Dual Diagnosis Research Articles

Characterization of substance use in homeless patients with mental disorders

Background In Denmark, 42% of homeless people suffer from dual diagnosis, i.e. the co-occurrence of a substance use of alcohol and/or illegal substances and another psychiatric disorder. Dual diagnosis homeless patients often cause differential diagnostic difficulties and fail to receive effective treatment. A solid grasp of the role of substance use in these patients may inform the diagnostic decision and contribute to improve their treatment. Today, knowledge of these issues remains scarce. The purpose of this study was to explore substance use in homeless patients with mental disorders and their subjective perspectives on their substance use. Methods 44 homeless dual diagnosis patients were included in the study. They were examined in interviews focusing on their substance use and their subjective perspective on their substance use. Results The most frequently used substances were cannabinoids (70.5%) and alcohol (45.5%), followed by cocaine, sedative/hypnotics, and amphetamine. The finding suggests that substance use in dual diagnosis homeless patients is a complex phenomenon with most patients (56.8%) using multiple substances. While substance use seems to contribute to keep the patients homeless, substance use was also reported to play an important role in coping with life on the streets by offering social contact and some relief from a desperate situation. Conclusion Substance use, mental disorder, and homelessness seem to be closely entangled, reinforcing each other and making it difficult to help these vulnerable patients. Diagnostic overshadowing may cause delays in adequate diagnosis and treatment of this group of patients.

Meditation and Empowerment of Female Trauma Survivors with Co-Occurring Disorders: Implications for Social Work Practice

Abstract The addition of an empowerment perspective to treatment of female trauma survivors with co-occurring mental health and substance use concerns has been found to be beneficial. Meditation is a mental health intervention that has the potential for increasing feelings of empowerment amongst this population. This qualitative study explores the experiences of female trauma survivors with co-occurring disorders engaging in a meditation intervention and its impact on their feelings of empowerment. Grounded theory approaches were used to analyse in-depth interviews with participants (N = 32). Results from analysis of the data show the process through which meditation allowed the women to gain empowerment in order to develop skills to heal on their own. This study provides evidence of the use of meditation as a viable strength-based intervention for social workers in order to increase feelings of empowerment amongst female trauma survivors of interpersonal violence with co-occurring disorders. Future research should expand understanding of this empowerment pathway by exploring the impact of meditation within other populations with high levels of trauma.

Artificial Neural Network Analysis Examining Substance Use Problems Co-Occurring with Anxiety and Depressive Disorders Among Adults Receiving Mental Health Treatment

Objective: The co-occurrence of anxiety disorders, depressive disorders, and substance use problems was examined. Methods: The Mental Health Client-Level Data dataset was used to conduct logistic regression models and an artificial neural network analysis. Logistic regression analyses were conducted among adults with anxiety (n = 547,473) or depressive disorders (n = 1,610,601) as their primary diagnosis who received treatment in a community mental health center. The artificial neural network analysis was conducted with the entire sample (N = 2,158,074). Results: Approximately 30% of the sample had co-occurring high-risk substance use or substance use disorder. Characteristics including region of treatment receipt, age, education, gender, race and ethnicity, and the presence of co-occurring anxiety and depressive disorders were associated with the co-occurring high-risk substance use or a substance use disorder. Conclusions: Findings from this study highlight the importance of mental health facilities to screen for and provide integrated treatment for co-occurring disorders.

Dysregulation of Plasma Growth Factors and Chemokines in Cocaine Use Disorder: Implications for Dual Diagnosis with Schizophrenia and Antisocial Personality Disorder in an Exploratory Study

Introduction: Dual diagnosis in individuals with cocaine use disorders (CUDs) presents a mental health challenge marked by an increased susceptibility to disabling morbidities and premature mortality. Despite extensive research on depression and anxiety, other prevalent comorbidities, such as psychotic and personality disorders, have received less attention. This study explores inflammation-related mediators as potential biomarkers for CUD and dual diagnosis with schizophrenia (SCZ) or antisocial personality disorder (APD). Methods: This exploratory study included 95 participants, comprising 40 healthy subjects and 55 abstinent patients with CUD. Lifetime CUD was diagnosed either as single diagnosis (CUD group, N = 25) or as a dual diagnosis (DD group. N = 30) with SCZ (CUD+SCZ subgroup) or APD (CUD+APD subgroup). Participants were clinically assessed, and the plasma concentrations of growth factors (i.e., G-CSF, BDNF, and VEGF-A) and chemokines (i.e., CCL11/eotaxin-1, CCL2/MCP-1, and CXCL12/SDF-1) were determined and log(10)-transformed for analysis. Results: Growth factors and chemokines were dysregulated by CUD and psychiatric diagnoses. Specifically, patients in the CUD group exhibited significantly lower concentrations of G-CSF and CCL11/eotaxin-1 than the control group. In contrast, the DD group showed significantly higher concentrations of all analytes than both the CUD and control groups. Additionally, no differences in these analytes were observed between the CUD+SCZ and CUD+APD subgroups within the DD group. Regarding cocaine-related variables, significant associations were identified in the CUD group: an inverse correlation between the age at first cocaine use and the concentrations of BDNF and CCL2/MCP-1; and a positive correlation between the duration of the cocaine abstinence and the concentrations of BDNF and CCL11/eotaxin-1. Lastly, a logistic regression model incorporating all these analytes demonstrated high discriminatory power in distinguishing patients with CUD alone from those with dual diagnosis. Conclusions: Individuals with dual diagnosis of CUD exhibit elevated concentrations of growth factors and chemokines, distinguishing them from those with CUD alone. It is unclear whether the differences in these inflammatory mediators are specific to the presence of SCZ and APD. The study highlights potential biomarkers and associations, providing valuable insights into the intricate interplay of CUD and psychiatric disorders to enhance clinical diagnosis and therapeutics.

Connections between specific mental health diagnoses of schizophrenia, bipolar disorder and schizoaffective disorder and primary substance use

PurposeThis study aims to use the database of consumers referred to the dual diagnosis shared care service to examine those connections. The Eastern Dual Diagnosis Service, based in Melbourne, Australia, has established a database of consumers with co-occurring mental health disorders and problematic substance use. An examination of mental health and substance-use information obtained over a two-year period in the delivery of dual diagnosis shared care to consumers of mental health services is supporting an improved understanding of substance use and the connections to specific mental health diagnoses of schizophrenia, bipolar disorder and schizoaffective disorder.Design/methodology/approachThis research uses a quantitative approach to review the prevalence of primary substance use and mental health diagnoses for consumers referred to as dual diagnosis shared care. Reviewed are referrals from adult mental health community and rehabilitation teams operating within a mental health and well-being program between January 2019 and December 2020 inclusive.FindingsOf the 387 clients referred to the specialist dual diagnosis shared care, methamphetamine, alcohol and cannabis are associated with 89.4% of the primary mental health diagnosis (PMHD). The most common PMHDs are schizophrenia, schizoaffective disorder and bipolar disorder. The most common PMHD and substance-use connection was schizophrenia and methamphetamine. Nicotine was reported to be used by 84% of consumers and often occurred in addition to another problematic primary substance.Originality/valueImproved dual diagnosis data collection from a community-based clinical mental health service is increasing understanding of the mental health and substance-use relationship. This is now providing clarity on routes of investigation into co-occurring mental health and problematic substance-use trends and guiding improved integrated treatments within a contemporary mental health setting.

Exploring dual diagnosis in opioid agonist treatment patients: a registry-linkage study in Czechia and Norway

BackgroundKnowledge of co-occurring mental disorders (termed ‘dual diagnosis’) among patients receiving opioid agonist treatment (OAT) is scarce. This study aimed (1) to estimate the prevalence and structure of dual diagnoses in two national cohorts of OAT patients and (2) to compare mental disorders between OAT patients and the general populations stratified on sex and standardized by age.MethodsA registry-linkage study of OAT patients from Czechia (N = 4,280) and Norway (N = 11,389) during 2010–2019 was conducted. Data on mental disorders (F00-F99; ICD-10) recorded in nationwide health registers were linked to the individuals registered in OAT. Dual diagnoses were defined as any mental disorder excluding substance use disorders (SUDs, F10-F19; ICD-10). Sex-specific age-standardized morbidity ratios (SMR) were calculated for 2019 to compare OAT patients and the general populations.ResultsThe prevalence of dual diagnosis was 57.3% for Czechia and 78.3% for Norway. In Czechia, anxiety (31.1%) and personality disorders (25.7%) were the most prevalent, whereas anxiety (33.8%) and depression (20.8%) were the most prevalent in Norway. Large country-specific variations were observed, e.g., in ADHD (0.5% in Czechia, 15.8% in Norway), implying differences in screening and diagnostic practices. The SMR estimates for any mental disorders were 3.1 (females) and 5.1 (males) in Czechia and 5.6 (females) and 8.2 (males) in Norway. OAT females had a significantly higher prevalence of co-occurring mental disorders, whereas SMRs were higher in OAT males. In addition to opioid use disorder (OUD), other substance use disorders (SUDs) were frequently recorded in both countries.ConclusionsResults indicate an excess of mental health problems in OAT patients compared to the general population of the same sex and age in both countries, requiring appropriate clinical attention. Country-specific differences may stem from variations in diagnostics and care, reporting to registers, OAT provision, or substance use patterns.

Implementation of the International Classification of Diseases 11th revision behavioural indicators for disorders of intellectual development with co-occurring autism spectrum disorder.

The classification of mental, behavioural and neurodevelopmental disorders in the World Health Organization's International Classification of Diseases 11th revision (ICD-11) includes a comprehensive set of behavioural indicators (BIs) within the neurodevelopmental disorders grouping. BIs can be used to assess the severity of disorders of intellectual development in situations in which standardised measures of intellectual functioning and adaptive behaviours are not available or feasible. This international study examines the implementation characteristics of the BIs and compares them to standardised measures for assessing the severity of intellectual impairment and adaptive behaviours in disorders of intellectual development and autism spectrum disorder (ASD). The clinical utility of the ICD-11 and the fidelity of its application in international clinical settings were also assessed. A total of 116 children and adolescents (5-18years old) with a suspected or established diagnosis of disorders of intellectual development were included across four sites [Italy (n=18), Sri Lanka (n=19) and two sites in India (n=79)]. A principal component analysis was conducted to evaluate the application of the ICD-11 guidance for combining severity levels. Assessment using the BIs showed a higher proportion of individuals classified with mild severity, whereas the standardised measures indicated a higher proportion of severe ratings. Additionally, individuals with co-occurring ASD tended to have more severe impairments compared with those without ASD, as indicated by both BIs and standardised measures. Overall, the BIs were considered clinically useful, although more time and consideration were required when applying the guidelines for individuals with a co-occurring disorder of intellectual development and ASD. The principal component analysis revealed one principal component representing overall disorders of intellectual development severity levels. The ICD-11 BIs can be implemented as intended in international clinical settings for a broad range of presentations of individuals with neurodevelopmental disorders. Use of the BIs results in similar severity diagnoses to those made using standardised measures. The BIs are expected to improve the reliability of severity assessments in settings where appropriate standardised measures for intellectual and adaptive behaviours are not available or feasible.

Negative Implications of Drug and Substance use on Mental Health

Mental health refers to a person's emotional, psychological, and social well-being, which encompasses aspects such as thoughts, feelings, behaviors, and the ability to cope with life's challenges. Several factors including drug abuse have been recognized to cause mental health disorders; hence, the urgent need to globally address these factors. Drug abuse emerges as a complex public health issue, involving the misuse of legal and illegal drugs, with consequences extending beyond individual health. The relationship between mental health and drug abuse intensifies challenges, as drug misuse contributes to the development or worsening of mental health disorders. This review examined biological, psychological, and social determinants, and advocate for a standardized approach to address the complex issue of drug abuse. Various electronic databases, such as PubMed, Scopus, Web of Science, Medline, and others, were used to access resources, in which thirty-three (33) literatures were reviewed. Results of the reviewed literatures revealed that the impact of drug abuse on mental health involves neurobiological alterations affecting neurotransmitter levels and structural changes in the brain. This does not only affect individuals, but also results in societal burdens, such as increased healthcare costs and criminal justice involvement, compounded by the stigma surrounding mental health and substance abuse. The classification of drugs into legal and illegal categories highlights the diversity of substances and emphasizes the need to understand their effects on mental well-being. Categories include legal drugs, prescription medications, socially accepted substances, and illegal drugs with varying dependency potentials. Addressing mental health disorders induced by drug abuse requires a comprehensive approach, involving strategies like Integrated Dual Diagnosis Treatment (IDDT), Medication-Assisted Treatment (MAT), Cognitive-Behavioral Therapy (CBT), Motivational Interviewing (MI), Dialectical Behavior Therapy (DBT), Peer Support, 12-Step Programs, and Recovery-Oriented Systems of Care (ROSC). These methods guarantee a care continuum that centers on the individual and emphasizes recovery, acknowledging the relationship between mental health and drug abuse disorders. Nevertheless, the review highlights a research gap in that, in-depth research is needed to evaluate the effectiveness of the aforementioned interventions. Additionally, exploring innovative strategies to address challenges such as stigma, limited treatment accessibility, and the cyclical nature of addiction would enhance intervention effectiveness.

A Predefined Rule-Based Multi-Factor Risk Stratification Is Associated With Improved Outcomes at a Rural Primary Care Practice.

This study built a predefined rule-based risk stratification paradigm using 19 factors in a primary care setting that works with rural communities. The factors include medical and nonmedical variables. The nonmedical variables represent 3 demographic attributes and one other factor represents transportation availability. Medical variables represent major clinical variables such as blood pressure and BMI. Many risk stratification models are found in the literature but few integrate medical and nonmedical variables, and to our knowledge, no such model is designed specifically for rural communities. The data used in this study contain the associated variables of all medical visits in 2021. Data from 2022 were used to evaluate the model. After our risk stratification model and several interventions were adopted in 2022, the percentage of patients with high or medium risk of deteriorating health outcomes dropped from 34.9% to 24.4%, which is a reduction of 30%. The medium-complex patient population size, which had been 29% of all patients, decreased by about 4% to 5.7%. According to the analysis, the total risk score showed a strong correlation with 3 risk factors: dual diagnoses, the number of seen providers, and PHQ9 (0.63, 0.54, and 0.45 correlation coefficients, respectively).

Parental and Child Sleep: Children with Vision Impairment, Autistic Children, and Children with Comorbid Vision Impairment and Autism.

Parents report associations between children's sleep disturbances and behaviors. Children with neurodevelopmental conditions (e.g., Williams Syndrome and autism) are consistently reported to experience increased sleeping problems. Sleep in children with vision impairment and children with a dual diagnosis of vision impairment and autism remains understudied. Our exploratory study compared sleep profiles in 52 children (aged 4-12 years) and their parents (n = 37), across four groups: children with vision impairment (VI; n = 9), autism (n = 10), comorbid vision impairment + autism (n = 6), and typically developing children (n = 27). Childhood sleep was measured using the parental report Childhood Sleep Habits Questionnaire and sleep diaries. Children's cognitive functioning was measured using digit span, semantic, and phonemic verbal fluency measures. Parental sleep was measured via the Pittsburgh Sleep Quality Index and Epworth Sleepiness Scale. Clinically disordered sleep was reported in all child groups (p ≤ 0.001), particularly children with VI + autism. Age, not sleep quality/quantity, predicted cognitive task performance in TD and autistic groups, but not in VI and VI + autism groups. The child's diagnosis affected parental sleep, particularly in children with a dual diagnosis of VI + autism. All participants experienced problematic sleep to varying degrees. Those most affected were children and parents in the VI + autism group, suggesting that autism may be the main driver of sleep problems in our sample.

Which Factors Are Associated With Comorbid Psychiatric Conditions in Patients Affected by Substance Use Disorders? The Impact of COVID-19 Pandemic on Dual-Diagnosis Subjects

Objective To investigate demographic/cinical variables associated to dual diagnosis and the psychological reaction of dual-diagnosis patients to COVID-19 pandemic. Methods Information was collected at the Addiction Service of Monza, Italy. The Impact of Event Scale-Revised (IES-R), a self-report questionnaire measuring the subjective response to a traumatic event, was administered. Univariate analyses and binary logistic regression were performed. IES-R scores were compared between groups defined by qualitative variables through one-way analyses of variance (ANOVA). Results 118 outpatients were included, 48.3% with dual diagnosis. Alcohol use disorder and being female were associated to dual diagnosis. IES-R scores were significantly higher in the dual-diagnosis group, especially for personality disorders (PDs). IES-R scores were higher in patients taking treatment for substance use disorder (SUD). Conclusions Females and alcohol abusers were at-risk subjects for dual diagnosis. Patients with SUD and PDs may benefit from additional support, especially when traumatic life events occur. Trial Registration ClinicalTrials.gov Identifier: NCT04694482

Effect of schizophrenia and substance use disorder on depressive symptoms and stressful life events

Aim of the studyThe main aim of this study was to examine the mutual effect of schizophrenia and substance use disorder on depression and stress level.Subject or material and methodsThe sample comprised a total of 184 participants, including 51 patients with schizophrenia (S), 45 with dual diagnosis (DD), 44 with substance use disorder (SUD) and 44 healthy controls (HC). The Patient Health Questionnaire-9 and the Hamilton Depression Rating Scale were used to measure depressive symptom severity, while the Social Readjustment Rating Scale was used for the assessment of stressful life events.ResultsWe found a greater main effect of substance use disorder relative to schizophrenia on the severity of depression symptoms and stressful life events. In addition, the observed significant interaction effect for stressful life events suggested that SUD patients experienced their greatest number while HC reported the fewest such incidents. Interestingly, significant links between stressful life events and depressive symptoms emerged in both SUD patients and HC. What is more, disease duration and exacerbations were significantly associated with depressive symptoms in DD and S patients.DiscussionThis study demonstrated the effect of schizophrenia and substance use disorders on depressive symptoms and the severity of stress. The relationship between stressful life events and depressive symptom severity was also investigated.ConclusionsCompared to schizophrenia, substance use disorder has a stronger effect on the presence of depression symptoms and the occurrence of stressful life events. The factors modifying depression symptom severity in both schizophrenia groups differ from those found in SUD patients and HC.

A graduate training protocol to provide evidence-based treatment for substance use and co-occurring disorders in rural correctional facilities: Process and lessons learned.

A graduate training protocol to provide evidence-based treatment for substance use and co-occurring disorders in rural correctional facilities: Process and lessons learned.

EXERCISE PROGRAM WITHIN ADULT PSYCHIATRIC INPATIENT SERVICES FOR THOSE WITH DISORDERED EATING

INTRODUCTION & AIMS Over one million Australians live with an eating disorder, with 40 – 80% reported to undertake dysfunctional exercise practices (e.g., compulsive exercise, exercise dependence). Dysfunctional exercise can be the first symptom to appear and the last symptom to resolved in eating disorder patients, with 41% of eating disorders patients relapsing into dysfunctional exercise patterns 4 to 9 months post inpatient treatment. We evaluated an accredited exercise physiology led program implemented for adult mental health inpatients with disordered eating and exercise behaviours to support patient outcomes and safe exercise participation. METHODS Data was collected as part of service evaluation and included patient characteristics, session data (e.g., mood and enjoyment via Exercise Enjoyment Scale) and patient outcomes (e.g., Compulsive Exercise Test (CET); Exercise Dependence Scale (EDS-21)). Characteristics of the cohort was reported and compared to clinical cut-offs, along with program feasibility measures. RESULTS Between Sep 2022 and Nov 2023, 20 female patients engaged in the program (mean age= 26 years). Of those 15 were diagnosed with Anorexia Nervosa, 16 with a co-occurring Personality Disorder and 9 with a Trauma Related Disorder. EDS-21 results showed 56% were symptomatic, and 33% exercise dependent, with 80% also presenting with suicidal ideation/self-harm. Across 137 service interactions, patients engaged 65% of the time, and 25% of the time deemed inappropriate. Pre-session mood was low (mean= -2.13 ± 1.46) with an average post-session mood improvement of + 4.46 Session enjoyment was high (mean=3.6±1.20) and no adverse events were recorded. CONCLUSIONS & IMPLICATIONS Exercise supported by AEPs is safe for inpatients with disorder eating, with patients valuing engagement in services focused on supporting positive exercise relationships and behaviours. A tailored and evidence-based approach to exercise can improve acute mood of consumers.

An Interdisciplinary Multimodal Integrative Healthcare Program for Chronic Spinal Pain and Comorbid Mental Disorders.

Previous studies evaluating interdisciplinary multimodal interventions for chronic spinal pain often excluded patients with comorbid mental disorders. This study aims to assess the effectiveness of an outpatient secondary care interdisciplinary multimodal integrative healthcare program for individuals experiencing co-occurring chronic spinal pain and mental disorders. Participants were 944 patients with chronic spinal pain and comorbid mental disorders. Primary outcomes were health-related quality of life, assessed using the Research and Development-36 (RAND-36), and pain-related disability, assessed using the Quebec Back Pain Disability Scale (QBPDS). Secondary outcomes included pain intensity, pain catastrophizing, kinesiophobia, fatigue, lumbar mobility, and isometric strength. Data were collected during the healthcare program at four time points: pretreatment (T0), midway through 20-week treatment (T1), end of 20-week treatment (T2), and at completion of 12-month relapse prevention program (T3). Multilevel regression analyses were conducted to examine the effects of the healthcare program on primary outcomes over time. The 20-week treatment period yielded significant improvements in both mental ( B = 0.44, t (943) = 19.42, p < .001) and physical component summary scores ( B = 0.45, t (943) = 18.24, p < .001) of the RAND-36, as well as in QBPDS total score ( B = -0.77, t (943) = -26.16 p < .001). Pretreatment scores indicated the presence of problematic fatigue, kinesiophobia, and clinical levels of pain catastrophizing, all of which resolved by the end of the 12-month relapse prevention program. An interdisciplinary multimodal integrative healthcare program seems effective for patients with chronic spinal pain and comorbid mental disorders.

Revitalizing classical Ayurveda practice in urban India—Contribution of Vaidya V. R. Padmanabha Rao

Abstract The renaissance of Ayurveda in contemporary times owes much to the remarkable contributions of exemplary practitioners. This paper explores the journey of Dr. V. R. Padmanabha Rao (1953–2020), an Ayurveda clinician who not only demonstrated excellence in clinical practice but also spearheaded the creation of “Agnivesha Ayurveda Anushthana,” an exclusive organization devoted to the education and training of Ayurveda doctors. Dr. Rao played a pivotal role in influencing and guiding numerous Ayurveda graduates to transition from allopathy to Ayurvedic clinical practice. His therapeutic knowledge was disseminated in a number of national and international forums, especially with regard to his successful treatment of male infertility. Central to his teachings was the concept of “How to be a successful Ayurveda clinician,” anchored in the three pillars of dual diagnosis (integrated Ayurveda and modern methods), the utilization of self-prepared classical medicines (single-herb therapy), and the cultivation of excellent clinical and administrative skills including documentation of clinical cases.

Tobacco use disorder and other mental disorders: The neglected dual disorder

Tobacco use disorder and other mental disorders: The neglected dual disorder

Intellectual Disability (Mental Retardation): Focus on Poverty, India, and Use of a Brain-Based Diagnostic Tool

Mental Retardation as a label has been replaced by several others including Severe Learning Disability in Britain. Intellectual Disability is the most commonly used one. The present report begins with the distinction between genetic factors and cultural-familial conditions such as maternal health and poverty. Assessment of intellectual ability as a diagnostic tool based on a Brain-Based approach to Intelligence is preceded by a brief description of its incidence in India where poverty is a significant cultural disadvantage. Brain- Based Intelligence Test (BBIT) comprising two major cognitive scales –Planning -Executive functions and Information-Integration is presented in a graphic model. This is followed by report an individual case. Record of test results shows a cognitive profile of Mild Intellectual Disability However a clinical examination of the case suggests a diagnosis of Autistic Spectrum Disorder. A case of dual diagnosis.

Chymotrypsin etched ultrasmall gold nanoclusters for dual response diagnosis and deeply penetrated chemodynamic therapy of pancreatic cancer

Pancreatic cancer (PC) is a highly invisible malignancy for which the early diagnosis is crucial to achieve the best treatment outcome. Abnormalities in serum chymotrypsin (ChT) are commonly associated with the development of PC, suggesting its potential role as a novel biomarker candidate. Herein, we report a ChT-responsive ultrasmall apo catalase-stabilized gold nanoclusters (AuCATapo NCs, core size ∼2 nm) with remarkable fluorescence and peroxidase (POD)-like activity. It can achieve "fluorescence" and "colorimetric" dual detection of ChT, with a wide detection range (0 – 100 μg/mL) and a low detection limit (0.029 μg/mL). Additionally, the weak acidity (pH 6.2 – 6.8) in the tumor microenvironment can meet the optimal catalytic capacity of deeply penetrated AuCATapo NCs, which generates cytotoxic reactive oxygen species to cause thorough tumor damage effects. The ChT-cleaved AuCATapo NCs may expose more catalytic active sites, resulting in higher tumor cytotoxicity, as demonstrated in both in vitro and in vivo models. Generally, these NCs probes can simultaneously realize accurate detection of ChT and efficient pancreatic tumor ablation via nanozyme based catalytic therapy, opening up a new idea of "diagnosis and treatment integration" for PC.

Prevalence of Opioid Use Disorder and Opioid Overdose Rates Among People With Mental Illness.

The authors examined the prevalence and correlates of co-occurring opioid use disorder and opioid overdose among individuals receiving psychiatric services. This was a cross-sectional study of adults with continuous enrollment in New York State Medicaid who received at least one psychiatric service in 2020 (N=523,885). Logistic regression models were used to examine the correlates of both opioid use disorder and overdose. In the study sample, the prevalence rate of opioid use disorder was 8.1%; within this group, 7.7% experienced an opioid overdose in the study year. Opioid use disorder rates were lower among younger (18-24 years; 2.0%) and older (≥65 years; 3.1%) adults and higher among men (11.1%) and among those residing in rural areas (9.9%). Compared with Whites (9.4%), opioid use disorder rates were lower for Asian Americans (2.0%, adjusted odds ratio [AOR]=0.22) and Blacks (6.8%, AOR=0.76) and higher for American Indians (13.2%, AOR=1.43) and Hispanics (9.6%, AOR=1.29). Individuals with any substance use (24.9%, AOR=5.20), posttraumatic stress (15.7%, AOR=2.34), bipolar (14.9%, AOR=2.29), or anxiety (11.3%, AOR=2.18) disorders were more likely to have co-occurring opioid use disorder; those with conduct (4.5%, AOR=0.51), adjustment (7.4%, AOR=0.88), or schizophrenia spectrum (7.4%, AOR=0.87) disorders were less likely to have opioid use disorder. Those with suicidality (23.9%, AOR=3.83) or economic instability (23.7%, AOR=3.35) had higher odds of having opioid use disorder. Overdose odds were higher among individuals with suicidality (34.0%, AOR=6.82) and economic instability (16.0%, AOR=2.57). These findings underscore the importance of providing opioid use disorder screening and treatment for patients receiving psychiatric services.