Substance-induced Mental Disorders Research Articles

Rethinking Mental Automatism: De Clérambault's Theory in the Age of Novel Psychoactive Drugs: Psychotropic Effects and Synthetic Psychosis.

The widespread use of novel psychoactive substances (NPSs)-defined as new narcotic or psychotropic agents not classified under the Single Convention on Narcotic Drugs of 1961 or the Convention on Psychotropic Substances of 1971-poses a significant challenge to contemporary mental health paradigms due to their impact on psychiatric disorders. This study revisits and expands upon the theory of mental automatism as proposed by Gaëtan Gatian de Clérambault, aiming to elucidate the psychopathological mechanisms underlying substance-induced psychoses (SIP) and their distinction from non-induced psychoses (schizophrenia and related disorders). Through a phenomenological and clinical investigation, we explore the relevance of mental automatism in the development of toxic psychoses, drawing upon the historical and contemporary literature. This research highlights the psychopathological distinctions between induced and non-induced psychoses and the transition mechanisms from acute to chronic psychosis states. De Clérambault's theory, supplemented by Janet, Jackson, and Bonhoeffer's contributions, provides a foundational framework for understanding the genesis of SIP. Our findings suggest that NPS consumption, particularly among adolescents and psychiatric patients, significantly correlates with increased risks of SIP, marked by a transition to chronicity influenced by biological lesions triggered by substance use. Furthermore, we propose a comprehensive framework for SIP, integrating mental automatism, psychopathological distinctions, and transition mechanisms. This framework aims to refine diagnostic criteria and therapeutic approaches, addressing gaps in clinical practice and research. The study underscores the need for a nuanced understanding of SIP, advocating for a paradigm shift in psychiatric assessment and treatment approaches to better address the complexities of substance-induced mental health disorders.

COVID-19 treatment corticosteroids-induced mania

IntroductionPsychiatric disturbances induced by substances are registered in both CIE-10 and DSM-5. It is also well known, since many years, the association between mania and corticosteroids (more than 200 results in PubMed found), recently widely used during the last pandemic against COVID-19.ObjectivesTo remember and to point out the association of substance-induced mental disorders, warning about the experimentation in new clinical settings and raising awareness to prevent or treat its possible consequences in mental health.MethodsA two cases clinical series with COVID-19 pneumonia treated with high-doses intravenous corticosteroids during more than a week. Two women, after theirs 50s, with no personal or family psychiatric history, developing after finishing the hospital treatment, insomnia, motor and behavioral hyperactivity and dysphoric mood with irritability, but preserving clinical insight.ResultsAt first, these states were assessed by internists and psychologists as reactive stress anxiety and were treated with benzodiazepines and psychotherapy, without success, during more than two weeks. After a psychiatric evaluation, considering the medical history and recent use of corticosteroids, the hipomania diagnosis was pointed out. Antipsychotic treatment (low doses olanzapine chosen) was induced with total remission of symptoms in less than 15 days with restitutio ad integrum. Regarding these cases, an updated bibliographic review on corticosteroid-induced mania and its treatment was carried out.ConclusionsWith this presentation, the authors would like to highlight, in these times of pandemic, the importance of remembering the influence and relationship of drugs use in major psychiatric syndromes, both in the causal origin and in the treatment.DisclosureNo significant relationships.

The Microbiome-Gut-Brain Axis, a Potential Therapeutic Target for Substance-Related Disorders.

Substance addiction is a complex worldwide public health problem. It endangers both personal life and social stability, causing great loss on economy. Substance-related disorder is considered to be a complicated chronic brain disorder. It resulted from interactions among pharmacological properties of addictive substances, individual susceptibility, and social–environmental factors. Unfortunately, there is still no ideal treatment for this disorder. Recent lines of evidence suggest that gut microbiome may play an important role in the pathogenesis of neuropsychiatric disorders, including substance-related disorders. This review summarizes the research on the relationship between gut microbiome and substance-related disorders, including different types of substance, different individual susceptibility, and the occurrence and development of substance-induced mental disorders. We also discuss the potentiation of gut microbiome in the treatment of substance-related disorders, especially in the treatment of substance-induced mental disorders and manipulation on individuals’ responsiveness to addictive substances.

2285Increased risk of out-of-hospital cardiac arrest associated with psychiatric disorders

Abstract Introduction Patients with psychiatric disorders are at high risk of cardiovascular morbidity and mortality; yet, the risk of out-of-hospital cardiac arrest (OHCA) compared to the general population remains unknown. Purpose We investigated whether the presence and severity of different psychiatric disorders were associated with a higher risk of OHCA. Methods We conducted a case-control study matching all adult patients with OHCA of presumed cardiac cause between 2001 and 2014 with up to nine controls from the entire Danish population on age, sex and ischemic heart disease (IHD). Patients with psychiatric disorders were identified using in- and out-patient hospital diagnoses – both primary and secondary - before index date. We identified six mutually exclusive psychiatric disorders that were separately examined: personality disorders, anxiety, substance-related mental disorders, depression, bipolar disorder and schizophrenia. The risk of OHCA associated with the six psychiatric disorders was evaluated by conditional logistic regression adjusting for comorbidities, concomitant pharmacotherapy, socioeconomic status and marital status. Results We included 32,447 OHCA cases matched with 291,999 controls from the general population. Overall, the median age was 72 years, 67% were male and 29% had IHD prior to index date. All the six psychiatric disorders examined were more common among cases than controls; depression was the most common psychiatric disorders in both groups: 5.0% among cases and 2.8% among controls. Concurrently, all six psychiatric disorders were associated with significantly higher odds of OHCA: personality disorders (odds ratio (OR) 1.30 [95% confidence interval (CI) 1.06–1.60], anxiety OR 1.26 [95% CI 1.15–1.39], substance induced-mental disorders OR 2.36 [95% CI 2.17–2.57], depression OR 1.27 [95% CI 1.19–1.35], bipolar disorder OR 1.32 [95% CI 1.16–1.50] and schizophrenia OR 1.80 [95% CI 1.58–2.05] (Figure). The association persisted unaffected when we studied psychiatric patients neither exposed to antipsychotics nor to antidepressants. We observed a trend towards a stronger association when we stratified according to the severity of the psychiatric disorder (Figure). Severe disorders where classified as at least one hospitalization for the specific psychiatric illness as primary diagnosis during the five years prior to index date. Conclusions Common psychiatric disorders including personality disorders, anxiety, substance-related mental disorders, depression, bipolar disorder and schizophrenia are significantly associated with higher odds of OHCA. These findings provide a rationale for early cardiovascular risk factor screening and, potentially, management among psychiatric patients to identify patients at high risk of OHCA. Acknowledgement/Funding ESCAPE-NET project

Out-of-hospital cardiac arrest in patients with psychiatric disorders — Characteristics and outcomes

AimsTo investigate whether the recent improvements in pre-hospital cardiac arrest-management and survival following out-of-hospital cardiac arrest (OHCA) also apply to OHCA patients with psychiatric disorders. MethodsWe identified all adult Danish patients with OHCA of presumed cardiac cause, 2001–2015. Psychiatric disorders were defined by hospital diagnoses up to 10 years before OHCA and analyzed as one group as well as divided into five subgroups (schizophrenia-spectrum disorders, bipolar disorder, depression, substance-induced mental disorders, other psychiatric disorders). Association between psychiatric disorders and pre-hospital OHCA-characteristics and 30-day survival were assessed by multiple logistic regression. ResultsOf 27,523 OHCA-patients, 4772 (17.3%) had a psychiatric diagnosis. Patients with psychiatric disorders had lower odds of 30-day survival (0.37 95% confidence interval 0.32–0.43) compared with other OHCA-patients. Likewise, they had lower odds of witnessed status (0.75 CI 0.70–0.80), bystander cardiopulmonary resuscitation (CPR) (0.77 CI 0.72–0.83), shockable heart rhythm (0.37 95% CI, 0.33–0.40), and return of spontaneous circulation (ROSC) at hospital arrival (0.66 CI 0.59–0.72). Similar results were seen in all five psychiatric subgroups. The difference in 30-day survival between patients with and without psychiatric disorders increased in recent years: from 8.4% (CI 7.0–10.0%) in 2006 to 13.9% (CI 12.4–15.4%) in 2015 and from 7.0% (4.3–10.8%) in 2006 to 7.0% (CI 4.5–9.7%) in 2015, respectively. ConclusionPatients with psychiatric disorders have lower survival following OHCA compared to non-psychiatric patients and the gap between the two groups has widened over time.

Approach to somatomorphic disorders in children. A case presentation

Description of clinical casePatient 10-year-old pediatrics sent from service due to history of frequent admissions for recurrent abdominal pain. In the bypass request indicate that this is a patient of perfectionistic traits; detect dysfunctional family dynamics highlighting the rivalry in the phratry, and with an equal difficulty in the field. From 2010 to 2016, he has made more than 30 visits to hospital emergency combined intervention of psychiatry and psychology and multidisciplinary service available with a pediatric surgery and pediatrics is performed.Exploration and complementary testsFrom 2011 to 2016, it has made 44 blood tests, sonograms 9 full abdomen, abdominal renal scintigraphy without significant findings.DiagnosisF45.5 pain disorder.Differential diagnosisSymptoms due to a medical condition. Other symptoms substance-induced mental disorders: non-specific conversion disorder, pain disorder, hypochondriasis, body dysmorphic disorder, somatization disorder, simulation, factitious disorder, medical symptoms…ConclusionsPsychosomatic disorders are one of the most common clinical forms of mental disorders in childhood and adolescence expression. Knowing the stages of development and operating characteristics. In clinical practice, mainly in primary care, tend to find an organic cause somatic complaints in children, so prevalence data and/or referral to specialized services vary depending on mental consulted sources is critical to understand the pathogenesis of these disorders.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Psychological trauma exposure and co-morbid psychopathologies in HIV+men and women

This study examined the association between trauma exposure, PTSD, suicide attempts, and other psychopathology among 316 racially/ethnically diverse HIV-infected men and women who underwent semi-structured psychiatric assessment. In addition, the role of psychological resilience in trauma exposure was examined in the context of neurological symptoms and functional status. Nearly half (47.8%; 151/316) of the participants reported trauma exposure, of which 47.0% (71/151) developed PTSD. Among trauma-exposed individuals, those with a current psychiatric diagnosis reported more neurological symptoms and lower functional status. Trauma exposure without PTSD was associated with a higher rate of panic disorder and substance-induced mental disorders. Trauma-exposed individuals who did not develop PTSD were less likely than those who reported no trauma exposure to meet criteria for major depressive disorder (MDD). Trauma exposure, MDD, borderline personality disorder, and substance-induced mental disorders were independently associated with increased odds of suicide attempt. These results indicate that co-morbid psychiatric disorders are common among trauma exposed individuals with a history of PTSD, but those with trauma exposure who do not develop PTSD are less likely to experience MDD. The role of other co-morbid psychopathologies in the genesis of suicidal behavior among individuals living with HIV deserves further study.

Demographic and clinical features of patients with substance-induced mental disorders admitted to the psychiatric hospital in Kermanshah, Iran

Background: Evaluating the prevalence and clinical features of substance induced mental disorders leading hospitalization is important in programming for better management of these disorders. There is a lack of studies investigated the pattern of drugs leading admission in mental hospitals.Objectives: To evaluate demographic and clinical features of patients with substance induced mental disorders admitted to Farabi psychiatric hospital in Kermanshah, Iran.Methods: This is a cross-sectional study conducted in 2013. 359 patients whom admitted with substance related psychiatric disorders were evaluated using demographic questionnaire, clinical and paraclinical exams. patients diagnosed with primary mental disorders, and mental disorders due to other medical condition were excluded.Results: The participant's mean age was 31.44 years. The most of the patients were unemployed males with low education living in urban areas. Amphetamines in 289 (80.5%), opioids in 57 (15.8%), cannabis in 11(3.1%), and benzodiazepines in 2 (0.6%) patients were the main drugs leading admission. Amphetamine induced psychotic disorder with hallucination (40.4%) were the most common diagnosis among the study subjects.Discussion: Amphetamines was the most problematic drug in our setting and amphetamine induced mental disorders were the most prevalent causes of hospitalization. Opioids induced psychiatric disorders were in the second rank.

Independent or Substance-Induced Mental Disorders? An Investigation of Comorbidity in an Acute Psychiatric Unit

Objective: The comorbidity of substance use disorders and mental disorders calls for instruments designed to disentangle the complex interactions that exist when these conditions co-occur. Targeted treatment is dependent on diagnostic accuracy. The aim of this study was to differentiate independent from substance-induced mood and psychotic disorders in patients hospitalized with substance use and mental disorders. Methods: Fifty-eight patients admitted to an acute psychiatric unit with substance use and presenting mood symptoms, psychotic symptoms, or both, were interviewed with the semi-structured Psychiatric Research Interview for Substance and Mental Disorders (PRISM). Substance use disorders and other mental disorders (independent and substance-induced) were registered. Results: Seventy-one percent were men, and median age was 33 years. The substances most often heavily used were alcohol (71%), cannabis (52%), and stimulants (38%). The four most common current diagnoses were major depressive episode (50%), schizophrenia (21%), manic episode (10%), and mood disorder with psychotic symptoms (9%). Forty percent of the participants had current substance-induced mood or psychotic disorders. Current major depressive episode was substance-induced in 72% of patients with this diagnosis, of which 57% were alcohol-induced. Current schizophrenia was substance-induced in 1 of 12 patients with schizophrenia and current non-schizophrenia psychotic disorders were substance-induced in 5 of 7 patients with this diagnosis. Conclusions: The majority of current major depressive episode was substance-induced, most often alcohol-induced. Current psychotic disorders were substance-induced in approximately one-third of cases. Diagnostic accuracy in an acute psychiatric unit is important for targeted treatment.

Prevalence of psychiatric disorders among young injection drug users

BackgroundStudies of individuals in treatment for substance use have found high rates of psychiatric disorders, however little is known about the mental health of drug users not in treatment. This study aimed to assess the prevalence of lifetime and recent substance use and psychiatric disorders among young injection drug users (IDU) outside of a treatment setting. MethodsParticipants were recruited through outreach and respondent-driven sampling. Trained interviewers administered the Psychiatric Research Instrument for Substance and Mental Disorders. Interviews were conducted at two field stations operated by Community Outreach Intervention Projects in Chicago. Participants were 570 young adults (18–25 years) who injected drugs in the previous 30 days. Heroin was the primary drug used in this sample. Past 12-month and lifetime substance use disorders and primary and substance-induced mental disorders were based on DSM-IV diagnostic criteria. ResultsNearly all participants met the criteria for heroin dependence. Multiple substance use disorders were common; cannabis was the most common substance involved after heroin, followed by alcohol and cocaine. Major depression, alcohol dependence, antisocial personality disorder, and borderline personality disorder were highly prevalent. Other psychiatric disorders were observed at levels consistent with other young adult samples. ConclusionsYoung IDU experience major depression, alcohol dependence, anti-social personality disorder, and borderline personality disorder at high rates, and multiple substance use disorders are common. Anxiety disorders in this population appear to be similar in prevalence to young adults in general.

Service Needs and Utilization for Dual-Diagnosis Patients

The authors examined treatment patterns for two groups of dually diagnosed psychiatric inpatients, those with a) co-occurring, but independent mental and substance use disorders (IMD + PSUD); and b) substance-induced organic mental disorders (PSUD-OMD). Assessments included the Addiction Severity Index for perceived service needs, discharge records for recommended treatments, and the Quality of Life Interview for follow-up treatment utilization. As expected, the groups differed on treatment patterns. Both received fewer services than needed during the 1-year follow-up. In particular, the IMD + PSUD patients utilized few substance abuse services and the PSUD-OMD utilized few psychiatric services.

Comorbidity between substance use disorders and psychiatric conditions

To review information relevant to the question of whether substance-induced mental disorders exist and their implications. This paper utilized a systematic review of manuscripts published in the English language since approximately 1970 dealing with comorbid psychiatric and substance use disorders. The results of any specific study depended on the definitions of comorbidity, the methods of operationalizing diagnostic criteria, the interview and protocol invoked several additional methodological issues. The results generally support the conclusion that substance use mental disorders exist, especially regarding stimulant or cannabinoid-induced psychoses, substance-induced mood disorders, as well as substance-induced anxiety conditions. The material reviewed indicates that induced disorders are prevalent enough to contribute significantly to rates of comorbidity between substance use disorders and psychiatric conditions, and that their recognition has important treatment implications. The current literature review underscores the heterogeneous nature of comorbidity.

Diagnostic Inaccuracy and Substance Abusing Patients with Comorbid Mental Disorders: A Brief Report

ABSTRACT Objectives: This study examined diagnostic errors with patients having comorbid substance abuse and mental disorders, while ruling out the influence of possible confounding subject variables such as chronicity and severity of mental disorder. Methods: Veteran inpatients with dual diagnoses were compared to a control group matched except for the presence of substance abuse. Subjects were diagnosed using a structured diagnostic interview and medical records were reviewed for working diagnoses and mental health treatment history. The frequencies of misdiagnoses were identified by comparing clinician working diagnoses to structured interview diagnoses. Results: Treating clinicians under-diagnosed the presence of substance-induced mental disorders, and alcohol and cocaine abuse (p < .01). Conclusions: The need for more precise diagnostic practices for the substance abusing dually diagnosed patient is affirmed in a well controlled study.

Primary and secondary substance misusers: do they differ in substance-induced and substance-independent mental disorders?

This study evaluated the primary/secondary distinction among substance misusers according to comorbid mental disorders. A consecutive sample (n = 287) of DSM-IV substance dependents from public treatment facilities in two counties in Norway were assessed by the Composite International Diagnostic Interview. According to the debut of the first independent mental disorder, patients were divided into primary substance use disorder (SUD) (17%), secondary SUD (76%) and SUD in the same year as the first mental disorder (7%). A lifetime substance-independent mental disorder was found in 90%. Forty-two per cent had a combination of substance-independent and substance-induced mental disorders. Five per cent had substance-induced mental disorders only. Primary SUD patients comprised less women, and a lower number of substance-independent mental disorders. Secondary SUD patients had more major depression, phobic disorders and obsessive-compulsive disorder. There were no differences between primary SUD and secondary SUD regarding the number of substance-induced disorders or the pattern of substance misuse. Clinical differences between primary and secondary SUD were small and do not support the distinction.

Awareness of Substance Abuse Problems Among Dually-Diagnosed Psychiatric Inpatients

This study examines the ability to acknowledge the need for treatment of mental illness and substance abuse problems among dually-diagnosed inpatients before and after an inpatient substance abuse treatment program. A cohort of 264 consecutively admitted patients diagnosed with a mental illness and substance use disorder were entered into a dual diagnosis treatment program. Perceptions of patients diagnosed with a substance-induced mental disorder were compared to those of patients with a primary mental illness regarding their problems and need for treatment before and after the dual diagnosis program. Most patients acknowledged a substance abuse or mental illne ss problem and need for treatment. Patients with substance-induced mental disorders were more likely to acknowledge a substance use problem and need for treatment (p<.001). After treatment, changes in perception of mental illness were greater for substance-induced mental disorder patients compared to patients with a primary mental illness (p<.001). Persons with more severe substance abuse were more likely to acknowledge a problem and need for treatment. The majority of dually-diagnosed patients admitted with a substance use disorder agreed that substance use was a problem, suggesting that inpatient hospitalization presents a prime opportunity to address addict ion in dually-diagnosed patients. The type of mental illness and severity of substance use inf1uenced perceptions of illnesses and treatment readiness and must be considered by the clinician.

One-year follow-up of secondary versus primary mental disorder in persons with comorbid substance use disorders.

Service utilization and outcomes of dually diagnosed patients with independent mental disorders and those with substance-induced mental disorders were compared. Diagnosis, service use, and severity of substance use problems at baseline and 1 year later were assessed in consecutively admitted inpatients with independent mental disorders plus substance use disorders (N = 71), substance-induced mental disorders plus substance use disorders (N = 38), and independent mental disorders only (N = 59). At follow-up, patients with substance-induced mental disorders at baseline were more likely to have been rehospitalized than the other groups, were more likely to have used outpatient substance abuse services, were less likely to have an independent mental disorder, and had the most severe alcohol- and drug-related impairment. Treatment programs for both types of dual diagnosis patients must address mental health concerns.

HIV Status, Substance Dependency, and Psychiatric Diagnosis

The differences in DSM-III-R psychiatric diagnoses between HIV-positive and HIV-negative patients were assessed. Subjects were patients admitted for psychiatric treatment to a metropolitan, state-supported facility. Experimental group subjects consisted of all adult patients identified as HIV-positive. Control group subjects were non-HIV-positive adult patients of the same gender and within 10 years in age of the experimental group subjects. Results suggest that HIV-positive subjects were significantly more likely to have received a personality disorder diagnosis and to have a history of intravenous psychoactive substance use. The likelihood of HIV-positive subjects to have a lower incidence of thought disorder diagnosis than non-HIV-positive subjects approached significance. No significant differences were obtained for diagnoses of psychoactive substance use disorders, psychoactive substance-induced organic mental disorders, mood disorders, or schizoaffective disorder. The diagnosis of a personality diso...

Anxiety, Depression, and Substance Use Disorders: Diagnosis, Treatment, and Prescribing Practices

Attending physicians routinely encounter patients with signs and symptoms of anxiety and mood disorders as well as psychoactive substance use and psychoactive substance-induced organic mental disorders. These symptoms may represent either primary disorders or pathology that is secondary to other disorders. This article describes some of the relationships between substance use disorders and symptoms of anxiety and depressive disorders. In addition, some patients with these disorders may have a concurrent substance use disorder or be at high risk for developing one. Routine treatment of anxiety disorders with psychoactive drugs can be successful in many patients but may lead to iatrogenic dependence in high-risk patients. Prescribing for high-risk patients should include a stepwise treatment protocol having three progressive levels: (1) conservative, nonpharmacological approaches; (2) nonpsychoactive pharmacotherapy, including the use of anxioselective agents, such as buspirone; and (3) psychoactive pharmacotherapy, such as the use of benzodiazepines. Proper prescribing practices for high-risk patients are described in terms of diagnosis, dosage, duration, discontinuation, dependence, and documentation.