Diagnosis Of Substance Use Disorder Research Articles

The prevalence of substance use disorders in chiropractic patients in the United States: a descriptive study of two national datasets

ABSTRACTBackground and ObjectiveIndividuals commonly seek chiropractic care for pain with concurrent substance use. However, the prevalence of substance use disorder (SUD) diagnosis in adults utilizing chiropractic care is unknown. This descriptive study assessed the prevalence of adult (≥18 years) chiropractic patients with a SUD diagnosis.MethodsSelf-reported survey data from the All of Us Research Program and electronic health records from the TriNetX Research Network were queried in August 2023. The number of chiropractic patients and the number of chiropractic patients with a SUD diagnosis were calculated for each dataset. The prevalence of chiropractic patients with a SUD diagnosis was calculated for each dataset by dividing the number of chiropractic patients with a SUD diagnosis by the number of chiropractic patients.ResultsThe prevalence of chiropractic patients with a SUD diagnosis in the All of Us Research Program data was 6.8%. The prevalence of chiropractic patients with a SUD diagnosis in the TriNetX Research Program data was 7.8%.ConclusionsChiropractors commonly encounter patients with a SUD diagnosis. Given the individual and societal burden of SUDs, it is imperative that chiropractors are trained to recognize individuals living with SUDs and facilitate referral to appropriate treatment for those in need.

Drug Rehabilitation in Egypt: Achievements, Challenges and Research Needs

It is estimated that more than 800 drug rehabilitation centres are operating in Egypt now, with a total of around forty thousand beds. Almost all of these centres apply a 12-Step Therapeutic Community Philosophy. The first steps of this approach can be traced to the year 1989 and along these 34 years, the estimate of clients who achieved stable abstinence is about 120 thousand clients who had a diagnosis of Substance Use Disorder (SUD), with or without a concomitant other psychiatric diagnosis. In this article we shall report on history, development, structure, processes and some highlights of published and original research, and the achievements, challenges and research gaps of this psychosocial approach in this country. Regional and international connections and contexts will also be mentioned.

Characteristics and management of patients with substance use disorders referred to a consultation-liaison psychiatry service in Lebanon

BackgroundThis study explores the characteristics and management of individuals with substance use disorders (SUDs) who were referred to the consultation-liaison psychiatry (CLP) service in a tertiary care center in Lebanon. As part of the Consultation-Liaison at the American University of Beirut (CLAUB) analysis, we conducted a retrospective record review of patients referred to our CLP service between February 2019 and May 2020. We assessed differences between SUD and non-SUD consults using chi-square analysis, Fisher’s exact test, or Mann–Whitney U test, as appropriate.ResultsOf 1475 patients, 278 (18.8%) received a diagnosis of SUD. They were mostly males (73.7%) with an average age of 38.8 years. The most used substances were alcohol (60%) and cannabis (28.4%). Compared to non-SUD consults, patients with SUDs were more likely to be males (odds ratio OR = 3.18, p < 0.001) and to get intubated during admission (OR = 1.81, p = 0.048). Predictors of intensive care unit admission in patients with alcohol use disorder included pulmonary or endocrinological disease, benzodiazepine use disorder, and days until CLP referral.ConclusionsThe results of this study highlight the high prevalence of alcohol use among individuals with SUD referred to the CLP service. Additionally, they underscore the limited treatment avenues available in this part of the world. The institution of a comprehensive CLP service is crucial to address the unmet needs of patients with SUDs who present to a general hospital setting.

Prevalence and correlates of gambling disorder in Spain: findings from a national survey

ABSTRACT The aim of the study was to estimate the prevalence of gambling disorder (GD) in a sample of Spanish adults and analyze the sociodemographic variables, addictive behaviors (i.e. gambling-related characteristics, substance use, and problematic internet use), and lifetime clinical diagnoses related to the severity of GD. Participants from the 2020 Spanish Survey on Alcohol and Drugs (N = 17,105; 50.52% men; M age = 38.38 ± 13.07) were included. Individuals were classified as gamblers with GD when scored ≥4 points in the DSM-5 criteria. ANOVA and Pearson correlations were carried out to analyze differences in GD scores according to the variables noted above. The results showed that the rate of GD was 0.63% in the total sample and 1.05% in past-year gamblers. Characteristics which showed significantly higher GD scores were as follows: being a man, younger age, unmarried, greater gambling involvement both online and offline, gambling both online and offline, betting on both strategic and non-strategic games or on exclusively strategic games, lower gambling risk perception, greater substance use, higher problematic alcohol, cannabis, or internet use, or a lifetime diagnosis of anxiety, insomnia, or substance use disorder (all p-values ≤.001). The findings may guide future legal regulation policies and promote actions to prevent gambling-related problems.

Abstract 15466: Social Determinants of Health Vulnerabilities Among Patients With Substance Use Disorder and Infective Endocarditis

Introduction: Data indicate that the incidence of infective endocarditis (IE) is rising among patients with substance use disorder (SUD) and is linked with increased mortality. However, the social determinants of health (SDOH) vulnerabilities associated with IE in this population has not been well characterized. Aims: To examine the SDOH associated with IE among patients with SUD. Methods: Using our electronic medical records, we identified patients with concurrent diagnosis of IE and SUD from 2017 until May 2023. Socio-demographics and SDOH including unstable housing (identified using diagnosis codes, residential address test, and natural language processing of clinical notes documenting homelessness and shelter referrals) were identified. A multivariable regression model was conducted to identity independent risk factors associated with IE among patients with SUD. Results: Among 26,918 patients admitted with an SUD encounter, 1,422 (5.3%) had an IE encounter. Patients with IE were younger (37 vs 43 years, P&lt;0.001), mostly white (96% vs 87.7%, P&lt;0.001), Medicaid enrollees (84.2% vs 58.6%, P&lt;0.001), and had less than high school education (10.6% vs 8.1%, P=0.005). They were more likely to reside in rural areas (58.1% vs 44.8%) and have unstable housing (28.6% vs 16.3%). Patients with IE had higher prevalence of smoking (83.5% vs 67.3%) as well as cardiac, dental, mental and other health conditions. Certain socio-demographics and SDOH were independently associated with IE on multivariable regression (Figure). Conclusions: Patients with SUD and IE have distinct socio-demographics and SDOH characteristics. Incorporating these factors into future risk prediction tools could better help identifying SUD patients who are at risk to implement targeted techniques which have been proven to lower the risk of infection.

Abstract 14708: Heart Failure While Homeless: Examining the Relationship Between HF Hospitalizations and Housing Insecurity

Background: The association between housing insecurity and outcomes of hospitalizations for heart failure (HF) has not been previously well-established. Methods: We analyzed HF hospitalizations using the 2020 United States National Inpatient Sample database. Individuals were identified as having housing insecurity by related ICD-10 codes. Other demographic and comorbidity data were identified using corresponding ICD-10 codes. Characteristics of patients hospitalized for HF that were identified as having housing insecurity were compared to those hospitalized for HF who had no housing insecurity. We performed a multivariable risk adjustment for in-hospital mortality based on patient characteristics. Results: Out of 1,003,270 hospitalizations for HF, 16,150 were identified as having housing insecurity (1.6%). The average age of patients with housing insecurity hospitalized for HF was 56, as compared to 71 in the housed population. A higher proportion of patients in the housing-insecure group were Black (35% vs 20.1%) or Hispanic (11.1% vs 7.3%). Patients with housing insecurity were more likely to carry a diagnosis of alcohol use disorder (15.2% vs 3.3%) or substance use disorder (70.2% vs 17.8%), however they were less likely to use tobacco (18.3% vs 28.7%). Patients with housing insecurity were over 4.5 times more likely to have a primary Medicaid payer (52.4% vs 11.3%). Average length of stay did not differ between housing-insecure patients versus those without (5.37 vs 5.51 days). After adjusting for patient characteristics, housing insecurity was predictive of lower in-hospital mortality (OR 0.622, 95% CI 0.403 - 0.960). Conclusions: Significant differences occur between patients hospitalized for HF who also have housing insecurity. These differences are most pronounced for substance use and psychiatric disorders. However, housing insecurity was predictive of lower in-hospital mortality. Admissions for heart failure may provide important opportunities to screen for and address comorbid conditions for patients with housing insecurity, as well as for other vulnerable populations.

Health facility readiness to screen, diagnose and manage substance use disorders in Mbale district, Uganda

BackgroundSubstance use disorders (SUD) pose a significant public health problem in Uganda. Studies indicate that integrating mental health services into Primary Health Care can play a crucial role in alleviating the impact of SUD. However, despite ongoing efforts to integrate these services in Uganda, there is a lack of evidence regarding the preparedness of health facilities to effectively screen and manage SUD. Therefore, this study aimed to assess the readiness of health facilities at all levels of the health system in Mbale, Uganda, to carry out screening, diagnosis, and management of SUD.MethodsA health facility-based cross-sectional study was carried out among all the 54 facilities in Mbale district. A composite variable adapted from the WHO Service Availability and Readiness Assessment manual (2015) with 14 tracer indicators were used to measure readiness. A cut-off threshold of having at least half the criteria fulfilled (higher than the cutoff of 7) was classified as having met the readiness criteria. Descriptive analyses were performed to describe readiness scores across various facility characteristics and a linear regression model was used to identify the predictors of readiness.ResultsAmong all health facilities assessed, only 35% met the readiness criteria for managing Substance Use Disorders (SUD). Out of the 54 facilities, 42 (77.8%) had guidelines in place for managing SUD, but less than half, 26 (48%), reported following these guidelines. Only 8 out of 54 (14.5%) facilities had staff who had received training in the diagnosis and management of SUD within the past two years. Diagnostic tests for SUD, specifically the Uri stick, were available in the majority of facilities, (46/54, 83.6%). A higher number of clinical officers working at the health centres was associated with higher readiness scores (score coefficient 4.0,95% CI 1.5–6.5).ConclusionsIn this setting, a low level of health facility readiness to provide screening, diagnosis, and management for substance use disorders was found. To improve health facility readiness for delivery of care for substance use disorders, a frequent inventory of human resources in terms of numbers, skills, and other resources are required in this resource-limited setting.

'It opened my eyes, my ears, and my heart': Codesigning a substance use disorder treatment programme.

Pregnant and parenting women have low engagement and poor retention in substance use disorder (SUD) treatment. The aim of this study was to analyse the implementation of an adapted experience-based codesign (EBCD) process involving SUD treatment staff and pregnant or parenting women with lived experience (WWLE) of SUD to launch a residential treatment service where women could coreside with their children and receive long term comprehensive treatment for dual diagnosis of SUD and mental illness. A process evaluation was conducted utilising five data sources: two sets of semistructured interviews with WWLE and SUD treatment staff, ethnographic observation and transcripts from group events, and meeting minutes. Based on the Integrated Promoting Action on Research in Health Services framework constructs (context, recipients, facilitation, innovation) researchers applied thematic analysis to determine main themes within each construct. The full sample across the implementation totalled 34 individuals (WWLE = 13 and SUD staff = 21). The EBCD process engaged both cohorts and supported group cohesion and collaborative brainstorming. WWLE felt respected, emotionally safe to share, and empowered by participation. A cohesive, multidisciplinary codesign planning group, inclusive of WWLE, supported a more equitable codesign process. The need for a virtual platform due to the COVID-19 pandemic impeded human connection and relationship building. The complex environment of residential regulations and uncertainties during start-up phase of an organisation presented implementation challenges. These results highlight the feasibility of, and challenges to, effectively engaging WWLE in a codesign process. The findings also demonstrated a positive influence on WWLE's feelings of empowerment. Identified themes reinforce the purposeful components within EBCD that enhance participation, along with new insights to inform successful codesign with a vulnerable population. The author's team included a WWLE who collaborated throughout the full scope of the research process, enriching the overall research and ensuring the authenticity of the presentation of women in recovery's perspective. Utilising the codesign approach to design and implement new services should improve health equity by enhancing patient engagement and retention in care. Parenting WWLE of residential SUD treatment were involved in the full scope of the research process and the implementation being evaluated. For the actual codesign work WWLE were key members of the codesign planning team that met weekly throughout the implementation to plan, implement, problem solve and adapt the process over an 18 month timeframe. As is appropriate for codesign the actual ongoing workgroup participants had average 50% WWLE participation. For the research team, this research is a culmination of the lead author's doctoral dissertation. One member of the five-person dissertation committee was a recovery coach and a WWLE. She was an active participant across the entire research process overseeing and influencing the research design, conduct of the study, analysis, interpretation of findings and approval of the final manuscript. The findings were member checked with the larger codesign planning group that had additional WWLE members.

Sensory Processing Preferences in an Adult Acute Mental Health Setting: A Retrospective Study.

Sensory processing patterns may inform mental health diagnosis-specific treatment plans. To compare sensory processing preferences of patients admitted with depression and substance use disorder diagnoses. Retrospective cohort study. Acute inpatient mental health center. Patients ages 18 to 64 yr with a primary diagnosis of depression or substance use disorder who completed the Adolescent/Adult Sensory Profile (AASP). Comparison of AASP quadrant scores between subgroups. Participants (n = 211; M age = 33.8 yr) had a primary diagnosis of depression (n = 121; 57%) or substance use disorder (n = 90; 43%). The depression and substance use disorder groups yielded the following AASP quadrant scores, respectively: low registration, Ms = 38.2 and 34.3 (SDs = 9.4 and 8.0), p = .002; sensation seeking, Ms = 46.8 and 50.6 (SDs = 8.1 and 9.1), p = .002; sensory sensitivity, Ms = 43.4 and 39.8 (SDs = 10.3 and 9.9), p = .013; and sensation avoiding, Ms = 45.6 and 40.1 (SDs = 9.5 and 10.3), p < .001. These differences persisted when scores were normalized against standard population scores. The majority with a primary diagnosis of depression ranked "more/much more than most" for low registration (69; 57.0%), sensory sensitivity (61; 50.4%), and sensation avoiding (79; 65.3%). Those with a primary diagnosis of SUD ranked most frequently as "similar to most" in all quadrants. Sensory processing preferences differ by primary mental health diagnosis and may provide insight into treatment planning. What This Article Adds: This study identifies differences in sensory processing between patients with a primary diagnosis of depression and those with a primary diagnosis of substance use disorder, suggesting that clinical interventions should account for sensory preferences. Providing appropriate sensory experiences (sensory room, sensory boxes, etc.) may allow patients to function at an optimal level by improving their ability to self-regulate emotions and behaviors.

Measuring substance use disorder (SUD) in commercial and Medicaid insured patients with cancer in Washington state.

177 Background: Studies have shown that SUDs not only impact cancer risk, treatment, and survivorship but also increase ED and hospital use. We sought to characterize SUD within Medicaid enrollees diagnosed with cancer in Washington state, hypothesizing thatMedicaid enrollees were more likely to be diagnosed with SUDs than commercial enrollees, and that patients with an SUD experienced higher rates of emergency department (ED) visits or inpatient (IP) stays during initial cancer treatment. Methods: We linked Washington State cancer registry records with claims data from two large commercial insurers and Medicaid. Eligibility criteria included patients under 65 diagnosed with a solid tumor between 2013-2021 who started systemic therapy within 6 months of diagnosis. SUD diagnoses were identified using codes from CMS’s hierarchical condition category for SUD in the 6 months following diagnosis. Chi-square tests were used to compare demographic characteristics of those with and without a SUD diagnosis. Multivariate logistic regressions were used to evaluate the association between SUD and likelihood of at least one ED visit or IP stay, after controlling for payer, sex, race, ethnicity, age, marital status, stage, cancer group, area deprivation index, and diagnosis year. Results: Among the 10,709 patients (6,680 Commercial, 3,718 Medicaid, 311 Multiple) who received systemic therapy, 7.2% had a SUD diagnosis. SUD patients were less likely to be Asian and more likely to be male, living without a partner, diagnosed at a later cancer stage, and living in more deprived areas. Medicaid patients had significantly higher rates of SUD than commercial-insured patients (14.3% vs 3.3%). Overall, 46.6% of cancer patients had an ED visit or IP stay. Patients with SUD had greater use of ED or IP visits than patients without SUD (70.1% and 44.8%, respectively). In the first 6 months of systemic therapy patients with SUD were significantly more likely to visit the ED or be admitted to IP (OR 2.12, 95% CI 1.79 - 2.50) than cancer patients without SUD. Conclusions: More than 1 in 7 Medicaid cancer patients in WA state has an identified SUD. SUD is associated with significant excess risk for ED/IP admissions during treatment. Accurate identification of SUD in patients is necessary prior to strategies aimed at mitigation of unplanned ED visits and hospitalizations during cancer care. Further research is needed on interventions that effectively reduce the risk during treatment.[Table: see text]

Characterizing and Comparing Evidence-Based Psychotherapy Utilization Among Veterans with Co-occurring PTSD and Substance Use Disorder

Objective: The current study sought to describe a nationally representative sample of Veterans diagnosed with co-occurring PTSD and substance use disorder (SUD) who initiated and completed evidence-based psychotherapy (EBP) for PTSD, and explored whether completion rates differed by SUD subtype. Methods: Using electronic health record data from the Veterans Health Administration (VHA) Corporate Data Warehouse, Veterans with a dual diagnosis of PTSD and SUD who initiated either Cognitive Processing Therapy (CPT) or Prolonged Exposure (PE) between January 01, 2019 and July 16, 2019 were identified (N = 2,996). Logistic analyses were employed to determine whether there were differences in EBP completion rates among Veterans with an alcohol use disorder (AUD; n = 1,383) versus all other SUDs (n = 1,613). Results: On average, Veterans were 45 years old, and identified as male, White, and non-Hispanic. Logistic regression analyses revealed there was not a significant difference between Veterans with AUD only and other SUDs in the probability of completing EBP treatment, OR = 1.02, 95% CI =0.87, 1.17, p = 0.79. Conclusions : No differences in EBP completion rates were observed between SUD subtypes, indicating that EBPs for PTSD are tolerated well for individuals with various types of SUDs and may be offered as treatment options.

Diagnostic Criteria for Identifying Individuals at High Risk of Progression From Mild or Moderate to Severe Alcohol Use Disorder

Current Diagnostic and Statistical Manual of Mental Disorders (Fifth Edition) (DSM-5) diagnoses of substance use disorders rely on criterion count-based approaches, disregarding severity grading indexed by individual criteria. To examine correlates of alcohol use disorder (AUD) across count-based severity groups (ie, mild, moderate, mild-to-moderate, severe), identify specific diagnostic criteria indicative of greater severity, and evaluate whether specific criteria within mild-to-moderate AUD differentiate across relevant correlates and manifest in greater hazards of severe AUD development. This cohort study involved 2 cohorts from the family-based Collaborative Study on the Genetics of Alcoholism (COGA) with 7 sites across the United States: cross-sectional (assessed 1991-2005) and longitudinal (assessed 2004-2019). Statistical analyses were conducted from December 2022 to June 2023. Sociodemographic, alcohol-related, psychiatric comorbidity, brain electroencephalography (EEG), and AUD polygenic score measures as correlates of DSM-5 AUD levels (ie, mild, moderate, severe) and criterion severity-defined mild-to-moderate AUD diagnostic groups (ie, low-risk vs high-risk mild-to-moderate). A total of 13 110 individuals from the cross-sectional COGA cohort (mean [SD] age, 37.8 [14.2] years) and 2818 individuals from the longitudinal COGA cohort (mean baseline [SD] age, 16.1 [3.2] years) were included. Associations with alcohol-related, psychiatric, EEG, and AUD polygenic score measures reinforced the role of increasing criterion counts as indexing severity. Yet within mild-to-moderate AUD (2-5 criteria), the presence of specific high-risk criteria (eg, withdrawal) identified a group reporting heavier drinking and greater psychiatric comorbidity even after accounting for criterion count differences. In longitudinal analyses, prior mild-to-moderate AUD characterized by endorsement of at least 1 high-risk criterion was associated with more accelerated progression to severe AUD (adjusted hazard ratio [aHR], 11.62; 95% CI, 7.54-17.92) compared with prior mild-to-moderate AUD without endorsement of high-risk criteria (aHR, 5.64; 95% CI, 3.28-9.70), independent of criterion count. In this cohort study of a combined 15 928 individuals, findings suggested that simple count-based AUD diagnostic approaches to estimating severe AUD vulnerability, which ignore heterogeneity among criteria, may be improved by emphasizing specific high-risk criteria. Such emphasis may allow better focus on individuals at the greatest risk and improve understanding of the development of AUD.

Follow-Up Timing After Discharge and Suicide Risk Among Patients Hospitalized With Psychiatric Illness

Although early outpatient follow-up after psychiatric inpatient discharge may prevent suicide, the association between early follow-up care and a reduced risk of suicide after discharge has not been fully explored. To investigate outpatient follow-up care after psychiatric inpatient discharge and determine whether the timing of the first outpatient follow-up is associated with a reduced risk of suicide. This population-based, retrospective cohort study used the National Health Claim Database from 2017 to 2018 in Korea. Patients were observed until December 31, 2021, to confirm the occurrence of suicide. The study population included all patients aged 18 years or older who were newly admitted to hospitals with psychiatric illness except for dementia from January 1, 2017, to December 31, 2018. Statistical analysis was performed from January to May 2023. The timing of the first mental health outpatient care follow-up within 30 days after discharge. The outcome of interest was suicide after hospital discharge. The timing of the first follow-up visit was observed within 30 days after discharge. The Cox proportional hazard model was used to explore the association between the risk of suicide and the timing of outpatient follow-up. Of the 76 462 patients admitted to hospitals from 2017 to 2018, 225 (52.6%) were male; 21 313 (27.9%) had a primary diagnosis of substance use disorder, 17 608 (23.0%) had schizophrenia, and 15 018 (19.6) had depression; mean (SD) age was 46.4 (16.3) years. A total of 49 319 patients (64.5%) received follow-up outpatient care within 30 days of discharge. The mean (SD) follow-up period was 30.8 (20.2) months, and 1536 patients died of suicide during the study period. The hazard ratio for suicide risk in patients who received outpatient care within 7 days compared with those who did not receive any care within 30 days after discharge was 0.82 (95% CI, 0.80-0.83). The earlier the time of outpatient follow-up care, the lower the risk of suicide for those with substance use disorder, schizophrenia, bipolar disorder, and depression. In this cohort study of patients with psychiatric illness, early follow-up outpatient care after discharge was associated with a lower risk of suicide. These results suggest that those at high risk of suicide during hospitalization need intensive follow-up immediately after discharge.

Association of opioid or other substance use disorders with health care use among patients with suicidal symptoms

IntroductionPrior literature establishes noteworthy relationships between suicidal symptoms and substance use disorders (SUDs), particularly opioid use disorder (OUD). However, engagement with health care services among this vulnerable population remains underinvestigated. This study sought to examine patterns of health care use, identify risk factors in seeking treatment, and assess associations between outpatient service use and emergency department (ED) visits. MethodsUsing electronic health records (EHRs) derived from five health systems across New York City, the study selected 7881 adults with suicidal symptoms (including suicidal ideation, suicide attempt, or self-harm) and SUDs between 2010 and 2019. To examine the association between SUDs (including OUD) and all-cause service use (outpatient, inpatient, and ED), we performed quasi-Poisson regressions adjusted for age, gender, and chronic disease burden, and we estimated the relative risks (RR) of associated factors. Next, the study evaluated cause-specific utilization within each resource category (SUD-related, suicide-related, and other-psychiatric) and compared them using Mann-Whitney U tests. Finally, we used adjusted quasi-Poisson regression models to analyze the association between outpatient and ED utilization among different risk groups. ResultsAmong patients with suicidal symptoms and SUD diagnoses, relative to other SUDs, a diagnosis of OUD was associated with higher all-cause outpatient visits (RR: 1.22), ED visits (RR: 1.54), and inpatient hospitalizations (RR: 1.67) (ps < 0.001). Men had a lower risk of having outpatient visits (RR: 0.80) and inpatient hospitalizations (RR: 0.90), and older age protected against ED visits (RR range: 0.59–0.69) (ps < 0.001). OUD was associated with increased SUD-related encounters across all settings, and increased suicide-related ED visits and inpatient hospitalizations (p < 0.001). Individuals with more mental health outpatient visits were less likely to have suicide-related ED visits (RR: 0.86, p < 0.01), however this association was not found among younger and male patients with OUD. Although few OUD patients received medications for OUD (MOUD) treatment (9.9 %), methadone composed the majority of MOUD prescriptions (77.7 %), of which over 70 % were prescribed during an ED encounter. ConclusionsThis study reinforces the importance of tailoring SUD and suicide risk interventions to different age groups and types of SUDs, and highlights missed opportunities for deploying screening and prevention resources among the male and OUD populations. Redressing underutilization of MOUD remains a priority to reduce acute health outcomes among younger patients with OUD.

Incidence, Severity and Characteristics of Patients' Aggression in Acute Psychiatric Wards: Data from a Slovenian National Survey.

To evaluate the incidence, severity and characteristics of aggressive behaviour in patients hospitalized in acute psychiatric wards, as well as the association between patient characteristics and the incidence of recurrent aggressive behaviour. A multicentre prospective study included all twelve acute wards in Slovenian psychiatric hospitals with a total capacity of 232 beds. Over five consecutive months, data on the number of treatment episodes involving aggressive behaviour and the number of aggressive incidents, their severity and characteristics were obtained using the Staff Observation Aggression Scale-Revised (SOAS-R). Patient- and event-based incident rates of verbal and physical aggression were calculated. The association between patient characteristics and recurrent aggressive behaviour was analysed. Patient characteristics data were extracted from hospital databases. 3,190 treatment episodes were included during a 5-month period. Aggressive behaviour was observed in 13.4% of treatment episodes, and 922 aggressive incidents were recorded, which resulted in 3.98 incidents per 100 occupied bed days and 9.48 incidents per bed per year. 74.1% of incidents were severe, and more than half of incidents included physical aggression. 75.5% of incidents were directed against medical staff. 5.9% of treatment episodes were involved in multiple aggressive incidents. Compared to patients with single incidents, patients with recurrent aggression had a less frequent main diagnosis of substance use disorders and a longer duration of hospitalization. Monitoring the frequency and characteristics of aggressive behaviour allows comparisons with other studies and, more importantly, it is necessary for planning and assessing the effectiveness of preventative aggression management strategies.

Monotonic Association of Increasing Past-Year Substance Use Disorder across a Four-Level Trauma Post-Traumatic Stress Disorder (PTSD) Hierarchy in a Nationwide Sample

Objective There is limited information on the differences in the association of substance use disorders (SUD) with four clinically relevant hierarchical groups based on trauma exposure and its consequences (1-no trauma; 2-trauma but no PTSD; 3-remitted PTSD; and 4-current PTSD). Methods Among adults enrolled in a large nationally representative survey, the National Epidemiologic Survey on Alcohol and Related Conditions Wave III (NESARC III), we compared differences in SUD prevalence between each of the hierarchical trauma group and the prior group adjusting for potentially confounding factors. Results Unadjusted results show that each increase in the hierarchy was associated with a greater likelihood of SUD diagnoses, even after adjusting for potentially confounding variables. However, after adjusting for covariates, comparison of adults with past to those with current PTSD showed persistence of SUD indicators. Conclusion SUD prevalence increased substantially with trauma exposure even without PTSD and monotonically increased further with past and current PTSD, respectively, illustrating the differential effect of the clinical consequences of trauma.

Forensic psychiatry evaluation of criminal law cases at a university hospital in Eastern Turkey

ABSTRACT This study aimed to determine the epidemiological distribution of the cases referred to the forensic psychiatric assessments according to the reasons for their referral. The medical files of 214 cases referred to the Forensic-Psychiatry Outpatient-Clinic and forensic reports within the scope of criminal law were reviewed retrospectively. 76% of cases were ‘suspected perpetrators’ who were sent for the purpose of determining criminal responsibility, 9.3% were ‘’mentally disordered victims’, 14% were sent to determine ‘victim developing a mental disorder(MD)’. In our study, it was determined that the majority of the suspected perpetrators were male and in the 20–39 age group. Marriage rates were high in both suspected perpetrator groups with(42.2%) or without(39.9%) of MD. The most common diagnosis of suspected perpetrators was schizophrenia/psychosis. Regarding the group sent as perpetrators, it was found that the rate of intellectual disability(ID) has a high rate of 20.2% among all cases, and the diagnoses of substance use disorder(SUD) and personality disorder(PD)were low. Full criminal responsibility was significantly correlated with age, PD, SUD, and pre-criminal substance use. Logistic regression analysis was determined gender and education can predict the perpetration or victimization of individuals with MD. Our findings show that protective-preventive practices specific to risk groups should be developed for the sociodemographic and clinical differences we detected in the Turkish forensic psychiatry sample. In the process of evaluating whether there is a medical problem in the marriage of patients with schizophrenia, possible harm to the spouse and children of the patient should be considered. We are of the opinion that all MD should be evaluated from the perspective of the implementation of preventive security measures, the focus of which is the state of dangerousness.

Whole person care: Outcomes from a 5-year care model integrating primary care into a behavioral health clinic.

Integrated mental and physical health care has the potential to improve health outcomes. A behavioral health organization established a reverse integration program site using a co-located model to provide primary care services to patients receiving behavioral health services. We ask whether this model of co-located care was effective in improving a range of physical health outcomes for clients. This program was funded with a grant from the Substance Abuse and Mental Health Services Administration Primary and Behavioral Health Care Integration. Patients received services in a community mental health setting that embedded primary care services. The population included adult patients with mental illness, substance use disorder (SUD), or co-occurring medical diagnoses in an urban setting. Just under half of the patients identified as non-White, and over one quarter identified as Hispanic. These characteristics demonstrate a medically complex and underserved population. This description and exploratory analysis utilized National Outcome Measures data and clinical health measures from electronic health records. We stratified data by SUD and mental illness diagnoses. We measured changes in health outcomes for this complex population of 532 patients from 2015 to 2019. From enrollment to last visit, patient outcomes improved for blood pressure and cholesterol. Conversely, waist circumference and breath carbon monoxide levels significantly worsened. This reverse integration co-location program demonstrates that positive health outcomes can be achieved through evidence-based care, adaptable clinic arrangements, and robust community connections and support. More work is needed to generate positive health outcomes in medically complex patients. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Parental substance use disorder and risk of intellectual disability in offspring in Sweden: a national register study

Intellectual disability (ID) is a disorder with unknown aetiology in many cases. Maternal alcohol use is a known risk factor for ID, but less is known about the importance of maternal and paternal substance use disorder (SUD) and risk of ID in offspring. Data from multiple nationwide registers were used to create a cohort of children born from January 01, 1978 to December 31, 2002. All participants were born in Sweden, had available parental identification information and did not emigrate or die before age 12 (n=1,940,820). Logistic regression modelling was performed with exposure defined as having a parent who received any SUD diagnosis, including alcohol use disorder (AUD) and drug use disorder (DUD). The outcome was registration of diagnosis of any form of ID. First, we analysed the risk of ID if parental SUD was registered prior to childbirth with stepwise adjustment of multiple covariates. Second, the effect of timing of SUD diagnosis in relation to childbirth was analysed. Of 37,410 offspring with parental SUD registered prior to birth, 3.0% (n=1110) had any form of ID compared to 1.2% (n=23,168) of those 1,903,410 individuals without parental SUD prior birth. Parental SUD prior birth was associated with an increased risk of any form of ID (Odds Ratio [OR]: 2.3 [2.2-2.5]), with ORs similar for maternal (OR: 2.3 [2.1-2.5]) and paternal SUD (OR: 2.3 [2.1-2.5]). These ORs were reduced but remained statistically significant after adjusting for parental education, migration, psychiatric comorbidity, and co-parent SUD (OR parental SUD: 1.6 [1.5-1.8]; OR maternal SUD: 1.4 [1.2-1.5]; OR paternal SUD: 1.6 [1.5-1.7]). Parental SUD was associated with increased risk of ID in offspring irrespective of timing of diagnosis, but if mothers or fathers were diagnosed with AUD during pregnancy (OR maternal AUD: 5.0 [3.1-8.2]; OR paternal AUD: 2.8 [2.2-3.6]), the risk was significantly greater than if the AUD diagnosis was first registered after childbirth (OR maternal AUD: 1.9 [1.8-2.0]; OR paternal AUD: 1.6 [1.6-1.7]). Both paternal and maternal SUD were associated with an increased risk of ID in offspring, with greatest risk observed when AUD was diagnosed during pregnancy. Possible mechanisms may involve shared genetic and environmental factors, including toxic effects from alcohol intake. These findings have clinical implications in suggesting that parental SUD in either parent represents a possibly modifiable risk factor to consider when developing prevention, diagnostics and treatment programs for children with ID. Stockholm County Council, the Research Council of the Swedish Alcohol Retailing Monopoly, Fredrik and Ingrid Thurings stiftelse, Academy of Finland, the Swedish Research Council and the Swedish Research Council for Health, Working Life and Welfare, Nordforsk by the Nordic Council of Ministers and the Polish Medical Research Agency.

Using Machine Learning of Online Expression to Explain Recovery Trajectories: Content Analytic Approach to Studying a Substance Use Disorder Forum.

Smartphone-based apps are increasingly used to prevent relapse among those with substance use disorders (SUDs). These systems collect a wealth of data from participants, including the content of messages exchanged in peer-to-peer support forums. How individuals self-disclose and exchange social support in these forums may provide insight into their recovery course, but a manual review of a large corpus of text by human coders is inefficient. The study sought to evaluate the feasibility of applying supervised machine learning (ML) to perform large-scale content analysis of an online peer-to-peer discussion forum. Machine-coded data were also used to understand how communication styles relate to writers' substance use and well-being outcomes. Data were collected from a smartphone app that connects patients with SUDs to online peer support via a discussion forum. Overall, 268 adult patients with SUD diagnoses were recruited from 3 federally qualified health centers in the United States beginning in 2014. Two waves of survey data were collected to measure demographic characteristics and study outcomes: at baseline (before accessing the app) and after 6 months of using the app. Messages were downloaded from the peer-to-peer forum and subjected to manual content analysis. These data were used to train supervised ML algorithms using features extracted from the Linguistic Inquiry and Word Count (LIWC) system to automatically identify the types of expression relevant to peer-to-peer support. Regression analyses examined how each expression type was associated with recovery outcomes. Our manual content analysis identified 7 expression types relevant to the recovery process (emotional support, informational support, negative affect, change talk, insightful disclosure, gratitude, and universality disclosure). Over 6 months of app use, 86.2% (231/268) of participants posted on the app's support forum. Of these participants, 93.5% (216/231) posted at least 1 message in the content categories of interest, generating 10,503 messages. Supervised ML algorithms were trained on the hand-coded data, achieving F1-scores ranging from 0.57 to 0.85. Regression analyses revealed that a greater proportion of the messages giving emotional support to peers was related to reduced substance use. For self-disclosure, a greater proportion of the messages expressing universality was related to improved quality of life, whereas a greater proportion of the negative affect expressions was negatively related to quality of life and mood. This study highlights a method of natural language processing with potential to provide real-time insights into peer-to-peer communication dynamics. First, we found that our ML approach allowed for large-scale content coding while retaining moderate-to-high levels of accuracy. Second, individuals' expression styles were associated with recovery outcomes. The expression types of emotional support, universality disclosure, and negative affect were significantly related to recovery outcomes, and attending to these dynamics may be important for appropriate intervention.