1991), and involve themselves minimally in structured treatment programs Lehman, Herron, Schwartz, & Myers, 1993;Richardson, Craig, & Haugland, 1985). This pattern of poor treatment compliance and exacerbated symptoms leads to greater use of institutional and emergency services, with higher associated costs (Bartels et al, 1993;Kivlahan, Heiman, Wright, Mundt, & Shupe, 1991).…”

Section: Introductionmentioning

confidence: 99%

Measuring readiness-to-change substance misuse among psychiatric outpatients: I. Reliability and validity of self-report measures.

et al. 2001

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Objective-The high rates of comorbid substance use disorders among persons living with severe and persistent mental illness (SPMI) have increased interest in assessing and enhancing motivation to change substance misuse in this population. This study provides evidence for the psychometric adequacy of three self-report measures of readiness-to-change.Method-The sample consisted of 84 persons (65% men) with co-occurring substance abuse or dependence and an SPMI. After a psychiatric assessment, participants completed three measures of readiness-to-change, which yielded seven subscales: (1) the Stages of Change Readiness and Treatment Eagerness Scale (ambivalence about change, recognition of substance-related problems, taking steps), (2) Decisional Balance Scale (pros of using, cons of using) and (3) the Alcohol and Drug Consequences Questionnaire (costs of quitting, benefits of quitting).Results-All of the subscales were stable over time, and 6 of the 7 subscales demonstrated excellent internal consistency. Reliability indices were comparable when analyses were repeated on subsets of participants defined by diagnosis, cognitive function, positive symptoms and negative symptoms. A pattern of theoretically meaningful intercorrelations provided convergent evidence of validity, and a general lack of relationships with demographic variables and indices of psychiatric status provided discriminant evidence of validity. These findings support efforts to quantify readiness-to-change substance misuse among persons with an SPMI.Substance use disorders are highly prevalent among persons with schizophrenia and other major mental illnesses. Persons with major (Axis I) mental disorders have three times the risk of drug or alcohol diagnoses compared to the rest of the population (Regier et al., 1990). Persons with schizophrenia represent a particularly high risk group for problems related to substance use. Among all persons with a diagnosis of schizophrenia, 47% meet lifetime criteria for a substance use disorder (Regier et al., 1990). This prevalence rate is often higher in samples of schizophrenic patients in treatment (Mueser et al., 1990;Test, Wallisch, Allness, & Ripp, 1989).A diagnosis of substance abuse or dependence impairs both the process and outcome of mental health treatment. Symptom exacerbation and psychiatric admissions have both been linked to acute drug use in outpatients with a severe and persistent mental illness (SPMI), such as schizophrenia (Haywood et al., 1995;Shaner et al., 1995). Individuals enrolled in outpatient treatment and "dually diagnosed" with psychiatric and substance use disorders exhibit poor (Keck, McElroy, Strakowski, Bourne, & West, 1997;Owen, Fischer, Booth, & Cuffel, 1996;Pristach & Smith, 1990), report more severe psychiatric symptoms (Carey, Carey, & Meisler, 1991), and involve themselves minimally in structured treatment programs Lehman, Herron, Schwartz, & Myers, 1993;Richardson, Craig, & Haugland, 1985). This pattern of poor treatment compliance and exacerbated symptoms leads ...

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“…The importance of the comorbidity of substance use disorders -SUD-with other psychiatric disorders has been evidenced in several studies due to its influence on clinical evaluation, evolution, and costs (Carey, Carey, & Meisler, 1991;Hunt, Bergen, & Bashir, 2002).…”

Section: Introductionmentioning

confidence: 99%

“…A number of epidemiological studies conducted mainly in the United States indicate that this comorbidity is very high, greater in subjects under treatment, and that the concomitant presence of several disorders has major clinical, evolutionary, and therapeutic implications (Compton, Thomas, Stinson, & Grant, 2007;Swendsen et al, 2010).Dual disorders have been associated with an increase in the number of psychiatric admissions (Hunt et al, 2002); violence (Soyka, 2000); suicidal behavior (Appleby et al, 1999), an increase in health expenditure (McCrone et al, 2000), greater medical comorbidity (Dickey, Normand, Weiss, Drake, & Azeni, 2002), poor adherence to treatment (Kamali et al, 2001), and limited results of the latter in both pathologies (Carey et al, 1991).…”

Section: Introductionmentioning

confidence: 99%

Sociodemographic and clinical factors associated with dual disorders in a psychiatric hospital

Pérez

Bernal

Silva

et al. 2017

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Introduction. Among patients with mental illness, dual disorders patients are characterized by a heterogeneous and more severe clinical presentation that is difficult to treat. Therefore, knowledge about the distribution of this disorder and the characteristics of these patients can be helpful to optimize and organize health resources. Objective. To explore the prevalence and socio-demographic and clinical factors associated with dual disorders patients who were hospitalized due to mental illness at a psychiatric unit in Colombia between January and June 2013; this data was collected and analyzed on the basis of the medical records of each patient. Method. Observational, quantitative, cross-sectional study of a secondary source. It included the analysis of 201 patients aged 18 to 65. Results. There were 201 patients analyzed; 45.3% had dual disorders, with a ratio of 2.24 men:women; there was a high frequency of single marital status (69.2%) and more than 90% had a low socioeconomic level. The factors significantly associated with dual disorders in order of importance were: age from 18 to 35 years (OR = 11.03; CI 95% [4.43, 27.46]), male (OR = 5.10, CI 95% [2.26, 11.50]), history of aggression (OR = 3.35; CI 95% [1. 63, 6.91]), and readmission in the year after hospital discharge (OR = 2.23; CI 95% [1.08, 4.61]). Discussion and conclusion. Dual disorders prevalence in this study is similar to that found by other authors. The high prevalence of dual disorders requires specialized therapeutic programs for treatment. The more hospitals know about the associated variables in this study, the more they will be able to improve their approach to patients.

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Psychiatric Symptoms in Mentally Ill Chemical Abusers

Cited by 77 publications

References 0 publications

Correlates of Substance Use Disorder Among Psychiatric Outpatients: Focus on Cognition, Social Role Functioning, and Psychiatric Status

Correlates of Substance Use Disorder Among Psychiatric Outpatients: Focus on Cognition, Social Role Functioning, and Psychiatric Status

Measuring readiness-to-change substance misuse among psychiatric outpatients: I. Reliability and validity of self-report measures.

Sociodemographic and clinical factors associated with dual disorders in a psychiatric hospital

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