Comorbid Substance Dependence Research Articles

The effects of childhood trauma and mental disorders on treatment engagement, contact with the criminal justice system, and mortality among people with opioid dependence

BackgroundChildhood trauma and mental disorders increase the risk of opioid dependence. We aimed to examine whether childhood trauma and mental disorders are associated with opioid agonist treatment (OAT) engagement, contact with the criminal justice system, and mortality among people with opioid dependence. MethodsThis observational study linked survey data from 1482 people receiving OAT in Sydney, Australia (2004–2008) to administrative data on OAT, crime, and mortality through 2017. We used survey data to assess childhood trauma, depression, panic disorder, post-traumatic stress disorder (PTSD), borderline personality disorder, anti-social personality disorder (ASPD), and comorbid substance dependence. We used discrete-time analysis to examine time from opioid dependence onset to OAT entry and mortality. Poisson regressions were used to analyze time receiving OAT and number of charges. ResultsParticipants with extensive childhood trauma histories and ASPD were less likely to enter OAT and those with depression were more likely to enter OAT in any given year after opioid dependence onset. Panic disorder, PTSD, and borderline personality disorder were associated with less time in OAT. Extensive histories of childhood trauma, PTSD, ASPD, and comorbid substance dependence increased risk of charges for any offence. There were no significant associations between the exposure variables and mortality. ConclusionsOur findings suggest that childhood trauma and mental disorders increase the risk of adverse treatment and social outcomes among people with opioid dependence. Interventions that aim to reduce harm among people with opioid dependence may consider the effect of childhood trauma and mental disorders on OAT engagement and crime.

Prevalence and association of comorbid substance dependence on the course and outcome of bipolar disorder: Findings from the bipolar disorder course and outcome study from India (BiD-CoIN study)

To evaluate the prevalence of substance use disorder (SUD) and its association with the course and outcome of bipolar disorder (BD). A total of 773 patients with BD were recruited from 14 centers in different parts of India, and they were evaluated for the prevalence of comorbid substance dependence, course and outcome, subjective cognitive functioning, and disability. About one-fourth (22.9%) of the participants had one or more substance dependence. In terms of specific substance of abuse, 136 (17.6%) had nicotine dependence, 80 (10.3%) patients had alcohol dependence, 13 (1.7%) had cannabis dependence, and nine (1.2%) had opioid dependence. Compared to those without comorbid substance dependence, those with a dual diagnosis (i.e., using at least one substance in a dependent pattern) were less educated, more often males, more often currently single, more often employed, had a lower number of depressive episodes per year of illness, had a higher number of manic and mixed episodes per year of illness in the first 5 years of illness, had a higher level of disability, and more often had a history of hospitalization and a history of receiving electroconvulsive therapy (ECT); also, a higher proportion of them had manic predominant polarity, more often had recurrent mania course, and were more often receiving a combination of lithium and valproate. About one-fourth of BD patients have comorbid SUDs, and presence of SUD has a negative impact on the course and outcome of BD.

Bipolar Disorder Course and Outcome Study from India (BiD-CoIN study): Sample Description & Methods

ObjectivesThis multicentric study from India aimed to evaluate the long term course and outcome of bipolar disorder (BD). MethodSeven hundred and seventy-three participants diagnosed with BD, attending 14 outpatient clinic centers across the country, were evaluated using the National Institute of Mental Health- Retrospective Life Charts to assess the long term course of BD. ResultsThe mean age of onset of the first episode of illness of the study sample was 26.3 (8.54) years, and mean duration of illness at the time of assessment was 233.05 (94.55) months. In terms of the total number of lifetime episodes, the mean number of manic episodes (mean: 3.68; SD: 4.75) exceeded the mean number of depressive episodes (mean: 3.36; SD: 5.51). The mean numbers of total lifetime episodes were 8.58 (10.6%). When the number of episodes per year was computed, the mean number of manic episodes per year exceeded that of the mean number of depressive episodes. Compared to females, a higher proportion of males had a history of comorbid substance dependence. LimitationsThe course was assessed retrospectively and the study was limited to participants attending the outpatient clinics. ConclusionsThe course of BD in India differs from that described from developed countries in the form of a number of manic episodes exceeding the depressive episodes.

Substance Dependence Comorbidity With Mental Disorders in Egyptian Young Adults

Objectives: Substance dependence is commonly seen among Egyptian young adults. Unfortunately limited data are available about the prevalence of comorbidity of mental disorders and substance dependence in this age group. In addition, substance dependence is correlated with many psychopathologic factors such as low self-esteem, childhood abuse, and stressful life events, etc. which could aggravate the load of the disorder. Methods: A case control study that included 80 patients diagnosed with substance dependence according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, text revised (DSM-IV-TR). The sample was recruited from Kasr Al-Ainy Psychiatry and Addiction Hospital. Subjects were divided into 2 groups: group 1 (cases with the diagnosis of comorbid substance dependence and other mental disorder) and group 2 (cases with the diagnosis of substance dependence only). They were examined using Addiction Severity Index (ASI) and Rosenberg Self-Esteem Scale (RES). Results: Patients in group 1 had significantly higher levels of impairment and disability in scores of ASI: drug use, social impairment, and psychiatric problems. They had higher percentage of psychopathologic factors, for example, history of childhood abuse. There was no significant difference in the presence of comorbid personality disorder, or history of stressful life events. Conclusions: Comorbidity of mental disorders with substance dependence is associated with more impairment and functional deterioration. Young adults with substance dependence have high levels of associated psychopathologic factors, such as childhood abuse, stressful life events, and deliberate self-harm.

Gender differences, family size and fertility rate among patients with bipolar disorder: A study from India

This study aimed to estimate the gender differences, family size and fertility rate among patients with Bipolar disorder (BD). 219 patients diagnosed with BD, who were married for at least 3 years and aged more than 25 years were assessed clinically for the course of illness as per the NIMH-life chart. Fertility and infertility were assessed based on the information on number of living children, abortions and medical termination of pregnancies. Significantly higher proportion of male patients had comorbid substance dependence while females had significantly higher prevalence of physical comorbidity. Additionally, female participants reported significantly higher mean number of depressive episodes per year of illness and suicidal attempts. When marriage was considered as a life event and its association with onset or relapse of illness was evaluated, about one-fourth (23.3%) of the study sample reported relapse of illness at the time of marriage or immediately following the marriage. About one-fourth (24.7%) of the couple with one of the partner having bipolar disorder had no living children even after four years of their marriage. To conclude, this study suggests that there are certain gender differences with regard to the clinical profile and longitudinal course of illness of BD.

Clinical correlates of subsyndromal depression in African American individuals with psychosis: The relationship with positive symptoms and comorbid substance dependence

Patients with psychosis exhibit subsyndromal depressive symptoms during the course of illness and yet the clinical correlates of these symptoms remain under-investigated. We aimed to investigate the clinical correlates of subsyndromal depression in psychosis including the extent to which they mediate commonly observed comorbid substance dependence. We developed a model of depression in a non-clinical sample recruited via Amazon's Mechanical Turk (N = 266), and confirmed that model in a locally recruited African-American clinical sample comprising psychotic and non-psychotic individuals (N = 256). Using scores from this model we tested: the strength of relationships between depressive symptomatology and positive, negative and disorganized symptoms in a range of psychotic disorders; whether depressive symptoms were higher in individuals with affective psychoses versus schizophrenia; and if depressive symptomatology mediated the relationship between psychosis and substance dependence. Subsyndromal depressive symptomatology was significantly higher in individuals with psychosis than without psychosis, but did not significantly differ between affective and non-affective psychotic groups. Depressive symptomatology was significantly related to positive (but not negative or disorganized) psychotic symptoms, and mediated the relationship between psychosis and substance dependence. The present study underlines the importance of assessing subsyndromal depression in patients with psychosis, and generates a number of testable predictions for future work. In particular, the examination of the relationships between comorbid psychopathology, namely depression and substance abuse, may improve insight into the neurobiology of psychosis.

Efficacy and Safety of Atypical Antipsychotics in Bipolar Disorder With Comorbid Substance Dependence: A Systematic Review

Bipolar disorder (BD) patients with a comorbid substance use disorder (SUD) are notoriously difficult to treat. Atypical antipsychotics (AAPs) are widely prescribed in BD, but their efficacy in patients with comorbid SUD is still debated. The aim of the present article is to systematically review the literature findings on the efficacy and safety of AAPs in BD patients with comorbid SUD. We searched PubMed to identify original studies focused on the treatment of dual diagnosed BD with AAPs. Ten articles met our inclusion/exclusion criteria, involving a total of 969 subjects, 906 affected by BD and 793 with comorbid SUD: 4 were randomized controlled trials, 4 were open label trials and 2 were observational studies, published between 2002 and 2017. The most commonly abused substances were alcohol and cocaine. The AAPs used to treat patients were quetiapine (n = 337), asenapine (n = 119), olanzapine (n = 80), risperidone (n = 62), and aripiprazole (n = 48). In terms of safety, AAPs were usually well tolerated. Atypical antipsychotics were usually efficacious on acute mood symptoms, whereas their impact on substance-related issues was reported only in those studies without a placebo comparison. According to our results, even though AAPs are widely used and efficacious in treating the clinical symptoms of BD, there are not enough data to suggest their adjunctive benefit on craving and substance consumption.

T27. DYSFUNCTIONAL ATTITUDES IN ADOLESCENTS WITH EARLY-ONSET PSYCHOSIS: PRELIMINARY RESULTS

BackgroundDysfunctional attitudes such as defeatist performance beliefs (DPB) and asocial beliefs (AB) have been linked to negative symptoms and functional outcome in chronic schizophrenia (Campellone et al., 2016; Grant and Beck, 2010) and in adults with recent onset schizophrenia (Ventura et al., 2014). Adolescents with early-onset psychosis (EOP) are at major risk of having persistent negative symptoms (Puig et al., 2017) but no previous study has examined dysfunctional attitudes in this population. We aimed: (1) to examine if more DPB and AB were present in adolescents with EOP compared with normal controls, and (2) to study the relationships between DPB and AB with symptoms and functioning.MethodsSample: 15 adolescents with EOP (11♀, age=15.33 ± 1.23) and 10 healthy controls (8♀, age=15.60 ± 1.51), participants in a trial about cognitive and behavioral social skills treatment in EOP developing in Hospital Clínic of Barcelona (baseline data). Patients were under antipsychotic meds. Inclusion criteria: having an early-onset schizophrenia spectrum disorder diagnosed between 9–18 years-old (schizophrenia, schizoaffective disorder, psychosis n.o.s.); being within the 5 first years after the disease onset; clinical stability. Exclusion criteria: IQ<70; comorbid substance dependence disorder; neurological disorders. Instruments: PANSS (Kay et al., 1987), Calgary Depression Scale (CDS, Addington et al., 1990), Children’s Global Assessment Scale (C-GAS, Shaffer et al., 1983), Social and Role Functioning Scales (GF:S, GF:R, Cornblatt et al., 2007), Life Skills Profile - Adolescent version (Puig et al., 2013), Dysfunctional Attitudes Scale - Spanish version (DAS, Sanz et al., 1993); Asocial Beliefs Scale (Grant and Beck, 2010). DPB was extracted from the DAS scale following Beck et al. (2013). Groups were compared with T-test or Chi-square tests. Pearson correlations were computed for examining relationships between variables.ResultsEOP and control groups were homogeneous in age (t=-0.49, p=0.632) and sex (X2=0.15, p=0.702). All subjects were living with their parents. Family SES was lower in EOP group (X2=10.69, p=0.030). All subjects but one patient were studying although patients had repeated more courses (t=4.00, p=0.001). EOP subjects had a predominance of negative symptoms (positive symptoms=14.07 ± 3.85; negative symptoms=23.50 ± 13.79; general symptoms=31.86 ± 7.28). Mean score of CDS in EOP was low (3.77 ± 4.76). EOP group had lower scores in all functional measures than controls (C-GAS: 51.14 ± 9.38 vs 93.70 ± 4.45, GF:S: 5.71 ± 1.07 vs 9.00 ± 0.47, GF:R: 5.21 ± 1.12 vs 8.80 ± 0.42, LSP: 67.64 ± 12.30 vs 44.13 ± 3.60; t>6.67, p<0.001). Regarding dysfunctional attitudes, EOP group had higher scores in dysfunctional attitudes scales than healthy controls (DPB: 55.60 ± 19.57 vs 33.00 ± 9.37, AB: 6.67 ± 3.42 vs 3.00 ± 2.11; t>3.02, p<0.006). In EOP, DPB and AB scores were negatively correlated with functioning (DPB: C-GAS r=-0.60, GF:S r=-0.66, GF:R r=-0.66, LSP r=0.65; p<0.002; AB: C-GAS r=-0.45, GF:S r=-0.55, GF:R r=-0.49, LSP r=0.53; p<0.029). No significant correlation were found between dysfunctional attitudes and negative symptoms in EOP.DiscussionThese preliminary results showed that adolescents with EOP had higher levels of dysfunctional attitudes than controls. Accordantly to recent literature, defeatists performance beliefs and asocial beliefs were correlated with poorer functioning. However, dysfunctional attitudes were not associated with negative symptoms. It might be that dysfunctional attitudes do not contribute to negative symptoms but in functional outcome in youngs with EOP although larger samples are required. Acknowledgments: Fundación Alicia Kolplowitz.

Mobile cognitive testing in patients with schizophrenia: A controlled study of feasibility and validity

Summary There is now abundant evidence that cognitive deficits are a core component of schizophrenia. Ecological momentary assessment (EMA) uses mobile technologies to provide lacking information concerning fluctuations in the cognitive functions and their immediate association with the expression of symptoms among individuals with this disorder. The present investigation examines the compliance rates, biases, and validity indicators of this methodology in patients with schizophrenia compared to healthy controls. Twenty-two outpatients with schizophrenia (50% with comorbid substance dependence comorbidity) and 27 healthy controls participated in this study. All participants received a traditional battery of neuropsychological assessments including the Stroop test and Letter-verbal fluency. EMA was also used to provide five electronic interviews per day over a one-week period. Two different versions of a brief cognitive test were administered alternately during the electronic interviews to assess executive functioning (a color-word interference task and letter-word generation task). Feasibility was examined as a function of compliance, fatigue and practice effects. Convergent validity was assessed by examining the correlation between neuropsychological test scores and the corresponding EMA executive assessments. Our findings indicate strong support for the overall feasibility of mobile cognitive testing in this population, and significant correlations between mobile cognitive tests and standard clinical measures support their convergent validity.

Indian Association for Geriatric Mental Health's multicentric study on depression in elderly: Symptom profile and influence of gender, age of onset, age at presentation, and number of episodes on symptom profile

Aim of the Study: To assess the symptom profile of depression among elderly patients presenting to psychiatric outpatient settings. An additional aim was to evaluate the influence of gender, age of onset, age at presentation, and type of episode (i.e., the first episode versus recurrent depressive episodes) on symptom profile of geriatric depression. Materials and Methods: This multicentric study was conducted at eight centers in which 488 elderly patients (aged ≥60 years) with depression were evaluated on Geriatric Depression Scale (GDS-30), Generalized Anxiety Disorder-7 Scale (GAD-7), Patient Health Questionnaire-15 (PHQ-15) scale, and Columbia Suicide Severity Rating Scale. Results: Males had significantly higher prevalence of comorbid substance dependence, whereas females had significantly higher prevalence of comorbid psychiatric disorders. As per the GDS-30, about two-third or more of the study sample had symptoms of feeling helpless (71.7%), often getting restless and fidgety (70.1%), dropped many of their activities (68.4%), frequently feel like crying (67.4%), trouble concentrating (67%), feels pretty worthless (66.4%), often feeling downhearted and blue (65.8%), frequently getting upset over little things (64.8%), and not satisfied with life (62.9%). More than two-third of the sample had all the symptoms of anxiety as per the GAD-7 and 7 out of the 14 somatic symptoms as per the PHQ-15. When comparisons were made between males and females, significant difference in prevalence was noted for some of the depressive symptoms as assessed by the GDS-30 and somatic symptoms as assessed by the PHQ-15, but no differences emerged in terms of anxiety symptoms. Significantly higher proportion of females reported active suicidal ideation with specific plan and intent and had higher intensity of suicidal ideations. Differences in symptom profile were also noted with regard to age of onset (

Comorbid depressive symptoms in persistent delusional disorder: A retrospective study from India

BackgroundPrevious studies have reported depressive symptoms in patients with persistent delusional disorder (PDD). Patients with PDD and depression may need antidepressants for treatment.AimThe aim of the study was to compare the sociodemographic profile, clinical presentation and treatment response in patients with PDD with and without comorbid depressive symptoms.MethodsWe conducted a retrospective chart review of patients diagnosed with PDD (ICD-10) from 2000 to 2014 (n = 455). We divided the patients into PDD + depression (n = 187) and PDD only (n = 268) for analysis.ResultsOf the 187 patients with PDD + D, only eighteen (3.9%) were diagnosed with syndromal depression. There were no significant differences in sociodemographic profile including sex, marital and socioeconomic status (all P &gt; 0.05). PDD + D group had a significantly younger age at onset ([PDD + D: 30.6 9.2 years vs. PDD: 33.5 11.1 years]; t = 2.9, P &lt; 0.05). There was no significant difference between the clinical presentation including mode of onset, the main theme of their delusion and secondary delusions (all P &gt; 0.3). However, comorbid substance dependence was significantly higher in patients with PDD only. (χ2 = 5.3, P = 0.02). In terms of treatment, response to antipsychotics was also comparable ([&gt; 75% response: PDD + D = 77/142 vs. PDD = 106/179); χ2 = 1.9, P = 0.3). There was a significant difference between the two groups in terms of antidepressant treatment ([PDD + D = 32/187; 17% vs PDD: 17/268; 6%), χ2 = 12.9, P = 0.001).DiscussionPatients with PDD + D had significantly earlier onset of illness. These patients may require antidepressants for treatment.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Disruption of white matter structural integrity and connectivity in posttraumatic stress disorder: A TBSS and tractography study

Most studies of brain white matter (WM) in posttraumatic stress disorder (PTSD) have focused on combat trauma, and often were confounded by neurological and substance dependence comorbidity. This study used tract-based spatial statistics (TBSS) and probabilistic tractography to characterize WM microstructure in a mixed-sex community sample of PTSD patients exposed to diverse and multiple traumas, and in trauma-exposed normal comparison (TENC) subjects. TBSS compared diffusion measures between 20 adults with DSM-IV PTSD and 17 TENC, using a whole-brain voxel-wise approach. Probabilistic tractography using Freesurfer's TRACULA was employed to measure diffusion tensor imaging (DTI) metrics within anatomically defined pathways. DTI metrics were compared between groups and correlated with PTSD symptom severity and trauma load. Controlling for age, sex, and motion, PTSD subjects had significantly reduced fractional anisotropy (FA) in a left frontal lobe cluster compared with TENC, at p < .05, family-wise error corrected. Tractography identified significant group differences in the inferior longitudinal fasciculus (ILF), including lower FA and higher radial diffusivity in PTSD compared with TENC. Within the PTSD group, FA values were not correlated with symptom severity or trauma load. Results remained significant after removing participants using psychotropic medication or those with comorbid major depression. PTSD patients had reduced WM integrity in left hemisphere frontal WM and temporal-occipital WM tracts, compared to trauma-exposed controls. Reduced frontal FA is consistent with compromised top-down attentional control and emotion regulation in PTSD, while reduced ILF FA may be related to sensory processing and gating abnormalities in this disorder.

Demoralization in Patients With Substance Use and Co-Occurring Psychiatric Disorders

ABSTRACTObjective: In recent years, treatment of substance use disorder has rekindled emphasis on recovery which, being a gradual process, starts with remoralization. In this study, we examine the level of demoralization throughout the treatment process for patients with comorbid substance dependence and psychiatric disorders. Methods: 217 patients with co-occurring disorders and 179 community-based individuals participated in this study. Demoralization was measured twice over one month as inpatient treatment happened. Results: In contrast with the community sample, we found high levels of demoralization in the clinical cohort, with 86% of patients having demoralization scores above threshold. During the first month there was a statistically significant reduction in demoralization scores. However, clinically relevant change appeared limited, with only 3% of patients moving from dysfunctional to functional status in this naturalistic setting without targeted intervention aimed at remoralization. Conclusions: Although the level of demoralization is significantly improved during the first month of treatment, patients still remain strongly demoralized. Clinically relevant improvement is limited. It could be worthwhile to set up targeted interventions aimed at remoralization. Furthermore, we advocate for the assessment of demoralization in the clinical setting to monitor patients' treatment outcomes.

Factors Associated with the Length of First Time Hospitalization in a Referral Psychiatric Hospital in North of Iran

Background: Length of hospitalization is an important indicator for optimal management and to reduce and save the costs. Objective: Considering the limited hospital capacity as a referral center for psychiatric patients, the high prevalence of the disease, and the high expense of the treatment, this study aimed to identify the factors associated with psychiatric patients’ length of hospitalization. Methods: The data were obtained from the records of all patients hospitalized for the first time since the April 2007 to the March 2012. The data collection tool was a checklist comprising of demographic variables, variables related to the socioeconomic status, psychiatric disorders, and the related variables such as length of hospitalization and a previous history. Results: In the present study, 2397 (72.8% males and 27.2% females) medical documentations were investigated. Median length of stay was 25 days. Using the Cox model, the variables including age, educational level, material status, employment, the insurance status, the history of hospitalization at psychiatric center, type of treatment and disorder, duration of disorder, the referral source , and hospitalization during religious months (Ramadan and Muharram) and agricultural seasons had a significant relationship with the length of hospitalization (P value < 0.05). Conclusions: The patients with anxiety disorders and substance dependence and also patients with the comorbid anxiety disorders and substance dependence had a higher hospitalization length than patients with psychotic disorders. Substance dependence and variables such as insurance status had a significant relationship with the length of hospitalization. In patients with the comorbid substance dependence and anxiety disorders, women had a longer length of hospitalization.

Persistent Cannabis Dependence and Alcohol Dependence Represent Risks for Midlife Economic and Social Problems

With the increasing legalization of cannabis, understanding the consequences of cannabis use is particularly timely. We examined the association between cannabis use and dependence, prospectively assessed between ages 18-38, and economic and social problems at age 38. We studied participants in the Dunedin Longitudinal Study, a cohort (n=1,037) followed from birth to age 38. Study members with regular cannabis use and persistent dependence experienced downward socioeconomic mobility, more financial difficulties, workplace problems, and relationship conflict in early midlife. Cannabis dependence was not linked to traffic-related convictions. Associations were not explained by socioeconomic adversity, childhood psychopathology, achievement orientation, or family structure; cannabis-related criminal convictions; early onset of cannabis dependence; or comorbid substance dependence. Cannabis dependence was associated with more financial difficulties than alcohol dependence; no difference was found in risks for other economic or social problems. Cannabis dependence is not associated with fewer harmful economic and social problems than alcohol dependence.

Profiles of Youths With PTSD and Addiction

ABSTRACTObjective: Understanding the relationship between PTSD and addiction in adolescents may dramatically improve evidence-based practice in child psychiatry. We hypothesized that in a sample of substance addicted youth, PTSD would correlate with (1) female gender and racial minority status, (2) preference for anxiolytic substances, (3) higher burden of self injury and suicide attempts, and (4) earlier age of first use. Methods: One-hundred and ninety-five adolescents (52% female, ages 14–18) were court-referred to residential treatment and assessed at intake. Multi-informant data regarding Axis I diagnostic status and other clinical variables were collected via rater-administered, semi-structured interviews; medical chart review; and youth, parent, and clinician reports. Differences between subjects were evaluated using Fisher's exact test for binary variables or Kruskal-Wallis Chi-Square Test. Results: Substance dependent youth with comorbid PTSD were significantly more likely to be female and Latino. PTSD was correlated with preference for alcohol, narcotics, tranquilizers and inhalants. In addition, PTSD was correlated with higher burden of self-injury and suicidal behavior. Youth with PTSD were also more likely to have begun using before age 13 and reported that PTSD symptoms preceded first use. Conclusions: Girls and Latinos may be particularly vulnerable in developing comorbid substance dependence and PTSD. Drug preferences among youth with PTSD may reflect tendencies to target symptoms such as hypervigilance and anxiety. The recognition and early intervention among youth with trauma could prevent early first use and eventual substance dependency.

An association study revealed substantial effects of dominance, epistasis and substance dependence co-morbidity on alcohol dependence symptom count.

Alcohol dependence is a complex disease involving polygenes, environment and their interactions. Inadequate consideration of these interactions may have hampered the progress on genome-wide association studies of alcohol dependence. By using the dataset of the Study of Addiction: Genetics and Environment with 3838 subjects, we conducted a genome-wide association studies of alcohol dependence symptom count (ADSC) with a full genetic model considering additive, dominance, epistasis and their interactions with ethnicity, as well as conditions of co-morbid substance dependence. Twenty quantitative trait single nucleotide polymorphisms (QTSs) showed highly significant associations with ADSC, including four previously reported genes (ADH1C, PKNOX2, CPE and KCNB2) and the reported intergenic rs1363605, supporting the overall validity of the analysis. Two QTSs within or near ADH1C showed very strong association in a dominance inheritance mode and increased the phenotype value of ADSC when the effect of co-morbid opiate or marijuana dependence was controlled. Highly significant association was also identified in variants within four novel genes (RGS6, FMN1, NRM and BPTF), two non-coding RNA and two epistasis loci. QTS rs7616413, located near PTPRG encoding a protein tyrosine phosphatase receptor, interacted with rs10090742 within ANGPT1 encoding a protein tyrosine phosphatase in an additive × additive or dominance × additive manner. The detected QTSs contributed to about 20 percent of total heritability, in which dominance and epistasis effects accounted for over 50 percent. These results demonstrated that perturbations arising from gene-gene interaction and conditions of co-morbidity substantially influence the genetic architecture of complex trait.

Mentalization-based therapy adherence and competence stimulates in-session mentalization in psychotherapy for borderline personality disorder with co-morbid substance dependence

Objective: To test whether adherence to mentalization-based treatment (MBT) principles predict better patient in-session mentalizing. Methods: Two sessions for each of 15 patients with borderline personality disorder and comorbid substance abuse disorder were rated for MBT adherence and competence. Individual patient statements were rated for Reflective Functioning (RF), therapist statements were rated as demanding RF or not. Data were analysed using multilevel modelling. Results: MBT adherence and competence predicted higher session RF (β = .58–.75), even while controlling for pre-treatment RF. In addition, therapist interventions directed toward exploring mental states predicted higher RF of subsequent patient responses (β = .11–.12). Conclusions: MBT adherence and competence were significantly related to patient in-session mentalizing, supporting the validity of MBT principles. Results point to the importance of supervision for therapists to become adherent to MBT principles. The small number of patients and sessions limits generalizability of results.

The impact of psychotic disorders and co-morbid substance abuse on vocational rehabilitation: results from an Australian national survey of psychosis

Introduction It is unclear from prior research whether or not substance abuse co-morbid with psychosis is an added barrier to success in vocational rehabilitation. The aim of this study was to examine the relationships among three types of co-morbid substance abuse or dependence, by type of employment assistance received (disability employment services, mainstream unemployment services, other government programmes, and own resources), and by type of employment attained (competitive and non-competitive). Method Data were drawn from the Australian National Survey of High Impact Psychosis ( N = 1825). The survey was conducted in seven Australian catchment areas March to December 2010. Descriptive statistics and logistic regression methods were used. Results There were no added effects of lifetime substance abuse or dependence on any employment. However, there were some minor substance-specific effects. Past year cannabis use was negatively associated, while alcohol use was positively associated with being employed. All categories of lifetime substance abuse or dependence were associated with reduced utilisation of intensive forms of employment assistance. Conclusion At a population level, lifetime substance abuse or dependence had no added impact on current employment status. Those with psychosis co-morbid with lifetime substance abuse or dependence could benefit from greater utilisation of evidence-based supported employment.

Clinical Presentation and Course of Persistent Delusional Disorder: Data From a Tertiary Care Center in India.

Despite its long history as a psychiatric diagnosis, little is known about the sociodemographic and clinical profile of persistent delusional disorder (PDD) or its subtypes, treatment response, and outcomes, particularly in India. We examined the clinical characteristics and course of PDD in patients presenting to a tertiary neuropsychiatry center in India. A retrospective chart review of patients diagnosed with PDD (ICD-10) between January 2000 and May 2014 was conducted. Sociodemographic and clinical data including age at onset, total duration of the illness, clinical symptoms and treatment, hospitalizations, occupational functioning, and follow-up were extracted from the files. The study was approved by the institute ethics committee. The sample (N = 455) consisted of 236 men and 219 women. The mean age at onset was 32.36 ± 10.47 years. The most common delusion was infidelity (n = 203, 44.6%) followed by persecution (n = 149, 32.7%). Hallucinations were present in 78 (17.1%), depressive symptoms in 187 (41.1%), and comorbid substance dependence in 61 (13.4%) subjects; 141 subjects (31.0%) had a family history of mental illness. Follow-up data were available for 308 subjects, of whom 285 (92.5%) reported good compliance with medication. Of the subjects, 163 (52.9%) showed a good response to treatment. The diagnosis of PDD remained unchanged in 274 of 308 subjects (88.9%). In our center, PDD appears to be uncommon and has a near-equal gender representation. Infidelity was the most common delusion, which is in contrast to the reported literature. The diagnosis of PDD appears to be stable with good response to atypical antipsychotics if compliance can be ensured.