Effectiveness of tianeptine in patients with major depressive disorder and substance use disorder.

The depressive disorder coexists in a high prevalence with a substance-related disorder, which is asso- ciated with a worst prognosis. The therapeutic interventions for this co-morbidity lack of the appropriate scientific sup- port. The existing evidence suggest that the currently avail- able anti-depressive drugs are of minor efficacy in this group of patients. An alternative would be the use of different drugs with distinctive neurobiological mechanism of action. The aim of this study was to describe the clinical develop- ment of a series of patients affected by this comorbidity un- der treatment with tianeptine under usual clinical practices.

Professional perception of clozapine use in patients with dual psychosis.

INTRODUCTION: Patients with psychotic disorders often have substance use disorders and other addictions. The objective of this study was to know the current treatment situation of these patients focusing on clozapine, which was proposed in most consensus as antipsychotic of first choice in this indication. MATERIAL AND METHODS: A survey with 14 questions on aspects related to the treatment and management of the dual disorders was developed, emphasizing the role of clozapine in this disease. RESULTS: The survey was answered by 199 experts in mental illnesses (90.5% physicians and 9.5% psychologists). A total of 88.4% of experts were able to prescribe clozapine, but the majority (89.4%) administered the drug to patients with resistant schizophrenia without considering a dual disorder. Only 30.8% considered the use of clozapine in patients with dual psychosis. The underutilization of clozapine in these patients was mainly attributed to controls of the pharmacovigilance plan, including frequent leukocyte count (57.1%), and lack of drug education (35.6%). The main measures proposed to increase its use are fewer blood tests (29.3%), more training (27.8%), and fewer administrative problems (25.1%). CONCLUSIONS: In order to improve the treatment of patients with dual psychosis, it is necessary to simplify the therapy and increase the training of professionals in the use of atypical antipsychotics, especially clozapine, designed to be the drug of choice in the main expert consensus.

Coexistence between personality disorders and substance use disorder. Madrid study about prevalence of dual pathology.

INTRODUCTION: Personality disorders (PD) and substance use disorders (SUD) have a high prevalence and an important health and socioeconomic impact so, it is interesting to study the relationship between them. The objectives of the study are: to compare the prevalence of SUD between patients with and without diagnosis of PD, to analyze if any PD is related to the SUD, and if a specific PD is associated with a specific SUD. MATERIAL AND METHODS: Cross-sectional study in 837 patients from centers of attention to drug addiction and mental health in Madrid, Spain. The Mini International Neuropsychiatric Interview (MINI) and the Personality Diagnostic Questionnaire-4+ (PDQ4+) are used to detect mental disorder and PD, respectively. RESULTS: SUD is significantly higher in antisocial PD (p<0.01); sedative (p<0.01) and alcohol (p<0.05) use disorder in borderline PD; cocaine (p<0.05) and alcohol (p<0.01) use disorder in paranoid PD; and alcohol use disorder in histrionic PD (p<0.01). The SUD for cocaine is lower in obsessive- compulsive PD (p<0.05) and depressive PD (p<0.01). There is a positive correlation between the number of PD of a subject and the number of SUD that it presents. The risk of an alcohol [OR of 1,08 CI (1,01-1,16)] or sedatives [OR of 1,08 CI (1,001-1,17)] use disorders increases if an individual presents more than one type of PD. CONCLUSIONS: There is not differences of SUD prevalence between PD and not PD groups. We found an association between SUD and PD of cluster B (antisocial, borderline and histrionic) and also with paranoid PD. The SUD are more common among man with the exception of sedatives.

Dual disorders in individuals under treatment for both alcohol and cocaine: Madrid study on the prevalence of dual disorders / Patología dual en individuos en tratamiento por uso de cocaína y alcohol: estudio Madrid sobre prevalencia de patología dual

Abstract: Introduction: Descriptive data about co-occurrence of alcohol and cocaine consumption is scarce, despite its important prevalence. Dual disordes shows high prevalence in clinical samples, and patients report worse evolution and need more health services. Objective: To compare psychopathology in patients in treatment with lifetime alcohol and cocaine (Alc + Coc) substance use disorder (SUD) with subjects with alcohol but not cocaine (Alc) lifetime SUD and cocaine but not alcohol (Coc) SUD. Method: The sample consisted of 837 outpatients from Madrid, Spain, under treatment in substance misuse or mental health units. Two analyses were made: we compared subjects in the Alc + Coc (n = 366) to the Alc group (n = 162), and then to the Coc group (n = 122). Socio-demographic variables were addressed by interview. The Mini International Neuropsychiatric Interview (MINI) was used to evaluate Axis I disorders and the Personality Disorder Questionnaire (PDQ) to evaluate Personality Disorders (PD). Results: Compared to Alc group, patients in the Alc + Coc group were younger, had different socio-demographic characteristics, had more proportion of cannabis and opioid SUD, had less proportion of major depressive disorder, obsessive and depressive PD, more proportion of antisocial PD and lower suicide risk. Compared to the Coc group, they had more cannabis SUD and lower opioid SUD, showed higher prevalence of bipolar disorder, general anxiety disorder, paranoid, histrionic and dependent PD. Discussion and conclusion: We present a cross-sectional study describing comorbidity of dual disordes on treatment-seeking concurrent alcohol and cocaine problematic users. This concurrence showed different dual disordes prevalence profile than single users in some specific mental disorders.

Resumen: Introducción: La patología dual presenta una alta prevalencia en muestras clínicas. Estos pacientes sufren mayor comorbilidad y requieren más servicios. Existen escasos datos de comorbilidad por alcohol y cocaína. Objetivo: Valorar datos sociodemográficos, prevalencias de trastorno por uso de sustancias (TUS), trastorno mental y trastornos de personalidad en pacientes con trastorno por uso de alcohol y cocaína frente a pacientes con uno de los dos TUS. Método: La muestra incluyó 837 pacientes procedentes de Centros de Salud Mental y Centros de Atención a Drogodependientes. Se realizaron dos análisis: se comparó el grupo de alcohol y cocaína (Alc + Coc, n = 366) con el grupo de alcohol (Alc, n = 162), y posteriormente con el grupo de cocaína (Coc, n = 122). Se recogieron variables sociodemográficas y sobre TUS mediante entrevista, diagnósticos de trastorno mental del eje I mediante la entrevista estructurada Mini International Neuropsychiatric Inerview (MINI) y los trastornos de personalidad mediante el Personality Disorder Questionnaire (PDQ). Resultados: Los pacientes del grupo Alc + Coc frente al grupo Alc presentaban diferencias sociodemográficas significativas, mayor prevalencia de TUS asociados, riesgo más alto de suicidio y mayor proporción de trastorno antisocial de personalidad. Además, tenían menor prevalencia de trastornos depresivos. Frente al grupo Coc presentaron mayor prevalencia de trastorno por consumo de cannabis, pero menor de opioides y mayor prevalencia de trastorno bipolar, trastorno de ansiedad generalizada y trastornos de personalidad. Discusión y conclusión: Los pacientes comórbidos para alcohol y cocaína presentaron un distinto perfil de prevalencia de algunos trastornos mentales específicos.

Bipolar disorder and substance use disorders. Madrid study on the prevalence of dual disorders/pathology. / Trastorno bipolar y trastorno por uso de sustancias. Estudio Madrid sobre prevalencia de patología dual.

Given its prevalence and impact on public health, the comorbidity of bipolar and substance use disorders is one of the most relevant of dual diagnoses. The objective was to evaluate the characteristics of patients from community mental health and substance abuse centres in Madrid. The sample consisted of 837 outpatients from mental health and substance abuse centres. We used the Mini International Neuropsychiatric Interview (MINI) and Personality Disorder Questionnaire (PDQ4+) to evaluate axis I and II disorders. Of these patients, 174 had a lifetime bipolar disorder, 83 had bipolar disorder type I and 91 had type II. Most patients had dual pathology. Of the 208 participants from the mental health centres, 21 had bipolar disorder and 13 (61.9%) were considered dually-diagnosed patients, while 33.2% of non-bipolar patients had a dual diagnoses (p = 0.03). Of the 629 participants from the substance abuse centres, 153 patients (24.3%) had a bipolar diagnosis. Bipolar dual patients had higher rates of alcohol and cocaine dependence than non-bipolar patients. Moreover, age at onset of alcohol use was earlier in bipolar duallydiagnosed patients than in other alcoholics. Bipolar dually-diagnosed patients had higher personality and anxiety disorder comorbidities and greater suicide risk. Thus, alcohol and cocaine are the drugs most associated with bipolar disorder. Given the nature of the study, the type of relationship between these disorders cannot be determined.

La comorbilidad entre trastorno bipolar y trastorno por uso de sustancias (TUS) es de las más relevantes dentro del espectro de la patología dual por su prevalencia y sus repercusiones evolutivas y sociosanitarias. Nuestro objetivo fue estudiar las características de los pacientes con diagnóstico de trastorno bipolar y trastorno por uso de sustancias procedentes del Estudio Madrid sobre prevalencia de patología dual en sujetos en tratamiento en el servicio sanitario público. La muestra procede de pacientes en tratamiento en las redes públicas de salud mental y de tratamiento para las adicciones de la Comunidad de Madrid. Los sujetos fueron evaluados con la entrevista Mini International Neuropsychiatric Interview (MINI) para el diagnóstico de los trastornos mentales y con la escala Personality Disorder Questionnaire (PDQ) para el diagnóstico de los trastornos de personalidad. De los 837 pacientes incluidos, 174 tenían un diagnóstico a lo largo de la vida de trastorno bipolar, 83 con trastorno bipolar tipo I y 91 del tipo II. La mayoría de ellos tenían algún diagnóstico de TUS. En la red de salud mental, de los 208 participantes, 21 tenían un diagnóstico de trastorno bipolar, de estos el 13 (61.9%) tenían un diagnóstico de TUS y se consideraron duales, mientras que en el resto de los pacientes de salud mental el 33.2% tenían un diagnóstico comórbido de TUS (p = 0.03). En los centros de drogas, de los 629 pacientes valorados, un 24.3% (n = 153) tenían un diagnóstico de trastorno bipolar. El subgrupo de pacientes con trastorno bipolar tenía mayor prevalencia de adicción al alcohol y a la cocaína que el resto de los pacientes. Además, la edad de inicio en el consumo de alcohol era más precoz entre los adictos bipolares que entre los adictos no bipolares. Los bipolares duales era un subgrupo con mayor comorbilidad con trastornos de personalidad, otros trastornos mentales como trastornos de ansiedad y mayor riesgo de suicidio. Estos datos apoyan que el alcohol principalmente y la cocaína son las drogas más relacionadas con la presencia de un trastorno bipolar, pero al ser un estudio transversal no se pueden extraer conclusiones etiológicas.

[Madrid study on the prevalence and characteristics of outpatients with dual pathology in community mental health and substance misuse services]. / Estudio Madrid sobre prevalencia y características de los pacientes con patología dual en tratamiento en las redes de salud mental y de atención al drogodependiente.

The objective was to quantify the prevalence of dual diagnosis and to evaluate the characteristics of these patients from community mental health and substance misuse services in Madrid. The sample consisted of 837 outpatients from Madrid, 208 from mental health services and 629 from substance misuse services. We used the Mini International Neuropsychiatric Interview (MINI) and Personality Disorder Questionnaire (PDQ4+) to evaluate disorders from axis I and II. It was considered that 517 (61.8%) patients had dual pathology (current diagnoses of axis I or II disorders and an addictive disorder): 36,1% in mental health services and 70,3% in substance misuse services. There were fewer males amongst the dual patients and it was also found that they had a worse employment situation, along with higher figures of alcohol and cannabis dependence than addicts without dual diagnoses (n=194). When comparing them with patients with mental disorder diagnoses only, excluding substance use disorder (n=126), there were differences in all socio-demographic characteristics analyzed, and dual patients were associated with diagnoses of bipolar disorder, agoraphobia, generalized anxiety disorder, post-traumatic stress disorder, and had more suicide risk and different personality disorders. Thus, dual pathology is higher in patients who are in treatment and have differential characteristics (higher suicide risk, worse employment situation) that suggest greater severity that could be of help in the planning of care resource policies for these patients.

Abuse or dependence on cannabis and other psychiatric disorders. Madrid study on dual pathology prevalence.

OBJECTIVES: Cannabis use has been associated to a wide variety of mental disorders, the possible causal role of this use in the etiology of severe mental disorders as schizophrenia or bipolar disorder standing out. Moreover, the cannabinoid system is involved in emotional regulation, so cannabis use could disturb this process and provoke anxiety and mood disorders. The main objective of this study was to analyze the cannabis addict subgroup from Madrid study of prevalence of dual disorders in community mental health and substance misuse services. MATERIAL AND METHODS: The sample consisted of 837 outpatients under treatment in the mental health network or drug network of the Community of Madrid (Spain). Of these, 353 subjects had a lifetime diagnosis of cannabis abuse or dependence and 357 subjects did not have cannabis substance use disorder. We used the Mini International Neuropsychiatric Interview (MINI) to evaluate axis I mental disorders, and Personality Disorder Questionnaire to evaluate personality disorders. RESULTS: It was considered that 76.5% of the cannabis addicts had a current dual disorder. The most prevalent ones were mood and anxiety disorders. Of those addicted to cannabis, 51% had a personality disorder. Most of them had several substance use disorders. Cannabis abuse or dependence subjects had an earlier onset in consumption of other drugs such as alcohol, cocaine, and tobacco than addicts without cannabis abuse or dependence. The cannabis addicts also differed from the other addicts because of an association to antisocial personality disorder, bipolar disorder, psychosis and agoraphobia. The presence of these mental disorders was significantly associated to a lower age at initiation of cannabis use. CONCLUSIONS: Dual pathology is very high in cannabis addicts under treatment. Said consumption of cannabis, probably within a polysubstance use pattern, is associated to severe mental disorders as psychosis and bipolar disorder. An earlier age of onset in cannabis use is associated to a greater risk of said mental disorders.

Cocaine abuse or dependency and other pyschiatric disorders. Madrid study on dual pathology.

OBJECTIVES: The main objective of this study was to analyse the cocaine addict subgroup from the Madrid study of prevalence of dual disorders in community mental health and substance misuse services. MATERIAL AND METHODS: The sample consisted of 837 outpatients from Madrid, Spain. We compared 488 subjects who had a lifetime diagnosis of cocaine abuse or dependence, and 222 subjects who did not have a cocaine substance use disorder. We used the Mini International Neuropsychiatric Interview to evaluate axis I mental disorders, and the Personality Disorder Questionnaire to evaluate personality disorders. RESULTS: Almost three-quarters (73.4%) of cocaine addicts had a current dual disorder. Most prevalent were mood and anxiety disorders. Almost half (49.6%) had a personality disorder. Most of them (94.9%) had other substance use disorders. Cocaine addicts did not have higher prevalence rates of dual pathology than addicts with no cocaine abuse or dependence. Cocaine addicts were associated to a diagnosis of antisocial personality disorder, agoraphobia, and post-traumatic stress disorder, and they had an early age of onset of alcohol and cannabis use. CONCLUSIONS: Dual pathology is no higher in cocaine addicts in treatment than in addicts who do not use cocaine, however cocaine addicts started other drugs earlier, and were associated with specific mental disorders.

Dual diagnosis and suicide risk in a Spanish outpatient sample.

The present study compares dual-diagnosis patients with other groups of psychiatric patients to determine the differential characteristics in suicide risk and other clinical variables between them. During 2008 in Madrid, 837 outpatients were evaluated in addiction and mental health services. Three comparison groups were created according to current diagnosis: (i) dual patients, (ii) patients with substance use disorders but no other mental disorders, and (iii) patients with mental disorders but no substance use disorders. A multinomial logistic regression model was built to explore the risk associated with dual diagnosis. Criteria for dual diagnosis were met at the time of the study by 440 patients (52.6%). Dual patients showed several demographic and clinical differences and a higher risk for suicide than the other two comparison groups. Further research is needed to define suicide preventive strategies for dual patients.