Treatment Of Dual Diagnosis Patients Research Articles

Aripiprazole oral treatment in a sample of patients with dual diagnosis

IntroductionAripiprazole is the firstborn of the new dynasty of antipsychotic called third generation or neuromodulator of dopamine-serotonin system. It has proven to be an effective and well-tolerated antipsychotic. Dual Pathology represents the presence of comorbidity between mental illness and substance use disorders. It is an under-diagnosed problem and it is increasing frequency.ObjectivesThe aim of this study was to determine and describe the clinical profile of the patients admitted to the Dual Pathology Unit (UPD) at The Montalvos Hospital (Part of Salamanca University Teaching Hospital, Spain) treated with oral Aripiprazole.MethodsDescriptive, observational, retrospective study of a sample of patients admitted to the UPD to which oral aripiprazole was prescribed during hospitalization. A number of sociodemographic, clinical, and treatment-related variables are described.ResultsFrom a sample of 25 patients and according to DSM-5 criteria (APA, 2013) main diagnoses were: 14 cases of substance-induced psychotic disorder, 3 cases of schizophrenia; 3 cases of schizoaffective disorder; 2 cases of bipolar disorder; 1 case of schizophreniform disorder; 1 case of borderline personality disorder; 1 case of personality syndrome. The most used drugs before the admittance were cocaine, cannabis and opioids. The average dose of aripiprazole was 9 mg and no side effects or drug interactions were reported.ConclusionsApart from its well known efficacy in treament of psychosis, oral aripiprazole may be a first line treatment for Dual diagnosis patients, specially those with problems of non-compliance, due to high level prolactine side effects.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Trans-Sector Integrated Treatment in Psychosis and Addiction.

Patients with psychosis often develop comorbid addiction, with a lifetime prevalence of ca. 50%. Dual diagnoses are considered hard to treat. Long-term integrated treatment programs might improve such patients' outcomes, at least to a moderate extent, but they have not yet been adequately studied or implemented in Germany to date. 100 dual diagnosis patients participated in a single-center, randomized, controlled trial under standard hospital treatment conditions. They were randomly allotted to two groups. Patients in the intervention group were admitted to a specialized open hospital ward, where they were given integrated treatment, including disorder-specific group therapy. Their treatment was continued with further disorder-specific group therapy in the outpatient setting. Patients in the control group were admitted to an open general psychiatric ward and received treatment as usual, but no disorder-specific treatment either during their hospitalization or in the subsequent outpatient phase. Follow-up examinations were performed three, six, and twelve months after inclusion. The primary outcome was defined as the changes in substance use and abstinence motivation. The secondary outcome consisted of the patients' satisfaction with treatment and with life in general, retention rate, psychopathology, rehospitalizations, and global level of functioning. The patients in the intervention group developed higher abstinence motivation than those in the control group (p = 0.009) and transiently reduced their substance use to a greater extent (p = 0.039 at three months). They were also more satisfied with their treatment (group effect: p = 0.011). Their global level of functioning and their retention rate were also higher, but these differences did not reach statistical significance. Low-threshold, motivational, integrated treatment programs with psycho-educative and behavioral therapeutic elements may be helpful in the treatment of dual diagnosis patients and should be more extensively implemented as part of standard hospital treatment. Larger-scale, methodologically more complex studies will be needed to identify subgroups of patients that respond to such treatments in different ways.

A randomised controlled trial of outpatientversusinpatient integrated treatment of dual diagnosis patients: a failed but informative study

The co-occurrence of severe mental illness (SMI) and substance use disorder (SUD) in dual diagnosis patients is common and associated with negative treatment outcomes. Therefore, integrated treatments, combining proven effective mental health and substance abuse interventions, have emerged. However, evidence about the effectiveness of integrated outpatient versus inpatient treatment for dual diagnosis patients from randomised controlled trials is lacking. The aim of the paper is to determine whether integrated outpatient treatment for patients with SMI and SUD is more effective than integrated inpatient treatment. Three months of post-treatment hospitalisation, problem drug use and psychiatric status were assessed in 82 patients with SMI and SUD in a randomised controlled trial (RCT) comparing five months of integrated inpatient treatment (n = 40) with five-months integrated outpatient treatment (n = 42) following a shared one-month inpatient stabilisation phase. No significant differences in outcomes wer...

Health Providers' Descriptions of the Significance of the Therapeutic Relationship in Treatment of Patients with Dual Diagnoses

Dual diagnosis of substance abuse and severe psychiatric illness is frequent, and the building of therapeutic relationships with this group of patients seems to be both important and difficult. An integrated treatment model has been claimed to be the preferred treatment for dual diagnosis patients. This study explores how providers in an integrated treatment model, and a substance abuse treatment model with less emphasis on psychiatric co-morbidity, handle relationship building. Two focus groups included providers working in a Therapeutic Community (TC) and a Dual Diagnosis (DD) ward. Participants were given a short case history and asked to describe how they would approach the case. The analysis was based on a phenomenological method. All providers perceived a good relationship to be central to the treatment. Providers in the DD ward were more ready to build close relationships with the patients, and described their relationship with the patients as more crucial to treatment. The providers in the TC ascr...

Predictors of completing treatment and achieving abstinence during inpatient dual diagnosis treatment

Background: Little is known about predictors of successful inpatient treatment of dual diagnosis patients. Methods: In a naturalistic prospective study, consecutive patients admitted to a dual diagnosis inpatient cognitive milieu therapy program were evaluated at intake to treatment with the Brief Psychiatric Rating Scale (BPRS), the Beck Depression Inventory (BDI), the Beck Anxiety Inventory (BAI), and the Severity of Dependence Scale (SDS). Logistic regression was used to determine predictors of confirmed abstinence during community linkage and completing treatment with medical advice. Results: No significant predictors were found of completing treatment. High thought disturbance, anxiety and severity of dependence were associated with drug or alcohol use during community linkage. A diagnosis of alcohol dependence was associated with abstinence during community linkage. Discussion: Dual diagnosis patients with severe substance dependence, as well as patients with elevated thought disturbance and anxiety...

Effectiveness of Day Treatment for Dual Diagnosis Patients With Severe Chronic Mental Illness

This study examined the clinical outcomes of dual diagnosis patients with severe chronic mental illness and a secondary diagnosis of an addictive substance (N = 48) who attended a daily Day Treatment Center (DTC). Clinical interventions included the DTC program plus weekly dual diagnosis groups. Outcome measures included urine toxicology screens, Global Assessment of Functioning (GAF) scores, relapses, and hospitalizations. Results revealed that the length of stay (LOS) in the DTC program was the only statistically significant predictor of both pre and post study GAF scores for all three groups. Patients with one year of remission were less likely to relapse. The longer the patient's stay in the DTC program, the better the treatment outcome.

Delusions Incorporating Cannabis use in Dually Diagnosed Patients with a Primary Psychotic Disorder

To describe and discuss the implications for treatment of 3 cases of dually diagnosed patients with a primary psychotic disorder who have developed persisting, cannabis-oriented delusional systems. Psychiatric assessment and daily observation on an acute inpatient psychiatric unit. Abstinence appears to be particularly difficult to attain for a patient with psychosis who hold delusional beliefs that cannabis is a conduit for supernormal experiences with positive affective content, grandiose themes and a sense of enhanced self-efficacy. This phenomenon poses special challenges in the treatment of dual diagnosis patients. Modifications to existing CBT protocols for the treatment of substance abuse in psychosis might be useful in such patients.

Pharmacological Treatment of Patients with Schizophrenia and Substance Abuse Disorders

Substance abuse and/or dependence among psychiatric patients is quite common. At least half of patients with schizophrenia will also have a lifetime diagnosis of a substance abuse disorder. These dual diagnosis patients have an increased likelihood of utilizing medical and psychiatric services and have higher rates of psychiatric hospitalization. They are more likely to suffer poor outcomes secondary to their substance abuse and their psychopathology or due to cumulative effects of both disorders. Traditionally these patients have been difficult to manage. However, the assessment and treatment of dually diagnosed patients has significantly improved over the last 20 years. To date, the strongest evidence for effective treatment of dual diagnosis patients has been the utilization of integrated treatment services, which combine both mental health and substance abuse treatments, and includes the effective use of psychotropic medications. This article will review the medication studies that have targeted the dually diagnosed, and will also summarize the currently available pharmacological treatment options for these. A future article will focus on the leading edge psychosocial treatment modalities available through the integrated treatment program.

Treatment for Dual Diagnosis Patients in the Psychiatric and Substance Abuse Systems

The purpose of this study was to describe and compare the extent to which psychiatric and substance abuse programs treating dual diagnosis patients in the residential and outpatient modalities offered the components recommended for this client group. Surveys were completed by managers of 753 programs in the Department of Veterans Affairs that had a treatment regimen oriented to dual diagnosis patients. Programs within both the psychiatric and substance abuse systems had some of the key services of integrated treatment (e.g., assessment and diagnosis, crisis intervention, counseling targeted at psychiatric and at substance use problems, medications, patient education, HIV screening and counseling, family counseling and education). However, compared to psychiatric programs, substance abuse programs were more likely to offer some of these services and other critical components (e.g., a cognitive-behavioral treatment orientation, assignment of a single case manager to each patient). Outpatient psychiatric programs were particularly lacking on key management practices (e.g., use of clinical practice guidelines, performance monitoring of providers) and services (e.g., detoxification, 12-step meetings) of integrated treatment. Generally, differences between psychiatric and substance abuse programs appeared to involve difficulties in developing treatment that is fully oriented toward the co-occurring diagnosis. To improve the provision of high-quality dual-focused care, we recommend planners' use of cross-system teams and applications of recently produced tools designed to increase programs' ability to deliver integrated care to dually disordered individuals.

Short-term outcomes of matching dual diagnosis patients’ symptom severity to treatment intensity

This study evaluated a patient-treatment matching strategy intended to improve the effectiveness of hospital-inpatient and community-residential treatment for dual diagnosis patients. Matching variables were the severity of patient disorders and the program’s service intensity. Each of three high-intensity hospital programs was paired with a nearby high-intensity community program; there were also four low-intensity pairs. Patients (N=230) were randomly assigned to hospital or community care at intake, and followed at discharge (96%) and at 4 months (90%). Support was found for the matching strategy at discharge in that severely ill patients treated in high-intensity programs improved more on substance abuse outcomes, and moderately ill patients treated in low-intensity programs improved more on psychiatric outcomes. The benefits of matching held at 4 months in that high-severity patients had better alcohol outcomes when they were treated in high-rather than low-intensity programs. High-and moderate-severity patients did not show differential outcomes in hospital-based or community-based programs. Dual diagnosis patients should be matched by symptom severity with program service intensity, but matching with hospital or community care may not enhance treatment outcomes.

One-year outcome of an integrative inpatient treatment for dual diagnosis patients

The purpose of this study was to evaluate a 4-month dual diagnosis inpatient treatment program that was based on integrative models for patients with substance use and psychiatric disorders. At intake and at 1-year follow-up, dual diagnosis patients ( N = 52) were assessed on housing and subsistence level, substance use and psychiatric symptoms. At 1-year follow-up, dual diagnosis patients reported a higher level of housing and subsistence, and less intensive psychiatric symptoms. No change occurred on frequencies of substance use. General improvement may occur even if psychotropic substances are used. Controlled studies are needed on extended inpatient treatment for dual diagnosis patients and outcomes in longer follow-ups.

Training of residents and medical students in the diagnosis and treatment of dual diagnosis patients.

Treatment of dual diagnosis patients requires simultaneous treatment of the addictive and the mental disorders. Available data suggest that this does not happen often. In a survey of several psychiatric services, the unit chiefs reported that dual diagnoses were underreported, no plans were present for combined treatment, families were infrequently involved, and few referrals were made for combined treatment. There is a need for competent, experienced clinician teachers who have had positive experience with the treatment of dual disorders. The training of addiction and mental health professionals must include cooperation, understanding, and respect for each other. Cross-training is needed in chemotherapy, psychotherapy, abstinence from alcohol and other addictive drugs, 12-Step programs, spiritual issues, and milieu therapy. Negative attitudes and ignorance must be overcome for this training to take place. Faculty Fellow training programs have provided a beginning in this direction, but have so far involved few professional schools. Some examples of training with regard to referrals, prescribing, and psychotherapy are given. The importance of supervised clinical experience in treating dual diagnosis patients is emphasized. The provision of this experience provides a challenge to specialists in addiction medicine and addiction psychiatry.

Treatment of dual diagnosis patients: A relapse prevention group approach

The authors describe the successful use of an adjunctive group psychotherapy for substance-abusing patients with major psychiatric disorders (bipolar, schizophrenia, schizoaffective, psychotic depression, and atypical psychosis). The group utilizes a psychoeducational approach that focuses on substance abuse causes and consequences, principles of recovery, and relapse prevention strategies. Eight patients with prolonged histories of abuse of cocaine, alcohol, marijuana, or other drugs were enrolled in this weekly group treatment at a community mental health center drug treatment program, while continuing in treatment with their current case manager or primary therapist. Six of the eight patients achieved periods of stable abstinence, documented by self-report, urine toxicology screens, continued group attendance, and improved social functioning. Case examples are utilized to illustrate the group process.