People who are diagnosed with both learning disability and schizophrenia are generally treated with antipsychotic medication. This review highlights the limited evidence available for the use of this treatment in cases where people have received such a dual diagnosis.
People who are diagnosed with both learning disability and schizophrenia are generally treated with antipsychotic medication. This review highlights the limited evidence available for the use of this treatment in cases where people have received such a dual diagnosis.
Extended abstract:
Author
DUGGAN L.; BRYLEWSKI J.;
Title
Antipsychotic medication versus placebo for people with both schizophrenia and learning disability (review).
Journal citation/publication details
Chichester: John Wiley and Sons; Cochrane Collaboration, 2004. 14p.
Summary
This updated review identified only one relevant randomised controlled trial (RCT), and this was excluded because it provided data for only two of the four participants. Excluded studies are listed, however, and the review provides a summary of issues relating to the treatment of this group of patients.
Context
Antipsychotic medication is very widely used for people with a dual diagnosis of mental illnesses and learning disability, but there is conflicting opinion about whether such patients may be at higher risk than non-learning disabled people of developing unpleasant side-effects.
Methods
What sources were used? The Cochrane Schizophrenia Group trials register (July 2004) was searched, together with the reference lists of relevant studies. Data were also sought from pharmaceutical companies. The sources used for two previous versions of the review were the Group’s register and the National Research Register (2001 version) and Biological Abstracts, the Cochrane Library, EMBASE (Excerpta Medica), Medline and PsycLIT (1999 version).
What search terms/strategies were used? Search strategies for all versions of the review are given in full.
What criteria were used to decide on which studies to include? Eligible studies were RCTs involving adults over 18 with both schizophrenia and learning disability (defined as an IQ of 70 or less) in which any type of antipsychotic medication delivered for one month was compared with placebo.
Who decided on their relevance and quality? The searches delivered 28 references which were screened independently by the authors, with disagreements resolved by discussion. The trials were graded for quality according to the guidance in the Cochrane Handbook
How many studies were included and where were they from? All 28 trials were excluded. Eighteen were not randomised, four were not placebo-controlled and others included participants without schizophrenia and/or learning disabilities. One 1958 trial involving four people fulfilled the inclusion criteria but provided insufficient data to draw meaningful conclusions.
How were the study findings combined? Not applicable.
Findings of the review
The limited number of trials – of whatever quality – identified for this review is of great concern, especially given the use of quite liberal inclusion criteria. Other studies suggest that the underlying neurological damage present in people with learning disabilities may render them more likely to develop additional problems as a result of taking antipsychotic medication. These may include irreversible movement disorders such as restlessness, abnormal movements of the face, mouth, shoulders and trunk, tremor and disturbances of expression and gait. In addition, there is some suggestion that there may be detrimental effects on learning and cognitive abilities. The authors also note that antipsychotic medication is widely used for its tranquillising effects in people who are learning disabled but not mentally ill.
Authors' conclusions
There is no good quality evidence to answer the review question.
Implications for policy or practice
At present the prescribing of anti-psychotic medication to this patient group is based on extrapolation from National Institute for Clinical Excellence (NICE) guidance which in turn is based on research evidence from the non-learning disabled population. This ‘may be considered unethical’. Clinicians should continue to follow NICE guidance but ‘should share their uncertainty with service users and their carers’. While it is understandable that researchers are often reluctant to work in this difficult area, it is essential that research funders take action on the evidence gap and ‘we feel that those with a learning disability and schizophrenia together with their families should help address this shortfall.’
Journal of Dual Diagnosis, 2(3), 2006, pp.101-108.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA
This American 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. 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. The results found treating clinicians under-diagnosed the presence of substance induced mental disorders, and alcohol and cocaine abuse. It is concluded that there is a need for more precise diagnostic practices for the substance abusing dually diagnosed patient. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
This American 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. 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. The results found treating clinicians under-diagnosed the presence of substance induced mental disorders, and alcohol and cocaine abuse. It is concluded that there is a need for more precise diagnostic practices for the substance abusing dually diagnosed patient. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Subject terms:
mental health problems, substance misuse, diagnosis, dual diagnosis, comorbidity;
Journal of Dual Diagnosis, 10(4), 2014, pp.177-186.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA
Objective: The authors conducted a comparative analysis of gender differences in patients with primary psychotic disorders with concurrent substance use and in those with substance-induced psychoses. Methods: A total of 385 individuals admitted to psychiatric emergency departments with early-onset psychosis and recent substance use were interviewed at baseline and at six-month intervals for two years. Using a standardised research diagnostic assessment instrument, the authors classified patients at baseline into primary and substance-induced psychosis groups and analysed the effects of gender on demographic, family, and clinical characteristics at baseline, the interaction of gender and diagnosis, and gender main effects on illness course, adjustment, and service use over the two-year follow-up period. Results: Women had better premorbid adjustment, less misattribution of symptoms, and a later age at onset of regular drug use compared to men. Women, however, showed greater depression and histories of abuse compared to men. Men had greater arrest histories. No interactions between gender and diagnosis were significant. Both genders in the primary and substance-induced psychosis groups showed clinical and functional improvement over the follow-up period despite the overall minimal use of mental health and substance abuse treatment services. Conclusions: Women and men with psychosis and substance use differ on several dimensions. The findings suggest the need for gender-specific treatment programming across both diagnostic groups.
(Edited publisher abstract)
Objective: The authors conducted a comparative analysis of gender differences in patients with primary psychotic disorders with concurrent substance use and in those with substance-induced psychoses. Methods: A total of 385 individuals admitted to psychiatric emergency departments with early-onset psychosis and recent substance use were interviewed at baseline and at six-month intervals for two years. Using a standardised research diagnostic assessment instrument, the authors classified patients at baseline into primary and substance-induced psychosis groups and analysed the effects of gender on demographic, family, and clinical characteristics at baseline, the interaction of gender and diagnosis, and gender main effects on illness course, adjustment, and service use over the two-year follow-up period. Results: Women had better premorbid adjustment, less misattribution of symptoms, and a later age at onset of regular drug use compared to men. Women, however, showed greater depression and histories of abuse compared to men. Men had greater arrest histories. No interactions between gender and diagnosis were significant. Both genders in the primary and substance-induced psychosis groups showed clinical and functional improvement over the follow-up period despite the overall minimal use of mental health and substance abuse treatment services. Conclusions: Women and men with psychosis and substance use differ on several dimensions. The findings suggest the need for gender-specific treatment programming across both diagnostic groups.
(Edited publisher abstract)
Subject terms:
gender, dual diagnosis, comparative studies, mental health problems, substance misuse, diagnosis, emergency health services;
Advances in Dual Diagnosis, 2(2), June 2009, pp.13-18.
Publisher:
Emerald
This paper describes a project developed to help an inpatient mental health team improve their care of service users with comorbid mental health and substance misuse problems. The project aims to enable team members to become active participants in improving their own practice through use of a practitioner action research model.
This paper describes a project developed to help an inpatient mental health team improve their care of service users with comorbid mental health and substance misuse problems. The project aims to enable team members to become active participants in improving their own practice through use of a practitioner action research model.
The guide for families, patients and clinicians faced with dual diagnosis and co-occurring disorders. Including descriptions of common diagnoses, new treatment strategies, case histories and more. Integrating the best evidenced-based medicine with Twelve Step recovery in a new approach that breaks down barriers and makes treatment work
The guide for families, patients and clinicians faced with dual diagnosis and co-occurring disorders. Including descriptions of common diagnoses, new treatment strategies, case histories and more. Integrating the best evidenced-based medicine with Twelve Step recovery in a new approach that breaks down barriers and makes treatment work
Drugs and Alcohol Today, 7(4), December 2007, pp.33-39.
Publisher:
Emerald
This article looks at some of the challenges that face staff working in both substance misuse services and mental health services as they work to deliver services to a group of service users with multiple and complex needs. It will look at the way in which dual diagnosis is defined, the challenges that face both services and service users, how new government guidance could impact upon improved working practice and outcomes in the future and what some of the barriers are to the successful implementation of this guidance.
This article looks at some of the challenges that face staff working in both substance misuse services and mental health services as they work to deliver services to a group of service users with multiple and complex needs. It will look at the way in which dual diagnosis is defined, the challenges that face both services and service users, how new government guidance could impact upon improved working practice and outcomes in the future and what some of the barriers are to the successful implementation of this guidance.
Subject terms:
mental health problems, substance misuse, treatment, therapy and treatment, diagnosis, dual diagnosis;
STRAUSSNER Shulamith Lala Ashenberg, NEMENZIK Jean M.
Journal article citation:
Journal of Social Work Practice in the Addictions, 7(1/2), 2007, pp.5-23.
Publisher:
Taylor and Francis
Place of publication:
Philadelphia, USA
Despite the high prevalence of personality disorders among substance abusing individuals, the literature on these co-occurring disorders is limited. This paper reviews the literature and provides the most current data on the demographics, the criteria for diagnosing both personality disorders and substance use disorders, and the effects of substance abuse and co-occurring personality disorders, particularly antisocial and borderline, on prognoses and treatment approaches. Recommendations for further research on these co-occurring disorders are provided. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Despite the high prevalence of personality disorders among substance abusing individuals, the literature on these co-occurring disorders is limited. This paper reviews the literature and provides the most current data on the demographics, the criteria for diagnosing both personality disorders and substance use disorders, and the effects of substance abuse and co-occurring personality disorders, particularly antisocial and borderline, on prognoses and treatment approaches. Recommendations for further research on these co-occurring disorders are provided. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Journal of Learning Disabilities, 8(3), September 2004, pp.221-235.
Publisher:
Sage
The mental health needs of adults with learning disabilities have not been adequately addressed in many European countries. Although carers can play a significant role in identification and referral, they usually lack the expertise necessary to identify signs of mental disorders. This study evaluated a care staff training programme aiming at improving awareness on issues of dual diagnosis in a group of 36 care staff from residential and community centres in Greece. Training was based on the British Mental Health in Learning Disabilities Training Pack and the PAS–ADD Checklist. The overwhelming majority of staff were very satisfied with training. Staff from institutional work settings, with no previous training on dual diagnosis and with a lower level of education, benefited to a significant degree. Changes occurred mostly in their knowledge and attitudes rather than practice. Supervised practical training is vital to transfer, strengthen and maintain positive changes at work.
The mental health needs of adults with learning disabilities have not been adequately addressed in many European countries. Although carers can play a significant role in identification and referral, they usually lack the expertise necessary to identify signs of mental disorders. This study evaluated a care staff training programme aiming at improving awareness on issues of dual diagnosis in a group of 36 care staff from residential and community centres in Greece. Training was based on the British Mental Health in Learning Disabilities Training Pack and the PAS–ADD Checklist. The overwhelming majority of staff were very satisfied with training. Staff from institutional work settings, with no previous training on dual diagnosis and with a lower level of education, benefited to a significant degree. Changes occurred mostly in their knowledge and attitudes rather than practice. Supervised practical training is vital to transfer, strengthen and maintain positive changes at work.
Subject terms:
learning disabilities, mental health services, multidisciplinary services, training, diagnosis, dual diagnosis, health professionals;
Community Mental Health Journal, 34(2), April 1998, pp.165-174.
Publisher:
Springer
Dual diagnosis necessitates that clinicians are able to recognise its presence in people with disabling mental illnesses. This study demonstrates that professionals often miss the diagnosis, but their ability to detect alcoholism can be greatly enhanced by the use of a simple screening tool. Describes an American research project using two screening tests.
Dual diagnosis necessitates that clinicians are able to recognise its presence in people with disabling mental illnesses. This study demonstrates that professionals often miss the diagnosis, but their ability to detect alcoholism can be greatly enhanced by the use of a simple screening tool. Describes an American research project using two screening tests.
Subject terms:
mental health problems, models, screening, severe mental health problems, alcohol misuse, diagnosis, dual diagnosis;
British Journal of Learning Disabilities, 24(3), September 1996, pp.90-94.
Publisher:
Wiley
A survey of individuals known to the learning disability service in Cornwall as having a dual diagnosis of schizophrenia and learning disability discovered that very often there can be a long delay between the start of symptoms in schizophrenia in this client group and a diagnosis. This article seeks to inform staff in learning disability services about the symptoms of schizophrenia, how it presents in people with a learning disability and possible diagnostic difficulties.
A survey of individuals known to the learning disability service in Cornwall as having a dual diagnosis of schizophrenia and learning disability discovered that very often there can be a long delay between the start of symptoms in schizophrenia in this client group and a diagnosis. This article seeks to inform staff in learning disability services about the symptoms of schizophrenia, how it presents in people with a learning disability and possible diagnostic difficulties.
Subject terms:
learning disabilities, schizophrenia, severe mental health problems, surveys, assessment, diagnosis, dual diagnosis;