Addressing Dual Disorders in a Medium-Term Admission Unit

Due to the significant functional repercussions suffered by patients with dual disorder, we must evaluate which ones can benefit from intensive rehabilitative therapies in medium-stay psychiatric units. This was a retrospective study of patient medical records which intended to analyze sociodemographic and clinical variables and parameters related to the hospitalization and discharge of patients admitted to the Medium-Stay Unit (MSU) at the Castellón Provincial Hospital Consortium over 2 years (2017 and 2018), according to the presence or absence of dual disorders in these patients. Patients with a dual disorder represented 55.2% of the hospitalized patients. A higher proportion of them were male, were relatively younger, and had an earlier onset of mental illness, fewer associated medical pathologies, and shorter hospital admission times to the Short-Term Hospitalization Unit than those who did not present a dual disorder. A diagnosis on the schizophrenia spectrum with cannabis use or polyconsumption was the most common diagnosis; 98.2% of all the patients responded adequately to admission to the MSU. This work highlighted the need for higher doses of depot paliperidone in patients with dual disorders.

Partial Agonists and Dual Disorders: Focus on Dual Schizophrenia

Dual disorder is a term applied to patients with an addictive disorder and other mental disorder. Epidemiological studies have established that dual disorders are an expectation rather than an exception. They are difficult to diagnose and treat and constitute a huge burden for both patients and their relatives and society. Current treatments are a combination of those needed to treat the addictive disorder with those focused on the co-occurring psychiatric disorder. Focusing specifically on schizophrenia, growing scientific evidence supports the existence of a shared vulnerability for substance use in these patients and those at risk. Various antipsychotics have been found to be useful in the treatment of psychotic symptoms and disorders; however, few effective treatments have been identified until now for substance use disorders in patients with dual schizophrenia. Partial agonism stands as a new pharmacological option available in recent years. Molecules with this kind of action may act as functional agonists or as antagonists, depending on the surrounding levels of the neurotransmitter. Studies have found their efficacy in schizophrenia, addiction, anxiety and depression. Certain partial agonist antipsychotics seem to have a role in the treatment of dual schizophrenia. That could be the case with cariprazine. Because of its higher affinity for dopaminergic D3 receptors compared to D2, a potential to prevent relapse to addiction, added to its antipsychotic efficacy, has been suggested. Here we briefly review current advances and future directions and introduce some personal insights into the role of partial agonists in co-occurring schizophrenia and substance use.

The Impact of Co-occurring Post-traumatic Stress Disorder and Substance Use Disorders on Craving: A Systematic Review of the Literature

The frequent co-occurrence of post-traumatic stress disorder (PTSD) and substance use disorders (SUDs) leads to manifestations of both conditions that are more severe and more resistance to treatment than single disorders. One hypothesis to explain this synergy is the impact of intrusive memories on craving which, in turn, increases the risk of relapse among patients with substance use disorders. The aim of this systematic review is to examine this possibility by assessing the impact of PTSD and its symptoms on craving among dual disorder patients. Using PRISMA criteria, four databases were comprehensively searched up to June, 2021, in order to identify all candidate studies based on broad key words. Resulting studies were then selected if they examined the impact of PTSD or PTSD symptoms on craving, and if they used standardized assessments of PTSD, SUD, and craving. Twenty-seven articles matched the selection criteria and were included in this review. PTSD was found to be significantly associated with increased craving levels among patients with alcohol, cannabis, cocaine, tobacco, and other substance use disorders. Exposition to traumatic cues among dual disorder patients was also shown to trigger craving, with an additive effect on craving intensity when exposure to substance-related cues occurred. In addition, certain studies observed a correlation between PTSD symptom severity and craving intensity. Concerning mechanisms underlying these associations, some findings suggest that negative emotional states or emotion dysregulation may play a role in eliciting craving after traumatic exposure. Moreover, these studies suggest that PTSD symptoms may, independently of emotions, act as powerful cues that trigger craving. These findings argue for the need of dual disorder treatment programs that integrate PTSD-focused approaches and emotion regulation strategies, in addition to more traditional interventions for craving management.

Psychosocial rehabilitation and family intervention for people with dual disorders

In dual disorder, two serious and chronic disorders converge that are still a challenge to health and social care networks. In this context, families play an important role in keeping these people included in the community. Dual disorder is associated with a series of negative effects on the family environment, with a greater burden of care and conflict. For this article, four models of family intervention in dual disorder have been reviewed. Conclusions. Family intervention has proven to be an important element of dual disorder treatment. The four intervention programs presented coincide in share some common components: single / multi-family intervention, theoretical bases of the models of with proven efficacy, psychoeducation, communication training, problem solving, and the motivational interview across the entire program. Even so, some areas still persist without improvements and areas that do not improve persist and the results are not conclusive, so it is necessary to continue looking for formulas that point towards more flexible therapeutic resources according to the needs and circumstances of each of these people.

Integrated treatment of dual disorders in The Netherlands: a qualitative study of client experiences

Purpose Many clients who suffer from severe mental health problems also struggle with alcohol and drug use. And although there seems to be a consensus in most European countries that integrated treatment models (especially the integrated treatment of dual disorder clients model) are best fitted to help these clients, none of these have strong evidence, mostly owing to methodological limitations in the studies. This study aims to contribute to the knowledge of why integrated treatment is helpful by conducting in-depth interviews with dual disorder clients who are currently receiving integrated treatment. Design/methodology/approach This study is a qualitative thematic analysis using a timeline tool to elicit participants’ responses. In the interviews, dual diagnosis clients with severe problems reflected on their situation at admission, the care they received in integrated treatment and their opinions on positive and negative elements. The interviews were coded and analysed with MAXQDA. Findings In the analyses of the interviews, this study found three clusters of elements that clients indicated were the most helpful during their treatment and recovery process: trusting and meaningful relationship with the team, components of integrated treatment and organisation of care. Originality/value The findings emphasized the importance of working relationship in the treatment of complex and long-term problems. This has implications for the evaluation of these integrated treatment models which so far mainly focuses on specific interventions.

Gray Matter Abnormalities in Type 1 and Type 2 Diabetes: A Dual Disorder ALE Quantification

Aims/hypothesis: Diabetes mellitus (DM) is associated with comorbid brain disorders. Neuroimaging studies in DM revealed neuronal degeneration in several cortical and subcortical brain regions. Previous studies indicate more pronounced brain alterations in type 2 diabetes mellitus (T2DM) than in type 1 diabetes mellitus (T1DM). However, a comparison of both types of DM in a single analysis has not been done so far. The aim of this meta-analysis was to conduct an unbiased objective investigation of neuroanatomical differences in DM by combining voxel-based morphometry (VBM) studies of T1DM and T2DM using dual disorder anatomical likelihood estimation (ALE) quantification.Methods: PubMed, Web of Science and Medline were systematically searched for publications until June 15, 2020. VBM studies comparing gray matter volume (GMV) differences between DM patients and controls at the whole-brain level were included. Study coordinates were entered into the ALE meta-analysis to investigate the extent to which T1DM, T2DM, or both conditions contribute to gray matter volume differences compared to controls.Results: Twenty studies (comprising of 1,175 patients matched with 1,013 controls) were included, with seven studies on GMV alterations in T1DM and 13 studies on GMV alterations in T2DM. ALE analysis revealed seven clusters of significantly lower GMV in T1DM and T2DM patients relative to controls across studies. Both DM subtypes showed GMV reductions in the left caudate, right superior temporal lobe, and left cuneus. Conversely, GMV reductions associated exclusively with T2DM (>99% contribution) were found in the left cingulate, right posterior lobe, right caudate and left occipital lobe. Meta-regression revealed no significant influence of study size, disease duration, and HbA1c values.Conclusions/interpretation: Our findings suggest a more pronounced gray matter atrophy in T2DM compared to T1DM. The increased risk of microvascular or macrovascular complications, as well as the disease-specific pathology of T2DM may contribute to observed GMV reductions.Systematic Review Registration: [PROSPERO], identifier [CRD42020142525].

Does Cannabis, Cocaine and Alcohol Use Impact Differently on Adult Attention Deficit/Hyperactivity Disorder Clinical Picture?

While the association between adult Attention Deficit/Hyperactivity Disorder (A-ADHD) and Substance Use Disorders (SUDs) has been widely explored, less attention has been dedicated to the various substance use variants. In a previous paper, we identified two variants: type 1 (use of stimulants/alcohol) and type 2 (use of cannabinoids). In this study, we compared demographic, clinical and symptomatologic features between Dual Disorder A-ADHD (DD/A-ADHD) patients according to our substance use typology, and A-ADHD without DD (NDD/A-ADHD) ones. NDD patients were more frequently diagnosed as belonging to inattentive ADHD subtype compared with type 1 DD/A-ADHD patients, but not with respect to type 2 DD/ADHD. NDD/A-ADHD patients showed less severe symptoms of hyperactivity/impulsivity than DD/A-ADHD type 1, but not type 2. Type 1 and type 2 patients shared the feature of displaying higher impulsiveness than NDD/A-ADHD ones. General psychopathology scores were more severe in type 2 DD/ADHD patients, whereas type 1 patients showed greater similarity to NDD/A-ADHD. Legal problems were more strongly represented in type 1 than in type 2 patients or NDD/A-ADHD ones. Our results suggest that type 1 and type 2 substance use differ in their effects on A-ADHD patients—an outcome that brings with it different likely implications in dealing with the diagnostic and therapeutic processes.

Special Issue: Diagnosis and Management of Addiction and Other Mental Disorders (Dual Disorders)

The term “dual disorder” (DD) refers to the coexistence or concurrence of at least one substance use disorder (SUD) and another mental disorder in the same person, as the World Health Organization established in its lexicon of alcohol and drug terms [...]

FORENSIC PSYCHIATRY AND DUAL DIAGNOSIS

1.Objective: Dual diagnosis patients perpetrate crime more often than healthy individuals and is of great importance for forensic mental health services. However, in dual diagnosis patients, very little is known about factors explaining criminal behavior. This work aims to summarize the epidemiological and clinical approach of dual diagnosis patients, focusing on the Iberian Peninsula scope. Aditionaly, it aims to analyse the state of the art regarding associations between demographic and clinical factors and perpetration of crime in dual disorder patients. 2. Method: A non-systematic review of the literature is presented. Bibliographic selection was carried out through keyword research in MEDLINE and Google Scholar. 3. Results and conclusions: Perpetration of violence was independently associated with younger age, severity of alcohol use problems, lifetime trauma exposure, and higher manic symptom scores. The three drugs most commonly associated with the drugs–crime connection are heroin, crack and cocaine. A study conducted in penitentiary centers of the Interior in Spain found a high percentage of dual pathology (81.4%) In the portuguese largest security ward, in Coimbra, 40.5% of the sample had dual diagnosis disorders. Forensic units must take an integrated approach to addressing substance-use disorders. It is needed to consider not only the complexities of the substance misuse and the mental disorder, but also the offending behaviour that brought them into the forensic services. Also, social skills can effectively be improved in dual diagnosis patients. Further research is required to identify additional risk factors, such as individual substances of abuse, and establish a causal model leading to criminal perpetration.