Binnendijk, S. van, Amsterdam, J. G. C. van, Snijder, M. B., Schene, A. H., Derks, E. M., & Brink, W. van den. (2020). Contribution of Alcohol and Nicotine Dependence to the Prevalence of Depressed Mood in Different Ethnic Groups in The Netherlands: The HELIUS Study. Journal of Dual Diagnosis, 0(0), 1‑14. https://doi.org/10.1080/15504263.2020.1772526
Objective: Ethnic minorities report different levels of drinking and smoking and higher rates of depression compared to native populations. In this study we aimed to investigate in six ethnic groups whether tobacco and alcohol use were associated with depressive symptoms, which are more prevalent in ethnic minorities.Methods: Cross-sectional data from the multi-ethnic Healthy Life in an Urban Setting (HELIUS) study sample (N = 22,471) was used, comprising 4,580 native Dutch participants which were compared with participants from five ethnic minority groups (3,259 South Asian Surinamese, 4,292 African Surinamese, 2,262 Ghanaian, 3,891 Turkish, and 4,187 Moroccan).Results: Alcohol misuse was positively associated with depressed mood in all ethnic groups except for the Dutch and the Ghanaians. Nicotine dependence was positively associated with depressed mood in all ethnic groups except for the Ghanaian group.Conclusions: Alcohol misuse and nicotine dependence were significantly associated with depressed mood in most but not all ethnic groups and especially in men. However, across all groups the contribution of alcohol misuse and nicotine dependence to depressed mood was small. Prospective multi-ethnic studies should confirm whether the relations are causal and elucidate their direction.
Buleyko, A. A., Soldatkin, V. A., Murina, I. V., Ruban, D. A., Simak, O. Ya., Krysenko, P. B., & Kryuchkova, M. N. (2020). Does Alcohol Influence Cognitive Functions in Patients with Schizophrenia? Neuroscience and Behavioral Physiology, 50(4), 408‑412. https://doi.org/10.1007/s11055-020-00915-0
Objectives. To establish the characteristics of the influence of alcoholization on cognitive functions in patients with schizophrenia, Materials and methods. A total of 100 patients with paranoid schizophrenia were studied. A main group (MG) was identified with concomitant diagnosis of alcohol dependence (n = 50), along with a control group (n = 50). The characteristics of memory, attention, and thought were assessed, and the groups were compared in terms of the presence of concomitant addictive pathology. Results. Attention and short-term memory were at the borderline level and no statistically significant differences were seen between the groups studied. In the Benton test, the study group showed a predominance of errors of the schizophrenic type, while the control group was dominated by “organic” errors. A statistically significant dominance of mild decreases in thought were seen in the MG. Conclusions. Concomitant alcohol dependence was not a defining factor in cognitive impairments in patients with schizophrenia, though it introduced a distinct organic stigma to the structure of the patients’ cognitive profile. “Organic” impairments to thought structure in patients with concomitant alcohol dependence were seen. The best measures of attention were seen in patients suffering from shift-like schizophrenia who were healthy in addiction terms. This suggests that the influence of the alcohol factor has different significance in the continuous and episodic/progressive types of schizophrenia.
Gomez, K. U., Carson, J., Brown, G., & Holland, M. (2020). Positive psychology in dual diagnosis recovery: a mixed methods study with drug and alcohol workers. Journal of Substance Use, 0(0), 1‑9. https://doi.org/10.1080/14659891.2020.1760376
Background: In traditional dual diagnosis treatment, the primary aim is to attend the substance use problem and tackle the mental health issues with little attention to the positive aspects of clients’ lives. This deficit-based approach, however, may bring about an ignorance of clients’ potentials. The present study primarily aimed at investigating practitioners’ views of their clients; acquiring information on how to improve a previously designed positive psychology intervention for dual diagnosis, and finding ways of integrating positive psychology with current approaches.Methods: A positive psychology intervention developed for dual diagnosis individuals was delivered to two groups of psychosocial intervention workers (n = 17) at a drug and alcohol service. The study employed a mixed methods approach with a quantitative and a qualitative element (focus group).Results: Participants reported a number of personal and professional benefits gained from the intervention, but also discussed the structure of the intervention, practitioner qualities, and difficulties of incorporation into existing treatment as challenges that may arise in terms of feasibility with this client group.Conclusions: Through a strengths-based positive approach, a more balanced treatment would enable the recognition and appreciation of both the vulnerabilities and the emerging potential of clients. This would lead to better outcomes with clients achieved by a healthier workforce.
McGinty, E. E., & Daumit, G. L. (2020). Integrating Mental Health and Addiction Treatment Into General Medical Care: The Role of Policy. Psychiatric Services, appi.ps.202000183. https://doi.org/10.1176/appi.ps.202000183
Interventions that integrate care for mental illness or substance use disorders into general medical care settings have been shown to improve patient outcomes in clinical trials, but efficacious models are complex and difficult to scale up in real-world practice settings. Existing payment policies have proven inadequate to facilitate adoption of effective integrated care models. This article provides an overview of evidence-based models of integrated care, discusses the key elements of such models, considers how existing policies have fallen short, and outlines future policy strategies. Priorities include payment policies that adequately support structural elements of integrated care and incentivize multidisciplinary team formation and accountability for patient outcomes, as well as policies to expand the specialty mental health and addiction treatment workforce and address the social determinants of health that disproportionately influence health and well-being among people with mental illness or substance use disorders.
Mongan, D., Cannon, M., & Cotter, D. R. (2020). COVID-19, hypercoagulation and what it could mean for patients with psychotic disorders. Brain, Behavior, and Immunity. https://doi.org/10.1016/j.bbi.2020.05.067
Murney, M. A., Sapag, J. C., Bobbili, S. J., & Khenti, A. (2020). Stigma and discrimination related to mental health and substance use issues in primary health care in Toronto, Canada: a qualitative study. International Journal of Qualitative Studies on Health and Well-being, 15(1), 1744926. https://doi.org/10.1080/17482631.2020.1744926
Purpose: Community Health Centres (CHCs) are an essential component of primary health care (PHC) in Canada. This article examines health providers’ understandings and experiences regarding stigma towards mental health and substance use (MHSU) issues, as well as their ideas for an effective intervention to address stigma and discrimination, in three CHCs in Toronto, Ontario. Methods: Using a phenomenological approach, we conducted twenty-three interviews with senior staff members and peer workers, and three focus groups with front-line health providers. Ahybrid approach to thematic analysis was employed, entailing a combination of emergent and a priori coding. Results: The findings indicate that PHC settings are sites where multiple forms of stigma create health service barriers. Stigma and discrimination associated with MHSU also cohere around intersecting experiences of gender, race, class, age and other issues including the degree and visibility of distress. Clients may find social norms to be alienating, including behavioural expectations in Canadian PHC settings. Conclusions: Given the turmoil in clients’ lives, systematic efforts to mitigate stigma were inhibited by myriad proximate factors that demanded urgent response. Health providers were enthusiastic about implementing anti-stigma/recovery-based approaches that could be integrated into current CHC services. Their recommendations for interventions centred around communication and education, such as training, CHC-wide meetings, and anti-stigma campaigns in surrounding communities.
Palomar-Ciria, N., Blanco del Valle, P., Hernández-Las Heras, M. Á., & Martínez-Gallardo, R. (2020). Schizophrenia and COVID-19 delirium. Psychiatry Research, 290, 113137. https://doi.org/10.1016/j.psychres.2020.113137
Since its outbreak, coronavirus disease 2019 has been producing atypical manifestations aside from fever, coughing and dysnea. One of the most common is delirium, which, however, is highly overlooked. This has consequences in the treatment of patients and also may lead to underdiagnosing the infection. In this work, we present the case of a man diagnosed with schizophrenia, who had been stable for more than 20 years and that presented with an atypical picture of psychotic and confusional symptoms related to COVID-19 infection.
Richert, T., Anderberg, M., & Dahlberg, M. (2020). Mental health problems among young people in substance abuse treatment in Sweden. Substance Abuse Treatment, Prevention, and Policy, 15(1), 43. https://doi.org/10.1186/s13011-020-00282-6
Young people with substance use problems face a high risk of co-occurring mental health problems, something that may involve a more difficult life situation, social problems as well as worse treatment outcomes. The aim of this study is to analyse self-reported mental health problems among young people receiving outpatient treatment for substance use problems in Sweden. We explore what types of mental health problems are more or less predominant, and whether there are significant differences between boys and girls. In addition, we analyse how various mental health problems covary with indicators of substance abuse severity.
Ruppelt, F., Rohenkohl, A., Kraft, V., Schöttle, D., Schröter, R., Gaianigo, J., … Lambert, M. (2020). Course, remission and recovery in patients with severe psychotic disorders with or without comorbid substance use disorders: Long-term outcome in evidence-based integrated care (ACCESS II study). Schizophrenia Research. https://doi.org/10.1016/j.schres.2020.03.058
Objectives People with psychotic disorders have a high prevalence of comorbid mental disorders, especially if severe mental illness (SMI) criteria are fulfilled. Substance Use Disorders (SUD) are the most common comorbidity. The aim of the study is to investigate whether SMI patients with and without comorbid SUD have a comparable course, remission and recovery rates within evidence-based care. Methods ACCESS is an integrated care model for patients with severe nonaffective and affective psychotic disorders. Treatment trajectories of patients, who have been in ACCESS care for at least 4 years, with and without SUD were compared with regard to the course of illness using Mixed Model Repeated Measures (MMRM) as well as recovery rates and its predictors. Results 187 of 312 patients (60%) were at least 4 years in ACCESS. Of these, 126 (67.4%) had a comorbid SUD at admission. Patients had on average 2.96 SUD, 87 (69%) had a dependence. Both groups improved significantly over 4 years in all outcome parameters. However, patients with substance dependence showed significantly worse outcomes in psychopathology (p < 0.001), functioning (p = 0.006) and quality of life (p = 0.026). Using LOCF, 44 patients (23.5%) fulfilled recovery criteria at endpoint. Comorbid substance use dependence was the only significant predictor for non-recovery (OR = 0.462, p = 0.048). Conclusion SUD and especially substance dependence are common in psychotic disorders with SMI. Evidence-based integrated care also leads to long-term improvement in these patients, but to a lesser extent than in patients without SUD. In particular, the “optimal” outcome recovery is made more difficult by SUD dependence.
Sundet, R., Kim, H. S., Karlsson, B. E., Borg, M., Sælør, K. T., & Ness, O. (2020a). A heuristic model for collaborative practice – Part 1: a meta-synthesis of empirical findings on collaborative strategies in community mental health and substance abuse practice. International Journal of Mental Health Systems, 14. https://doi.org/10.1186/s13033-020-00376-5
Background Collaboration has become a cornerstone for healthcare practice in recent decades resulting in the efforts at international and national levels to integrate the concept into healthcare practice and services. However, there is a paucity of research delineating strategies for professionals to apply in collaborative practice with clients in general as well as in mental health and substance abuse (MHSA) care. Methods The method applied in this paper is a form of qualitative meta-synthesis referring to the integration of findings from multiple qualitative studies within a program of research by the same investigators. Eighteen empirical papers with the focus on community MHSA practice and recovery-orientation with relevance to the service user–professional relationship in MHSA practice were included in this meta-synthesis. Results Three types of processes of collaboration specified by meta-themes were identified. The meta-themes of the interactive-dialogical process type include (a) maintaining human relationship, (b) walking alongside, (c) information sharing, (d) seizing the present moment, (e) taking the perspective of the other, and (f) aligning/scaffolding. The meta-themes of the negotiated-participatory engagement type include (a) feedback-informing process, (b) putting differences to work, (c) negotiated partnering, (d) accommodating user participation, and (e) addressing the tension between help and control. The meta-themes of the negotiated supportive process type are (a) helping in context, (b) coordinating, (c) pulling together, (d) advocating, and (e) availing. These meta-themes are strategies for collaboration applicable in MHSA practice. Conclusions This meta-synthesis of collaborative processes found in community mental health practice points to the possibility of developing a set of repertoires of practice for service user/professional collaboration, especially in community MHSA practice.
Sundet, R., Kim, H. S., Karlsson, B. E., Borg, M., Sælør, K. T., & Ness, O. (2020b). A heuristic model for collaborative practice—part 2: development of the collaborative, dialogue-based clinical practice model for community mental health and substance abuse care. International Journal of Mental Health Systems, 14. https://doi.org/10.1186/s13033-020-00377-4
Background Various models for collaborative practice in mental health care incorporating the perspectives of service-user participation and collaboration in the care have been developed. However, the emphasis in these practice models has not been on identifying specific features of “how” collaboration and service-user participation can occur and be nurtured. This suggests a need for a collaborative practice model that specifies essential strategies operationalizing the tenets of service-user participation and collaboration applicable in mental health and substance abuse (MHSA) care. Methods A double helix approach of coalescing theoretical ideas and empirical findings to develop a practice model that is applicable in MHSA practice. A theoretical analysis is carried out to identify the critical, foundational elements for collaborative practice in MHSA practice, and has identified the philosophical-theoretical orientations of Habermas’ theory of communicative action, Bakhtin’s dialogicality, and the philosophy of personhood as the foundational features of collaboration. This base is juxtaposed with the results of a qualitative meta-analysis of 18 empirical articles on collaboration in MHSA to advance a collaborative practice model specifically in the domain of service user/professional collaboration. Results “The collaborative, dialogue-based clinical practice model” (CDCP Model) for community mental health care is proposed, within the structure of four main components. The first specifies the framework for practice that includes person-centered care, recovery-orientation, and a pluralistic orientation and the second identifies the domains of collaboration as service user/professional collaboration, inter-professional collaboration, and service sector collaboration. The third identifies self-understanding, mutual understanding, and shared decision-making as the essential principles of collaboration. The fourth specifies interactive-dialogic processes, negotiated-participatory engagement processes, and negotiated-supportive processes as the essential strategies of collaboration applicable in service user/professional collaboration which were extracted in the empirical work. An illustration of the CDCP Model in a clinical case is given. Conclusions The CDCP Model presented fills the gap that exists in the field of community MHSA practice regarding how to operationalize systematically the tenets of person-centeredness, recovery-oriented, and pluralism-oriented practice in terms of user/professional collaboration.
Flores-Aranda, J. et Goyer, M.-È. (2020). Guide québécois d’amélioration des pratiques sur la prise en charge du trouble lié à l’utilisation des opioïdes (TUO). Institut universitaire sur les dépendances. [accéder au contenu]
