Characteristics of homeless mentally ill people who lose contact with caring agencies

1994 ◽  
Vol 11 (4) ◽  
pp. 160-163 ◽  
Author(s):  
Max Marshall ◽  
Julia Nehring ◽  
Catherine Taylor ◽  
Denis Gath
Keyword(s):  
Mental Disorders ◽  
Mental Disorder ◽  
Alcohol Dependence ◽  
Substance Dependence ◽  
Homeless People ◽  
Consecutive Series ◽  
Care Clinic ◽  
Loss Of Contact ◽  
Alcohol Dependent

AbstractObjective: To discover whether (as predicted in the literature) loss of contact with caring agencies is related to age, substance dependence, a history of law-breaking, or a diagnosis of schizophrenia.Method: A consecutive series of 71 homeless people with mental disorders was recruited over a period of 18 months. The subjects were new referrals to psychiatrists working in a primary health care clinic for the homeless. The subjects were then followed up for a further 18 months (maximum follow up time 36 months, minimum follow up time 18 months) to determine duration of contact with Oxford services for helping the homeless (survival time).Results: Survival analyses indicated that early loss of contact with Oxford services for helping the homeless was strongly predicted by substance (mainly alcohol) dependence in the month before first attendance at the clinic (generalised Wilcoxon 15.8, p<0.001). Homeless people with mental disorders who are also alcohol dependent, were five times more likely to lose contact with caring agencies than homeless people with mental disorders who were not alcohol dependent (hazard ratio 5.05,95% confidence limits 14.9-3.0).Conclusions: Amongst homeless people with mental disorder, there appears to be an association between substance (mainly alcohol) dependence and loss of contact with caring agencies. This may be because homeless people with a dual diagnosis of mental disorder and substance dependence, tend to be more mobile than those who are not substance dependent.

scholarly journals Mental disorders and the risk of adult violent and psychological victimisation: a prospective, population-based study

2019 ◽  
Vol 29 ◽  
Author(s):  
C. Christ ◽  
M. Ten Have ◽  
R. de Graaf ◽  
D. J. F. van Schaik ◽  
M. J. Kikkert ◽  
...  
Keyword(s):  
Anxiety Disorder ◽  
Mental Disorders ◽  
Mental Disorder ◽  
Alcohol Dependence ◽  
Childhood Trauma ◽  
Sociodemographic Characteristics ◽  
Increased Risk ◽  
Specific Disorders ◽  
Violent Victimisation

Abstract Aims Psychiatric patients are at increased risk to become victim of violence. It remains unknown whether subjects of the general population with mental disorders are at risk of victimisation as well. In addition, it remains unclear whether the risk of victimisation differs across specific disorders. This study aimed to determine whether a broad range of mood, anxiety and substance use disorders at baseline predict adult violent (physical and/or sexual) and psychological victimisation at 3-year follow-up, also after adjustment for childhood trauma. Furthermore, this study aimed to examine whether specific types of childhood trauma predict violent and psychological victimisation at follow-up, after adjustment for mental disorder. Finally, this study aimed to examine whether the co-occurrence of childhood trauma and any baseline mental disorder leads to an incrementally increased risk of future victimisation. Methods Data were derived from the first two waves of the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2): a psychiatric epidemiological cohort study among a nationally representative adult population. Mental disorders were assessed using the Composite International Diagnostic Interview version 3.0. Longitudinal associations between 12 mental disorders at baseline and violent and psychological victimisation at 3-year follow-up (n = 5303) were studied using logistic regression analyses, with adjustment for sociodemographic characteristics and childhood trauma. Furthermore, the moderating effect of childhood trauma on these associations was examined. Results Associations with victimisation varied considerably across specific mental disorders. Only alcohol dependence predicted both violent and psychological victimisation after adjustment for sociodemographic characteristics and childhood trauma. Depression, panic disorder, social phobia, generalised anxiety disorder and alcohol dependence predicted subsequent psychological victimisation in the fully adjusted models. All types of childhood trauma independently predicted violent and psychological victimisation after adjustment for any mental disorder. The presence of any childhood trauma moderated the association between any anxiety disorder and psychological victimisation, whereas no interaction between mental disorder and childhood trauma on violent victimisation existed. Conclusions The current study shows that members of the general population with mental disorders are at increased risk of future victimisation. However, the associations with violent and psychological victimisation vary considerably across specific disorders. Clinicians should be aware of the increased risk of violent and psychological victimisation in individuals with these mental disorders – especially those with alcohol dependence – and individuals with a history of childhood trauma. Violence prevention programmes should be developed for people at risk. These programmes should not only address violent victimisation, but also psychological victimisation.

Standard EMDR Protocol for Alcohol and Substance Dependence Comorbid With Posttraumatic Stress Disorder: Four Cases With 12-Month Follow-Up

2016 ◽  
Vol 10 (1) ◽  
pp. 33-46 ◽  
Author(s):  
Claire Kullack ◽  
Jonathan Laugharne
Keyword(s):  
Posttraumatic Stress Disorder ◽  
Substance Use ◽  
Alcohol Dependence ◽  
Posttraumatic Stress ◽  
Substance Use Disorders ◽  
Substance Dependence ◽  
Stress Disorder ◽  
Case Series ◽  
Post Traumatic Stress

This report begins with a summary of the literature regarding the theoretical models behind the comorbid relationship between posttraumatic stress disorder and substance use disorders and the various modified addiction protocols formulated to assist in treating these disorders. This case series outlines the effect that the standard eye movement desensitization and reprocessing (EMDR) protocol had on alcohol and substance dependence for 4 patients who attended our Post Traumatic Stress Clinic in Fremantle, Western Australia, primarily for treatment for posttraumatic stress disorder. Patients were assessed for substance use disorders using the Mini International Neuropsychiatric Interview Plus prior to, immediately after, and 12 months after completing EMDR therapy. Results indicate that the standard EMDR protocol was successful in reducing alcohol and substance use. Prior to treatment, 3 patients met criteria for alcohol dependence and 1 met criteria for substance dependence. At 12-month follow-up, 3 out of 4 clients did not meet the diagnostic criteria for current alcohol dependence or current substance dependence. The implications of these findings are discussed with reference to theories of comorbid posttraumatic stress disorder and substance use disorder and the modified EMDR protocols developed for patients with substance dependence.

scholarly journals A Prospective Comparison of Bipolar I and II Subjects With and Without Comorbid Alcohol Dependence From the COGA Dataset

2020 ◽  
Vol 11 ◽  
Author(s):  
Ulrich W. Preuss ◽  
M. N. Hesselbrock ◽  
V. M. Hesselbrock
Keyword(s):  
Bipolar Disorder ◽  
Alcohol Use ◽  
Alcohol Dependence ◽  
Collaborative Study ◽  
Structured Interviews ◽  
Prospective Comparison ◽  
Bipolar Ii ◽  
Bipolar Patients ◽  
Alcohol Dependent

Objective: Comorbidity of alcohol use disorders in bipolar subjects is high as indicated by epidemiological and clinical studies. Though a more severe course of bipolar disorder in subjects with comorbid alcohol dependence has been reported, fewer studies considered the longitudinal course of alcohol dependence in bipolar subjects and the prospective course of comorbid bipolar II subjects. Beside baseline analysis, longitudinal data of the COGA (Collaborative Study on Genetics in Alcoholism) were used to evaluate the course of bipolar I and II disordered subjects with and without comorbid alcohol dependence over more than 5 years of follow-up.Methods: Characteristics of bipolar disorder, alcohol dependence and comorbid psychiatric disorders were assessed using semi-structured interviews (SSAGA) at baseline and at a 5-year follow-up. Two hundred twenty-eight bipolar I and II patients were subdivided into groups with and without comorbid alcohol dependence.Results: Of the 152 bipolar I and 76 bipolar II patients, 172 (75, 4%) had a comorbid diagnosis of alcohol dependence. Bipolar I patients with alcohol dependence, in particular women, had a more severe course of bipolar disorder, worse social functioning and more suicidal behavior than all other groups of subjects during the 5-year follow-up. In contrast, alcohol dependence improved significantly in both comorbid bipolar I and II individuals during this time.Conclusions: A 5-year prospective evaluation of bipolar patients with and without alcohol dependence confirmed previous investigations suggesting a more severe course of bipolar disorder in comorbid bipolar I individuals, whereas bipolar II individuals were less severely impaired by comorbid alcohol use disorder. While severity of alcohol dependence improved during this time in comorbid alcohol-dependent bipolar I patients, the unfavorable outcome for these individuals might be due to the higher comorbidity with personality and other substance use disorders which, together with alcohol dependence, eventually lead to poorer symptomatic and functional clinical outcomes.

scholarly journals O3E.2 Risk of mental health disorders in human service occupations: a register based study of 445,651 norwegians

2019 ◽  
Vol 76 (Suppl 1) ◽  
pp. A30.1-A30
Author(s):  
Petter Kristensen ◽  
Therese N Hanvold ◽  
Rachel L Hasting ◽  
Suzanne L Merkus ◽  
Ingrid S Mehlum
Keyword(s):  
Health Care ◽  
Social Work ◽  
Mental Disorders ◽  
Mental Disorder ◽  
Human Service ◽  
Causal Effect ◽  
Patient Contact ◽  
Customer Contact ◽  
Related Disorder

ObjectivesMental disorders contribute strongly to disability. Work in human service occupations has been considered a risk factor in several studies. We aimed at quantifying this relationship in a prospective follow-up of all employed persons born in Norway, 1967–1976.MethodsWe conducted follow-up in several national registries. Based upon the ISCO98 four-digit code, we classified 2007 occupations into customer contact, client/patient contact, and reference (no contact). Client/patient contact was subdivided into health care, education and social work. We collected mental disorder diagnoses (ICD-10 F00-F99), in particular affective (F30-F39) and stress-related (F40-F48), in the Norwegian Patient Registry, 2008–2011. Four-year prevalence differences (PD) per 100 across occupational categories were estimated in binomial regression models adjusted for year of birth, marital history, current family pattern, and education level.ResultsAmong 4 45 651 employed persons, 18% held customer-related occupations while 25% held occupations with client/patient contact. The total four-year prevalence of mental disorder was 8.6/100 (38,207 patients). Affective and stress-related prevalences were 5.3 and 6.5 for women, and 3.0 and 3.2 for men, respectively. Adjusted PD estimates showed positive associations between client/patient contact occupations and mental disorders: for women, affective and stress-related disorder PD estimates were 1.1 (95% confidence interval (CI); 0.9–1.3) and 1.3 (CI; 1.0–1.5), respectively. The corresponding PD estimates for men were 1.7 (CI; 1.5–2.0) and 1.5 (CI; 1.2–1.7). We found strongest associations for women in social work (PD 2.3 for stress-related disorders) and men in health care (PD 2.6 for affective disorders). Associations with other mental disorder categories were weak, as were associations with customer contact occupations.ConclusionsAffective and stress-related morbidity was clearly associated with occupations involving client/patient contact for both sexes. We cannot dismiss health selection as an alternative to a causal effect of work-related factors. This register-based study is not well suited to provide mechanistic explanations.

scholarly journals Mental disorders and total mortality after 20 years in an adult general population sample

2020 ◽  
Vol 63 (1) ◽  
Author(s):  
Ulrich John ◽  
Hans-Jürgen Rumpf ◽  
Monika Hanke ◽  
Christian Meyer
Keyword(s):  
Eating Disorders ◽  
Substance Use ◽  
General Population ◽  
Mental Disorders ◽  
Panic Disorder ◽  
Mental Disorder ◽  
Alcohol Dependence ◽  
Population Sample ◽  
Total Mortality ◽  
Study Participants

Abstract Background. General population data on associations between mental disorders and total mortality are rare. The aim was to analyze whether the number of mental disorders, single substance use, mood, anxiety, somatoform or eating disorders during the lifetime and whether treatment utilization may predict time to death 20 years later in the general adult population. Methods. We used data from the Composite International Diagnostic Interview, which includes DSM-IV diagnoses for substance use, mood, anxiety, somatoform, and eating disorders, for a sample of 4,075 residents in Germany who were 18–64 years old in 1996. Twenty years later, mortality was ascertained using the public mortality database for 4,028 study participants. Cox proportional hazards models were applied for disorders that existed at any time in life before the interview. Results. The data revealed increased hazard ratios (HRs) for number of mental disorders (three or more; HR 1.4; 95% confidence interval [CI] 1.1–1.9) and for single disorders (alcohol dependence, dysthymia, panic disorder with agoraphobia, and hypochondriasis), with the reference group being study participants who had not suffered from any of the mental disorders analyzed and with adjustments made for age, sex, and education. Among individuals with any mental disorder during their lifetimes, having been an inpatient in treatment for a mental disorder was related to a higher HR (2.2; CI 1.6–3.0) than was not having been in any treatment for a mental disorder. Conclusions. In this sample of adults in the general population, three or more mental disorders, alcohol dependence, dysthymia, panic disorder with agoraphobia, and hypochondriasis were related to premature death.

scholarly journals Efficacy of acamprosate in the treatment of alcohol-dependent outpatients

2003 ◽  
Vol 25 (3) ◽  
pp. 156-159 ◽  
Author(s):  
Danilo Antonio Baltieri ◽  
Arthur Guerra de Andrade
Keyword(s):  
Side Effects ◽  
Alcohol Dependence ◽  
Placebo Treatment ◽  
Controlled Study ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Continuous Abstinence ◽  
Icd 10 ◽  
Alcohol Dependent

OBJECTIVE: To evaluate the efficacy and security of acamprosate in the treatment of 75 men, aged 18 to 59 years, with diagnosis of alcohol dependence according to the ICD-10. METHODS: Double-blind, placebo-controlled study, 24-week long. After a one-week detoxification period, patients were randomly divided in two groups: the first group received acamprosate (six tablets of 333 mg/d for 12 weeks) and the second group received placebo (six tablets for 12 weeks). After the first 12 weeks, patients continued the follow-up for further 12 weeks without medication. RESULTS: Patients who were receiving acamprosate showed significantly higher continuous abstinence time within the 24 weeks of treatment compared with patients who were assigned to placebo treatment (p=.017). Twenty-five percent of patients who were receiving acamprosate and 20% of the placebo-treated patients dropped out. Few side-effects were reported in both groups. CONCLUSION: Acamprosate proved to be safe and effective in treating alcohol-dependent patients and to maintain the abstinence during 24 weeks.

Long-term effects of pharmacotherapy on relapse prevention in alcohol dependence

2004 ◽  
Vol 16 (5) ◽  
pp. 233-238 ◽  
Author(s):  
F. Kiefer ◽  
F. Andersohn ◽  
C. Otte ◽  
K. Wolf ◽  
H. Jahn ◽  
...  
Keyword(s):  
Alcohol Dependence ◽  
Relapse Prevention ◽  
Controlled Trial ◽  
Self Report ◽  
Long Term Effects ◽  
The Stability ◽  
Combined Medication ◽  
Relapse Rates ◽  
Alcohol Dependent

Background:There is growing evidence that pharmacological treatment with two of the best validated anticraving drugs, acamprosate and naltrexone, is efficacious in promoting abstinence in recently detoxified alcohol-dependent subjects.Objective:The stability of effects after termination of treatment remains to be answered, especially when combining both the drugs.Method:After detoxification, 160 alcohol-dependent subjects participated in a randomized, double-blind, placebo-controlled trial. Patients received naltrexone or acamprosate or a combination of naltrexone and acamprosate or placebo for 12 weeks. Patients were assessed weekly by interview, self-report, questionnaires and laboratory screening. Additionally, follow-up evaluation based on telephone interview of participants, general practitioners and relatives was conducted 12 weeks after terminating the medication.Results:At week 12, the proportion of subjects relapsing to heavy drinking was significantly lower in the group with combined medication compared with both placebo and acamprosate (P < 0.05). No difference was detectable between acamprosate and naltrexone, both of which were superior to placebo (P < 0.05). Relapse rates were 28% (combined medication), 35% (naltrexone), 50% (acamprosate) and 75% (placebo). After follow-up (week 24), combined medication led to relapse rates significantly lower than placebo, but not lower than acamprosate. Again, both naltrexone and acamprosate were superior to placebo. Relapse rates were 80% (placebo), 54% (acamprosate), 53% (naltrexone) and 34% (combined medication).Conclusions:The results of this study highlight the stability of effects of pharmacotherapy on relapse prevention in alcohol dependence.

Psychotic experiences and hyper-theory-of-mind in preadolescence – a birth cohort study

2015 ◽  
Vol 46 (1) ◽  
pp. 87-101 ◽  
Author(s):  
L. Clemmensen ◽  
J. van Os ◽  
M. Drukker ◽  
A. Munkholm ◽  
M. K. Rimvall ◽  
...  
Keyword(s):  
Theory Of Mind ◽  
Mental Disorders ◽  
Mental Disorder ◽  
Family Income ◽  
Population Based ◽  
Birth Cohort Study ◽  
Parental Mental Illness ◽  
Psychotic Experiences ◽  
Diagnostic And Statistical Manual

Background.Knowledge on the risk mechanisms of psychotic experiences (PE) is still limited. The aim of this population-based study was to explore developmental markers of PE with a particular focus on the specificity of hyper-theory-of-mind (HyperToM) as correlate of PE as opposed to correlate of any mental disorder.Method.We assessed 1630 children from the Copenhagen Child Cohort 2000 regarding PE and HyperToM at the follow-up at 11–12 years. Mental disorders were diagnosed by clinical ratings based on standardized parent-, teacher- and self-reported psychopathology. Logistic regression analyses were performed to test the correlates of PE and HyperToM, and the specificity of correlates of PE v. correlates of any Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV) mental disorder.Results.Univariate analyses showed the following correlates of PE: familial psychiatric liability; parental mental illness during early child development; change in family composition; low family income; regulatory problems in infancy; onset of puberty; bullying; concurrent mental disorder; and HyperToM. When estimating the adjusted effects, only low family income, concurrent mental disorder, bullying and HyperToM remained significantly associated with PE. Further analyses of the specificity of these correlates with regard to outcome revealed that HyperToM was the only variable specifically associated with PE without concurrent mental disorder. Finally, HyperToM did not share any of the investigated precursors with PE.Conclusions.HyperToM may have a specific role in the risk trajectories of PE, being specifically associated with PE in preadolescent children, independently of other family and child risk factors associated with PE and overall psychopathology at this age.

Nine Suicide Pacts a Clinical Study of a Consecutive Series 1974–93

1995 ◽  
Vol 167 (4) ◽  
pp. 448-451 ◽  
Author(s):  
Martin Brown ◽  
Elizabeth King ◽  
Brian Barraclough
Keyword(s):  
Mental Illness ◽  
Clinical Study ◽  
Mental Disorder ◽  
Alcohol Dependence ◽  
Mentally Ill ◽  
Medical Literature ◽  
Social Aspects ◽  
Consecutive Series ◽  
Time Of Death ◽  
History Of

BackgroundSuicide pacts are rarely discussed in the medical literature. We report here the medical and social aspects of a consecutive series of double or pact suicides.MethodCoroners' records were examined for 722 consecutive suicides. Data were extracted from them and from medical and psychiatric records.ResultsNine pacts (2.5% of suicides) were located: 11 of the 18 people appeared to have been mentally ill at the time of death and three more had a history of mental illness. Five had a significant medical history (three cancer).ConclusionsMental disorder is common in those who enter suicide pacts (mainly depression, with alcohol dependence rare). Motivations for suicide appear to be relief of mental disorder and pain.

Incidence and Outcomes of Mental Disorders in a Regional Population: The Northern Rivers Mental Health Study

2006 ◽  
Vol 40 (8) ◽  
pp. 674-682 ◽  
Author(s):  
John R. Beard ◽  
Uta C. Dietrich ◽  
Lyndon O. Brooks ◽  
Robert T. Brooks ◽  
Kathy Heathcote ◽  
...  
Keyword(s):  
Mental Disorders ◽  
Mental Disorder ◽  
Strong Predictor ◽  
Composite International Diagnostic Interview ◽  
Diagnostic Interview ◽  
Considerable Change ◽  
Health Study ◽  
Positive Diagnosis ◽  
Health Services Need

Objectives: To estimate the incidence of mental disorders in a cohort of previously symptom-free individuals who are representatives of a regional Australian population. To map changing patterns of diagnosis and comorbidity within the cohort over a 2 year period. Method: Two year follow-up of a community-based cohort drawn from a telephone screening of 9191 randomly selected adults. Subjects were administered a comprehensive face-to-face interview which included the Composite International Diagnostic Interview. A total of 1407 subjects were interviewed at baseline, and 968 subjects were reinterviewed (a 68.8% follow-up rate). Results: There was considerable change in disorder status over the study period, and analysis of the Composite International Diagnostic Interview scoring suggests that these changes reflected real changes in symptomatology. Of subjects interviewed at both baseline and follow-up, 638 were classified as disorder-free at their entry to the study. After 2 years, 98 of these met criteria for a mental disorder during the preceding 12 months. After adjusting for sampling and gender, the 12 month incidence of any mental disorder among subjects who had been disorder-free 2 years previously was 9.95 per hundred person-years at risk. At baseline, a further 330 subjects met ICD-10 criteria for a mental disorder during the previous 12 months. Two years later, 167 of these subjects (50.6%) were disorder-free, and 163 still met the criteria for a mental disorder, although there had often been considerable change in their diagnosis. Subjects with a mental disorder at the commencement of the study were significantly more likely than those without a disorder to have a positive diagnosis 2 years later (p < 0.001). The number of diagnoses at baseline was a strong predictor of the number of diagnoses at follow-up (p < 0.001), and each additional comorbid diagnosis at baseline also increased the probability of a persisting disorder at follow-up (p < 0.001). Conclusions: Over a 2 year period, the majority of subjects with a mental disorder will become disorder-free, while a significant number of previously disorder-free individuals will develop a positive diagnosis. Health services need to be designed to meet this labile demand.

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