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Predictors of successful return to work from HIV-related disability
- Authors:
- DiCLEMENTI Jeannie D., et al
- Journal article citation:
- Journal of HIV/AIDS and Social Services, 3(3), 2004, pp.91-98.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
This American study examines factors distinguishing HIV-infected persons who successfully return to work (RTW) from those who do not. Records were obtained from 135 participants in a return to work program; these were matched with the records of 135 persons who did not return to work. Matching was made on the basis of age, gender, race, CD4 counts, and length of time in treatment. The return to work group had a greater total number of mental health diagnoses than the non-return group; however, when type of diagnosis was controlled for, the non-return group had greater numbers of substance use disorders. It appears that substance use disorders precludes a successful return to the workforce, while accessing the mental health treatment system may actually facilitate a return to work. Careful psychosocial assessment of clients on entry into the primary care clinic can aid referrals directly into a RTW program or into services that would facilitate an eventual return to work. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580).
Early and late onset groups of substance misusers: differences in primary and secondary psychiatric disorders
- Authors:
- BAKKEN K., LANDHEIM A.S., VAGLUM P.
- Journal article citation:
- Journal of Substance Use, 9(5), October 2004, pp.224-234p.
- Publisher:
- Taylor and Francis
Aimed to identify clinical differences between early and late onset (EO and LO, under and over 18) groups with substance use disorders (SUDs) using a sample of 156 alcohol-dependent and 131 polysubstance-dependent patients from 3 out-patient and 6 in-patient public programmes in 2 counties in Norway. Primary axis I disorders (occurring at least 1 year before any SUD) and secondary axis I disorders (occurring at least 1 year after any SUD) were assessed with the Composite International Diagnostic Interview and axis II disorders with Millon Clinical Multiaxial Inventory-II. Significantly more in the EO group had primary anxiety disorders (especially social phobia and post-traumatic stress disorder (PTSD)) and anti-social, borderline and passive-aggressive personality disorders (PDs), and fewer had dependent and compulsive PDs. EO strongly predicted polysubstance misusers (versus pure alcoholism) and had more frequent secondary PTSD. Results were generally identical when a cutoff point of 25 years was used. The average EO patient's SUD manifested 6 years before psychiatric treatment; the LO patients had been in psychiatric treatment 2 years before the SUD. Concludes that EO/LO allowed the delineation of 2 clinical sub-groups and provided information about possible prevention strategies, early interventions and treatment.
Psychiatric research in Nigeria: bridging tradition and modernisation
- Authors:
- AYONRINDE Oyedji, GUREJE Oye, LAWAL Rahmann
- Journal article citation:
- British Journal of Psychiatry, 184(6), June 2004, pp.536-538.
- Publisher:
- Cambridge University Press
Mental health research in Nigeria is rich in untapped opportunities, such as the highest twin rate in the world among the Yoruba. International collaboration is a key to advancing psychiatric research in Nigeria through skill development and resource sharing.
Dual diagnosis: discovery of a critical role for environmental exposure
- Author:
- GOLD Mark S.
- Journal article citation:
- Journal of Dual Diagnosis, 1(1), 2004, pp.5-13.
- Publisher:
- Taylor and Francis
- Place of publication:
- Philadelphia, USA
It is estimated that 10 million persons in the United States have at least one mental disorder and at least one substance-related disorder in any given year. Dual disorders are common in psychiatry, but misdiagnosis may be even more common. Drug and alcohol testing should be expanded from routine use in the Olympics and intercollegiate athletics to psychiatric diagnosis of drug intoxication, dependence, and withdrawal states. Major Depression is co-morbid with opiate addiction, alcohol dependency, tobacco smoking, and many other substance abuse disorders. Drug use induces adaptations in brain systems associated with mood and motivation. The acute rewarding effects of drugs change the mesolimbic dopaminergic system. Cessation of drug self-administration induces dysphoria and anhedonia as a result of changes in monoamine levels in brain reward circuits; opposite to the effects that occur after the administration of drugs of abuse. While most models for dual disorders assume compulsive or volitional use or self administration, we have been interested in second-hand exposure which was common in the past among flight attendants and occurs today between smoking parent and child. We expand the concept from parent-to-child environmental tobacco toxicity to a workplace toxicity hypothesis for anesthesiologists. Such a hypothesis can explain the high rates of depression, workplace and social distress, drug abuse, and drug addiction among anesthesiologists. While co-occurring disorders have been the focus of epidemiological studies and twin and genetic studies, the role of exposure to potent drugs of abuse in the intra-uterine, home, and workplace environment has been neglected. We have demonstrated the unequivocal presence of fentanyl and other potent drugs of abuse in the air that anesthesiologists breathe in the operating room. Drug exposure sensitizes the brain. When sensitization is coupled with the stress of operating room, employment may produce the pattern of co-occurring disorders seen in anesthesiologists but not psychiatrists. Prevention is the goal in environmental or toxicity-related illness. After diagnosis, treatment for dual disorders should be vigorous with remission of all disorders in mind. For anesthesiologists, limiting toxic environmental exposure may prevent both drug and affective disorders. (Copies of this article are available from: Haworth Document Delivery Centre, Haworth Press Inc., 10 Alice Street, Binghamton, NY 13904-1580)
No need for a crystal ball
- Author:
- HOFFMANN Norman
- Journal article citation:
- Addiction Today, 15(88), May 2004, pp.22-23.
- Publisher:
- Addiction Recovery Foundation
Reports on the findings of a survey of a group of juvenile offenders aged between 13 and 18 in the United States. It was conducted in routine practice from 218 consecutive admissions to two juvenile criminal-justice facilities and adolescent diversion courts in a New England state. Results found that most appeared to have co-existing mental-health and substance-use disorders. Argues that these must be treated to reshape lives and cut re-offending.
Co-morbidity of substance misuse and mental illness collaborative study (COSMIC): research summary
- Editors:
- ADBULRAHIM Dima, (ed.)
- Publisher:
- National Treatment Agency for Substance Misuse
- Publication year:
- 2004
- Pagination:
- 6p.
- Place of publication:
- London
The study measured the extent of co-morbidity among users of substance misuse services and mental health services. It described the range of co-morbid presentations and treatment needs and looked at differences between London and other areas of the country.
Reaching the hard to reach: innovative housing for homeless youth through strategic partnerships
- Author:
- VAN LEEUWEN Jamie
- Journal article citation:
- Child Welfare Journal, 83(5), September 2004, pp.453-468.
- Publisher:
- Child Welfare League of America
Features 3 housing programmes designed to target the needs of youth ageing out of child welfare. One combines housing and treatment to move substance-dependent youth off the streets; one combines the resources of Urban Peak, the only licensed homeless and runaway youth shelter in Colorado, with the Denver Department of Human Services to prevent youth in child welfare from discharging to the streets; and one addresses the intense mental health needs of this population. It costs Colorado $53,655 to place a young person in youth corrections for one year and $53,527 for residential treatment. It costs Urban Peak $5,376 to move a young person off the streets. Describes how data have driven programme development and discusses how policy implications and relationships with the public and private sector can leverage additional resources.
Adherence in people living with HIV/AIDS, mental illness, and chemical dependency: a review of the literature
- Authors:
- ULDALL K. K., et al
- Journal article citation:
- AIDS Care, 16(Supplement 1), January 2004, pp.S71-S96.
- Publisher:
- Taylor and Francis
Adherence to antiretroviral medications is central to reducing morbidity and mortality among people living with HIV/AIDS. Relatively few studies published to date address HIV adherence among special populations. The purpose of this article is to review the existing literature on HIV antiretroviral adherence, with an emphasis on studies among the triply diagnosed population of people living with HIV/AIDS, mental illness, and chemical dependency. In order to reflect the most current information available, data from conference proceedings, federally funded studies in progress, and the academic literature are presented for consideration.
Economic evaluations of HIV treatment and health research with people diagnosed with HIV infection and co-occurring mental health and substance use disorders
- Authors:
- CONOVER C. J., et al
- Journal article citation:
- AIDS Care, 16(Supplement 1), January 2004, pp.S121-S136.
- Publisher:
- Taylor and Francis
This paper describes the research challenges involved in measuring costs in economic evaluations of patients who are coping simultaneously with HIV/AIDS and co-occurring mental health and substance abuse disorders--especially in multi-site studies. The authors describe the general issues that arise in measuring costs for this population and suggest some operational solutions for their resolution, drawing from our experience in a recent multi-site health services research study focused on this population. They show that while reliance on patient self-report data may be unavoidable to provide a common denominator in multi-site studies, there are also some practical ways of improving the accuracy of such data and the cost estimates that result from them. They also provide readers with a means for securing the data collection instruments developed for the cost component of this study in the hope that these may serve as templates for researchers doing.
Literature on integrated HIV care: a review
- Authors:
- SOTO T. A., et al
- Journal article citation:
- AIDS Care, 16(Supplement 1), January 2004, pp.S43-S55.
- Publisher:
- Taylor and Francis
With a significant proportion of HIV-infected patients now presenting with co-occurring substance abuse disorders and mental disorders, interest in integrated HIV care is growing. However, no review of integrated HIV care has been conducted. Using relevant key word searches of the Medline and Psychlit databases, the authors identified about 450 publications. The few evaluations of integrated models tended to focus on measurements of engagement and retention in medical care, and their findings indicated an association between integrated HIV care and increased service utilization. No random assignment controlled studies were identified, except in the peripheral area of integrated care (without HIV primary care) for persons with co-occurring substance abuse disorders and mental disorders. The majority of reviewed articles described integrated models operating in the field and various aspects of implementation and sustainability. Overall, they supported use of a wide range of primary and ancillary services delivered by a multidisciplinary team that employs a 'biopsychosocial' approach. Despite the lack of scientific knowledge regarding the effects of integrated HIV care, those wanting to optimize treatment for patients with multiple interacting disorders can gain useful and practical knowledge from this literature.