Diagnosis Of Substance Abuse Disorder Research Articles

Dutch forensic patients with and without intellectual disabilities: A comparison of demographic, offence, and diagnostic characteristics

BackgroundPatients with an intellectual disability (ID) and offending histories constitute a challenging clinical group. The present study examined commonalities and differences in demographic, diagnostic and offence characteristics in patients with and without intellectual disabilities who were either convicted for violent or sexual offences and who resided in mandated care in the Netherlands. MethodWe compared 165 offenders with an ID to 249 offenders without an ID.We compared both groups by type of offence (i.e., sexual versus violent offence) using Mann–Whitney U-test or independent samples t-tests for continuous variables and Chi-square tests for categorical variables. ResultsIn general, forensic patients with an ID were younger at admission (U=357, z = −12.668, p < .001), had more prior convictions for violent offences (χ2(1)= 6.175, p = .013) and more prevalent diagnoses of substance abuse disorders (χ2(1)= 9.266, p = .002) than those without an ID. Similar results were found for patients with IDs with sexual offence histories. ConclusionA clear understanding of distinct characteristics of forensic patients with intellectual disabilities is crucial in understanding (sexual) violent behavior in this population as it mayassistclinicians in prioritizing interventionstrategies.

Integrated Primary Specialty Care Access for Adults with Sickle Cell Disease in Delaware

INTRODUCTION A major gap in US care for Sickle Cell Disease (SCD) is a dearth of healthcare providers with expertise in adult SCD management. In 2014 TOVA Community Health launched a community-based primary specialty care clinic in Delaware (DE). The Delaware Department of Health and Social Services found that 96 individual adults in DE with Sickle Cell Disease (SCD) utilized hospital services 99.5% of the time for sickle cell crisis (Anderson et al., 2014). The majority of those adults lived in New Castle County, DE. The dearth of sickle cell hematologist/oncologists for adults in this county may drive them to seek recurrent care through the hospital system. Recognizing this as a nationwide public health crisis, the Delaware Department of Health and Social Services (DHSS) partnered with TOVA Community Health in 2014 to establish an adult primary specialty care clinic medical home in New Castle County, DE. This report describes the progress/impact of an integrated primary specialty clinic for adults with SCD METHODS Prospective/ Retrospective tracking of best practices for SCD are featured in the NIH 2014 guidelines. The staff included a hematologist with expertise in SCD, a primary care provider, an advanced practice nurse, a Social Worker (MSW), a nurse care coordinator, and a community health worker, were funded by Sickle Cell Disease Association of America (SCDAA) and Health Resources and Services Administration (HRSA). From 2014 to 2018, integrated primary specialty care services were provided for 33 discrete patients. RESULTS This first cohort of patients was notable for health complications that may be attributed to the lack of coordinated primary specialty sickle cell care access. Therapeutic counseling, support groups and preventive health maintenance services were measured by: outpatient visits to the clinic, access to disease modifying therapies (hydroxyurea therapy or chronic transfusion therapy), immunizations (Pneumococcal), Depression Screens and Personalized Sickle Care Plans (Table). 21 % percent of the patients had no sickle cell provider and/or hematologist/oncologist other than ED or inpatient care for the 12 months preceding their first visit to our clinic. 48% of the patients received a pneumococcal vaccine (Pneumovax 23 val - n=16/33 and Prevnar 13 - n=7/33) and three (n=3/33) received both Pneumococcal vaccines. 30% percent of the patients (n=10/33 patients) seen were offered access to HU but were not on the drug and 42% (n=14) were prescribed HU. All patients did not have a Personalized Sickle Cell Care Plan prior to receiving services at the Primary Specialty Care clinic. 12% (n=4/33) patients had a diagnosis of Substance Abuse Disorder, 15% (n=5/33) had a diagnosis of Opioid Use Disorder and 3% (n=1/33) had both Substance Abuse and Opioid Use Disorder. 70% (n= 7/10) were male and 30% (n-3/10) were female with a diagnosis of Substance Abuse and/or Opioid Use Disorder. 45% (n=15/33) had a Pain Management Agreement established within the time period at the primary specialty clinic. CONCLUSION The creation of an integrated practice primary specialty care clinic for adults with SCD in New Castle County, Wilmington, DE demonstrates the successful leverage of regional networks that engages an academic institution for telehealth consultation, public health, and community-based organizations to develop an adult SCD primary specialty care model. This safety net clinic provides team based primary specialty care to adults whose only option previously was the hospital and/or emergency room. Unique challenges in managing adult SCD acute and chronic pain were addressed. Overall, this is one model for access to integrated primary specialty care and behavioral health services for persons with SCD across their lifespan. Figure 1. Disclosures No relevant conflicts of interest to declare.

087 Characterizing the Priapism Superuser: A Longitudinal, Population-based Study

Priapism is a medical emergency requiring prompt intervention and utilizes significant healthcare resources. The estimated cost of emergency visits and hospital admission for priapism is $1,778 and $41,909, respectively. To our knowledge, no studies have characterized the patient factors associated with recurrent episodes of priapism on a population level. The purpose of this study is to identify patient factors associated with recurrent hospital visits for priapism. The Healthcare Cost and Utilization Project State Inpatient Databases and State Emergency Department Databases for California from 2007-2011 were linked and utilized. Patients were identified as having a diagnosis of priapism by ICD-9 diagnosis code (607.3). They were tracked longitudinally for subsequent encounters for priapism. Patients with >3 hospital encounters for priapism were compared to those with ≤3 hospital encounters in regards to patient and treatment characteristics. 2,843 patients presented for 4,344 hospital (emergency room or inpatient) encounters with a diagnosis of priapism in California between 2007-2011. Of these patients, 2,256 (79.35%) had a single encounter for priapism, while 5.42% had more than three priapism hospital visits (Figure 1). On multivariate analysis, predictive factors for recurrent priapism visits included African American race, diagnosis of sickle cell disease, diagnosis of mental health disorder, and diagnosis of substance abuse disorder. Patients with recurrent priapism are more likely to be discharged from the emergency department (OR 0.19, p<0.005) and are less likely to undergo a therapeutic priapism procedure, such as irrigation or shunt (OR 0.712, p<0.005).

Impact of State Psychiatric Hospital Waitlists on Monthly Admissions.

This study estimated the effects of a waitlist policy on the monthly number and case mix of admissions to state psychiatric hospitals (SPHs) in North Carolina (NC). Descriptive analyses compared pre/postwaitlist differences in the monthly number and case mix of nonforensic adult admissions (N=72,035) to NC's four SPHs by using data from the three years before and the three years after the waitlist announcement. Hospital-level fixed-effects regression models further evaluated the waitlist policy's impact on the number and case mix of admissions. Regression results confirmed that the waitlist policy was associated with both fewer admissions and changes to the case mix of admissions, including a 4.2% decrease in the percentage of monthly admissions by patients with diagnoses of substance abuse disorders (p=.002) across all months postwaitlist (partially offset by an increase of patients with diagnoses of severe mental illness alone). Waitlists led to reduced monthly admissions and altered case mix following implementation at NC SPHs.

Metacognitive abilities in adults with substance abuse treated in therapeutic community.

The term metacognition reflects a spectrum of psychological activities that allows people to form and integrate representations about their own mental states and those of others. The main goal of this study was to examine whether people with substance abuse disorders (SUDs), and treated in therapeutic community regime, displayed specific patterns of metacognitive deficits on Self-reflectivity, Understanding others&rsquo; mind, Decentration, and Mastery, comparing their scores with two clinical groups of patients with schizophrenia spectrum disorders (SSDs) and anxiety disorders. A mixed-methods (qualitative-quantitative) study was designed. Two hundred and sixteen adults aged 18-65 with principal diagnoses of SUDs (n = 52), SSDs (n = 49), and anxiety disorders (n = 115) were recruited. Qualitative data were obtained with the Metacognition Assessment Interview, which was then rated using a quantitative scale, the Metacognition Assessment Scale-Abbreviated (MAS-A). The anxiety disorders group had significantly higher MAS-A total scores than the SUDs group, and the SUDs group obtained significantly higher MAS-A total scores than the SSDs group. Concerning the MAS-A subscale scores, the SUDs group displayed significantly lower scores only on the Mastery subscale compared to the anxiety disorders group, with the SUDs and SSDs groups obtaining equivalent Mastery scores. According to these findings, current interventions for addiction should focus more specifically on improving metacognitive Mastery.

Factores asociados al abuso y la dependencia de sustancias en adolescentes colombianos, con base en los resultados del WMH-CIDI

IntroductionGiven the magnitude of mental health problem and the recommendations of national and international institutions, it was proposed to generate knowledge about risk and protective factors for the targeting of evidence-based practice, programs for the promotion and prevention substance use disorders in adolescents. MethodAs part of the WHO-WMH studied a probabilistic sample of 1,576 Colombian adolescents from 13 to 17 years old, CIDI instrument was applied for the diagnosis of substance abuse disorder, estimated the association with etiologic factors by bivariate analysis and application of logistic regression model using the method Step Wise. ResultsIn calculating the OR adjusted with 95% confidence, the risk factors most strongly associated with substance use disorders were: a history of marijuana use, parental history of mental illness, neglect in addressing the needs of food and health and abuse among parents, the cigarette and alcohol consumption and presence of stressful life events. They behaved as protective factors: Good communication with parents, spirituality, family cohesion and the strict application of the rules. ConclusionThese results suggest that prevention programs should pay special attention to population groups that present the risk and protective factors for drug use found in this study.

Substance abuse and psychiatric co-morbidities: a case study of patients at Mathari Psychiatric Hospital, Nairobi, Kenya

Substance abuse co-morbidity with psychiatric disorders is common and has been widely reported, except in Kenya. This study aimed to determine the prevalence, pattern and socio-economic burden of a dual diagnosis of substance abuse disorder and other psychiatric conditions. This was a cross-sectional descriptive study of 691 patients admitted at Mathari hospital. Only 42 patients had a first working diagnosis of substance abuse but nearly thirty-five percent of the patients scored for a Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) diagnosis of alcohol dependance/abuse. There was high co-morbidity of alcohol abuse/dependence with opiate, sedative and 'khat' use, as well as with mood and other psychotic disorders. Substance abuse disorders correlated significantly with other psychiatric disorders. Only 12 patients were in a drug rehabilitation unit, all of whom had a dual psychiatric diagnosis of affective disorder. There were high co-morbidity rates of substance abuse in both general psychiatric wards and drug rehabilitation units. KEY WORDS: substance abuse, co-morbidity, psychiatric disorders, Kenya

The Long-Term Relationships Between the Motivation for Change and Alcohol Use Severity Among Patients with Severe and Persistent Mental Illness

This study examined the long-term relationship of changes in the motivation to remedy alcohol abuse to alcohol use severity among patients with a dual diagnosis of substance abuse disorder and severe and persistent mental illness. Linear regression analyses showed that patients who increasingly recognized alcohol use problems over a 9-month period exhibited significantly greater alcohol use severity at 9 months and a significant increase in alcohol use severity over time. Moreover, patients who became increasingly determined to take actions against alcohol use over a 9-month period exhibited significantly lower alcohol use severity at 9 months and a significant decrease in alcohol use severity over time. The findings support Prochaska et al.'s transtheoretical model of the motivation for change. They suggest that the recognition of alcohol use problems comes along with learning adverse consequences of alcohol use and that increased determination to take actions is critical to the long-term behavioral changes in alcohol use.

Repeated psychiatric referrals to Belgian emergency departments: a survival analysis of the time interval between first and second episodes.

Repetition of psychiatric emergency department use by a relatively small number of patients constitutes a major problem for clinicians and service providers. This study aimed at the identification of risk factors for repetition by addressing the time interval between the first and second visits to the emergency department. The purpose was to investigate what patient characteristics and referral circumstances determine this interval. Over a two year period, data on all psychiatric emergency referrals to the emergency department of four public hospitals were collected with a standardized form. Data collected during the index referral of all patients were used for estimating the risk for repetition using survival analysis techniques. A large proportion of repeaters revisits the emergency department within a short time interval. Younger, male patients who present themselves spontaneously are more likely to repeat than others. Previous inpatient service use and the presence of a diagnosis of substance abuse disorder or psychotic disorder at the first visit further increases the risk for repetition. Previous service use and, to a lesser degree, demographic and clinical characteristics of psychiatric patients are useful in the prediction of variations in time between first and second referrals to the emergency department.

Psychiatric and substance abuse disorder diagnoses as predictors of length of hospital stay.

The mental health and substance abuse components of AN-DRG 3 were examined using data from all inpatient separations in two Australian States over a two-year period. Assignment to a mental health or a substance abuse diagnosis related group (DRG) predicted about 20 per cent of the variability in average length of stay of patients treated for such conditions. Assignment to a substance abuse DRG was a much less robust predictor of length of hospital stay than assignment to a mental health DRG. There was little variation between years or States. Day-only intent patients were excluded, as were long-stay outliers identified using an inter-quartile range trimming process. Psychiatric DRGs are similar to a number of other non-surgically focused diagnosis related groups in their capacity to predict length of hospital stay. They are likely to remain an important component of casemix classification systems.

Stability of Psychiatric Diagnoses in New Zealand Psychiatric Hospitals

This study examines the stability over a five year follow-up of first admission psychiatric diagnoses assigned in New Zealand psychiatric hospitals in 1980 and 1981. Diagnostic stability is a measure of the degree to which psychiatric diagnoses remained unchanged at a later hospital admission. Reasonably high levels of stability were found for the initial diagnoses of substance abuse disorders (86% stable), anorexia nervosa (70%), schizophrenia (67%), and affective disorder (67%). Poor levels of stability were noted for the initial diagnoses of personality disorder (36%), other psychosis (excluding schizophrenia and affective psychosis) (22%), and other neurosis (excluding neurotic depression) (20%). The major trends in diagnostic change are described. Factors influencing diagnostic instability are also examined. For patients with an initial diagnosis of schizophrenia, a change in hospital is found to be the strongest factor causing diagnostic instability, with time between admissions and age at first admission also having a significant influence. The implications of these findings are discussed.