Influence of attention deficit hyperactivity disorder symptoms on quality of life and functionality in adults with eating disorders.

INTRODUCTION: Eating disorders (ED) have been linked to attention deficit hyperactivity disorder (ADHD) because they present some symptoms in common. The aim of this study was to explore the influence on ED of symptoms suggestive of adult ADHD and how these symptoms affect the clinical presentation of adult patients. A further aim was to assess the impact of ADHD symptoms on quality of life and feelings of disability. METHOD: Participants comprised 89 patients diagnosed with ED according to DSM-5 criteria. The ASRS v.1.1 was used to divide them into two groups depending on whether they presented symptoms suggestive of adult ADHD or not, using a cut-off point of 4. Subsequently, we administered the EAT-40, BITE, BIS-11, SDI and Q-LES-Q scales. RESULTS: Patients diagnosed with ED who also had symptoms suggestive of ADHD presented a higher number and severity of eating disorder symptoms, greater motor and cognitive impulsivity, increased dysfunction and a poorer quality of life. CONCLUSIONS: The results indicate that on average, patients with eating disorders and ADHD symptoms presented more and worse eating disorder symptoms, greater impulsivity, increased dysfunction and a poorer quality of life. It is therefore important to assess the presence of ADHD symptoms in patients with ED due to the implications for prognosis and progression.

Relevant Differences in Perception and Knowledge of Professionals in Different Spanish Autonomous Communities Regarding Availability of Resources for Patients with Dual disorders.

OBJECTIVES: To assess the knowledge of health professionals attending patients with dual disorders about specific resources for patients with this condition in different Spanish regions. METHODS: Observational, cross-sectional, multicenter study to compare the perceptions of healthcare professionals (n=659) with reality regarding specific resources available for patients with dual disorders in Spain. The professionals completed an online questionnaire. Nineteen commissioners and managers responsible for national and regional substance abuse programs also completed the questionnaire. RESULTS: A representative sample of professionals from each community (553 centers in 235 Spanish cities) participated in the study. Most participants (93.2%) felt that specific resources for patients with dual disorders are needed. High percentages of professionals thought that there were no specific workshops (88.4%), subacute units (83.1%), day hospitals (82.8%), specific day centers (78.5%), or outpatient programs (73.2%) for patients with dual disorders. The real knowledge of professionals regarding the existence of specific resources varied according to the type of resource and autonomous community. The professionals generally underestimated the number of units available in their communities. CONCLUSIONS: There were clear differences in the real knowledge that healthcare professionals had about the resources available for patients with dual disorders in relation to the autonomous community where they were practicing. Actions are needed to harmonize knowledge nationally, for example, a single registry, white paper, or a national program for patients with dual disorders.

Dual diagnosis resource needs in Spain: a national survey of professionals.

OBJECTIVE: Since provision of integrated services for patients with dual pathology or dual disorders (coexistence of an addictive disorder and another mental health disorder) is an important challenge in mental health, this study assessed health care professionals' perceptions and knowledge of the current state of specific resources for patients with dual pathology in Spain. METHODS: We conducted a national survey of health care professionals seeing patients with dual pathology in treatment facilities throughout Spain. Participants completed a specific online questionnaire about the needs of and available resources for patients with dual pathology. RESULTS: A total of 659 professionals, mostly psychologists (n = 286, 43.4%) or psychiatrists (n = 217, 32.9%), participated in the study. Nearly all participants who responded to these items reported that specific resources for dual pathology were needed (n = 592/635, 93.2%); 76.7% (n = 487) identified intermediate resources, 68.8% (n = 437) acute detoxification units, and 64.6% (n = 410) medium-stay rehabilitation units as particularly necessary. In the opinion of 54.0% of respondents (n = 343), integrated mental health and addiction treatment services were available. Of the participants who answered these items, only a small proportion (n = 162/605, 26.8%) reported that there were appropriate outpatient programs for dual pathology, 30.4% (n = 184/605) specific hospitalization units, 16.9% (n = 99/587) subacute inpatient units, 34.2% (n = 201/587) outpatient intermediate resources, 15.5% (n = 91/587) day hospitals, and 21.5% (n = 126/587) day centers. Conversely, 62.5% (n = 378/587) of participants reported a greater presence of specific detoxification/withdrawal units, 47.3% (n = 286/587) psychiatric acute admission units, and 41.9% (n = 246/587) therapeutic communities. In the professionals' opinion, the presence of specialty programs was low; 11.6% of respondents (n = 68/587) reported that vocational programs and 16.7% (n = 98/587) reported that occupational rehabilitation programs were available. Employee turnover was common: 51.9% of respondents (n = 314/605) stated that employee turnover was occasional to frequent. CONCLUSIONS: According to the professionals surveyed, specific health care resources for the management of dual pathology are currently insufficient, underlining the need for additional efforts and strategies for treating individuals with comorbid disorders.

Is there such a thing as gambling dual disorder? Preliminary evidence and clinical profiles.

Patients with gambling disorder (GD) frequently present other mental disorders, such as substance use disorder (SUDs), attention deficit/hyperactivity disorder (ADHD), mood disorders, and impulse-control disorders. We propose that GD should not be conceptualized as a single nosological entity, but rather as a gambling dual disorder (GDD). This study aims to provide further evidence of the co-occurrence of GD and other mental disorders in routine clinical practice and to identify different clinical profiles of severity. This descriptive, cross-sectional, and observational study included 116 patients with GD who were undergoing treatment in a specialized center. The MULTICAGE-CAD 4 and South Oaks gambling screen questionnaires confirmed the presence of GD in 97.4% and 100% of the patients, respectively. Other addictive behaviors such as compulsive spending, Internet, video games, or SUD (59.5%, 27.6%, 11.2%, and 13.8%, respectively) were also identified. The most used substances were tobacco (42.2%) and alcohol (5.2%). Half of the patients suffered from ADHD, 30.2% showed moderate or severe depression, and 17.2% suffered from a social anxiety problem. The majority (76.7%) also presented a phenotype with high impulsiveness. The cluster analysis identified two different clinical profiles of severity in patients with GDD. One profile showed higher severity of other mental disorders (ADHD, depression, anxiety, SUD, or insomnia), impulsivity, general psychopathological burden, and disability. In conclusion, our study provides further evidence on the co-occurrence of GD and other mental disorders supporting the GDD existence, shows impulsiveness as a vulnerability factor for GD, and identifies two clinical severity profiles.

Factors contributing to the utilization of adult mental health services in children and adolescents diagnosed with hyperkinetic disorder.

OBJECTIVES: To examine whether age of First diagnosis, gender, psychiatric comorbidity, and treatment modalities (pharmacotherapy or psychotherapy) at Child and Adolescent Mental Health Services (CAMHS) moderate the risk of Adult Mental Health Services (AMHS) utilization in patients diagnosed with hyperkinetic disorder at CAMHS. METHODS: Data were derived from the Madrid Psychiatric Cumulative Register Study. The target population comprised 32,183 patients who had 3 or more visits at CAMHS. Kaplan-Meier curves were used to assess survival data. A series of logistic regression analyses were performed to study the role of age of diagnosis, gender, psychiatric comorbidity, and treatment modalities. RESULTS: 7.1% of patients presented with hyperkinetic disorder at CAMHS. Compared to preschool children, children and adolescents first diagnosed with hyperkinetic disorder at CAMHS were more likely to use AMHS. Female gender and comorbidity with affective disorders, schizophrenia, schizotypal and delusional disorders increased the risk of use of AMHS. Pharmacological or combined treatment of hyperkinetic disorder diagnosed at CAMHS was associated with increased risk of use at AMHS. CONCLUSIONS: Older age of first diagnosis, female gender, psychiatric comorbidity, and pharmacological treatment at CAMHS are markers of risk for the transition from CAMHS to AMHS in patients with hyperkinetic disorder diagnosed at CAMHS.

A Feasibility Study of Patients with Major Depression and Substance Use Disorders: Vortioxetine as Maintenance Treatment.

Background: Limited studies have evaluated the effectiveness of vortioxetine in real-world settings, and none of them has involved patients with dual depression (major depressive disorder [MDD] and substance use disorder [SUD]). The objective of the study was to describe the effectiveness of vortioxetine in clinical practice and determine its effect on affective symptoms, cognitive function, quality of life, and substance use in patients with MDD and SUD. Methods: Post-authorization, retrospective, multicenter, descriptive, and observational study in 80 patients with MDD and SUD receiving a maintenance treatment with vortioxetine for six months between January 2017 and April 2021. Results: Compared with baseline, scores significantly decreased after 3 and 6 months of treatment in the Montgomery-Åsberg Depression Rating Scale total (from 28.9 to 17.7 and 12.0), and global functional impairment of the Sheehan Disability Inventory (from 26.3 to 19.1 and 16.7). The number of correct answers in the symbol digit modalities test significantly improved during vortioxetine treatment (from 40.4 to 43.8 and 48.4). Regarding the clinical global impression scale, the score for disease severity significantly decreased from 3.8 to 3.0 and 2.4. Compared with baseline, there was a significant reduction in consumption of practically all substances, especially of alcohol, cannabis, and cocaine. Conclusion: Vortioxetine was effective in clinical practice for alleviating depressive symptoms and functional impairment, and in improving cognitive and executive functions and disease severity in patients with MDD and SUD. Moreover, the treatment with vortioxetine favored a reduction in substance use and the severity of the SUDs.

Results of a Hepatitis C Micro-Elimination Program in Two Addiction Centers Among Subjects With Substance Use Disorder.

OBJECTIVES: We aimed to evaluate a hepatitis C (HCV) micro-elimination program in 2 addiction centers among subjects with substance use disorders (SUD). METHODS: The program was based on simplifying the diagnosis of HCV infections by avoiding referral to primary care for the diagnosis and performing the necessary tests at the point of care (ie, the addition center) and simplifying the patient pathway by directly referring patients to the specialized care for treatment. Descriptive and multivariate analyses are presented. RESULTS: Of the 1497 subjects included in the program, 327 reported that they were anti-HCV-positive. Among the 1170 patients who were offered the HCV rapid antibody test, 180 (15.4%) did not perform the test. Performing the HCV rapid antibody test only contributed ten patients (3%) to the 337 who were anti-HCV-positive. A high proportion (147 out of 327 [45%]) of subjects who reported being anti-HCV-positive also reported that they had not been treated for HCV. Among the 67 subjects who were HCV-RNA-positive and were referred for treatment, 53 (79%) ultimately received and completed antiviral treatment. Unfortunately, we did not find any factors associated with not performing dry blood testing, and the factors associated with not performing the HCV rapid antibody test were difficult to interpret, and the model showed low goodness of fit. CONCLUSIONS: Our results suggest that a micro-elimination program focused on patients with SUD attending an addiction center is not effective for screening the presence of hepatitis C but is successful for linking patients with hepatitis C to antiviral treatment.

[Pilot study on the prevalence of dual pathology in community mental health and substance misuse services in Madrid]. / Estudio piloto sobre la prevalencia de patología dual en pacientes en tratamiento en la Comunidad de Madrid.

AIM: To evaluate retrospectively the comorbidity of mental and addictive disorders in community mental health and substance misuse services in Madrid. METHODS: The medical records of 400 patients from mental health and substance misuse services in Madrid were evaluated. Records were examined for the last 20 patients from each service unit. RESULTS: Dual pathology was constituted when a current diagnosis of mental and addictive disorders, excluding nicotine addiction, appeared on the patient's records. Prevalence of dual pathology was 34%. There were differences in the prevalence figures for the two kinds of service: 36.78% in substance misuse services, and 28.78% in mental health services. There was an association of dual diagnosis with alcohol or cocaine dependence, but not with opioid dependence. The mental disorders more prevalent in dually diagnosed than in non-dually diagnosed patients were mood disorders, personality disorders, and schizophrenia. CONCLUSION: There is a high prevalence of dual pathology in those seeking treatment, being higher in substance misuse services than in mental health services, and higher in patients with alcohol or cocaine dependence. These findings could be of help in the planning of care resource policies for these patients.

Gambling Dual Disorder: A Dual Disorder and Clinical Neuroscience Perspective.

Several behaviors, including compulsive gambling, have been considered non-substance-related addictive disorders. Categorical mental disorders (e.g., DSM-5) are usually accompanied by very different symptomatic expressions (affective, behavioral, cognitive, substance abuse, personality traits). When these mental disorders occur with addictive disorders, either concomitantly or sequentially over the life span, this clinical condition is called a dual disorder. Gambling disorder (GD) has been associated with other categorical psychiatric diagnoses: attention deficit hyperactivity disorder, depression, bipolar disorder, social anxiety, schizophrenia, substance use disorder, antisocial personality disorder; and dimensional symptoms including higher impulsivity, poorer emotional wellbeing, cognitive distortion, psychosis, deficient self-regulation, suicide, poorer family environment, and greater mental distress. We are calling this clinical condition Gambling Dual Disorder. From a clinical perspective, it is clear that Gambling Dual Disorder is not the exception but rather the expectation, and this holds true not just for GD, but also for other mental disorders including other addictions. Mental disorders are viewed as biological disorders that involve brain circuits that implicate specific domains of cognition, emotion, and behavior. This narrative review presents the state of the art with respect to GD in order to address current matters from a dual disorder, precision psychiatry, and clinical neuroscience perspective, rather than the more subjective approach of symptomatology and clinical presentation. This review also presents Gambling Dual Disorder as a brain and neurodevelopmental disorder, including from the perspectives of evolutionary psychiatry, genetics, impulsivity as an endophenotype, the self-medication hypothesis, and sexual biological differences. The wide vision of the disease advances a paradigm shift, highlighting how GD and dual disorders should be conceptualized, diagnosed, and treated. Rethinking GD as part of a dual disorder is crucial for its appropriate conceptualization from the perspective of clinical neuroscience and precision psychiatry.

Once-Monthly Long-Acting Injectable Aripiprazole for the Treatment of Patients with Schizophrenia and Co-occurring Substance Use Disorders: A Multicentre, Observational Study.

AIM: To evaluate the efficacy and impact of long-acting injectable (LAI) aripiprazole in patients with schizophrenia with a coexisting substance use disorder (SUD). PATIENTS AND METHODS: A multicenter, observational, descriptive and retrospective study was conducted in patients with a DSM-5 diagnosis of schizophrenia who had a coexisting SUD and were treated with LAI-aripiprazole. Disease severity was evaluated with the Clinical Global Impression (CGI) severity scale for schizophrenia, daily functioning and disability were evaluated with the World Health Organisation Disability Assessment Scale (WHODAS-2.0), and the severity of the addiction was evaluated with the Severity of Dependence Scale (SDS). RESULTS: The sample included 40 patients. Overall, after 6 months of treatment with LAI-aripiprazole at a dose of 400 mg/4 weeks in 77.5% of the patients, we observed significant improvement in the psychopathological symptoms, with a reduction of over 30% in the scores of the five CGI-severity scales. The WHODAS-2.0 mean (standard deviation) score was also significantly reduced from 57.6 (8.2) to 42.3 (4.3) points (p < 0.001). Regarding SUDs, after 6 months of treatment, substance use was stopped in 5 of the 9 patients with cocaine use disorder and in 3 of the 16 patients with alcohol abuse disorder. A significant reduction in the severity of the dependence was observed only in the subgroups of participants with cocaine and alcohol use disorders. CONCLUSION: Our study suggests that once-monthly LAI-aripiprazole retains its antipsychotic efficacy in patients with schizophrenia and a coexisting SUD and could be useful for the management of cocaine or alcohol use disorders in this population.

Correction to: Once­Monthly Long­Acting Injectable Aripiprazole for the Treatment of Patients with Schizophrenia and Co­occurring Substance Use Disorders: A Multicentre, Observational Study.

A randomized, 1-year follow-up study comparing LAI aripiprazole with LAI paliperidone in patients with psychosis, mostly schizophrenia, and SUD reported a large effect of the change from baseline in the CGI severity score, from 5.9 to 2.4 for LAI aripiprazole and from 5.7 to 2.6 for LAI risperidone [29].

Variables associated with familial suicide attempts in a sample of suicide attempters.

Attempted suicide appears to be a familial behavior. This study aims to determine the variables associated with family history of attempted suicide in a large sample of suicide attempters. The sample included 539 suicide attempters 18 years or older recruited in an emergency room. The two dichotomous dependent variables were family history of suicide attempt (10%, 51/539) and of completed suicide (4%, 23/539). Independent variables were 101 clinical variables studied with two data mining techniques: Random Forest and Forward Selection. A model for family history of completed suicide could not be developed. A classificatory model for family history of attempted suicide included the use of alcohol in the intent and family history of completed suicide (sensitivity, specificity, 98.7%; and accuracy, 96.6%). This is the first study that uses a powerful new statistical methodology, data mining, in the field of familial suicidal behaviors and suggests that it may be important to study familial variables associated with alcohol use to better understand the familiality of suicide attempts.

Using data mining to explore complex clinical decisions: A study of hospitalization after a suicide attempt.

BACKGROUND: Medical education is moving toward developing guidelines using the evidence-based approach; however, controlled data are missing for answering complex treatment decisions such as those made during suicide attempts. A new set of statistical techniques called data mining (or machine learning) is being used by different industries to explore complex databases and can be used to explore large clinical databases. METHOD: The study goal was to reanalyze, using data mining techniques, a published study of which variables predicted psychiatrists' decisions to hospitalize in 509 suicide attempters over the age of 18 years who were assessed in the emergency department. Patients were recruited for the study between 1996 and 1998. Traditional multivariate statistics were compared with data mining techniques to determine variables predicting hospitalization. RESULTS: Five analyses done by psychiatric researchers using traditional statistical techniques classified 72% to 88% of patients correctly. The model developed by researchers with no psychiatric knowledge and employing data mining techniques used 5 variables (drug consumption during the attempt, relief that the attempt was not effective, lack of family support, being a housewife, and family history of suicide attempts) and classified 99% of patients correctly (99% sensitivity and 100% specificity). CONCLUSIONS: This reanalysis of a published study fundamentally tries to make the point that these new multivariate techniques, called data mining, can be used to study large clinical databases in psychiatry. Data mining techniques may be used to explore important treatment questions and outcomes in large clinical databases and to help develop guidelines for problems where controlled data are difficult to obtain. New opportunities for good clinical research may be developed by using data mining analyses.

Professionals' perceptions about healthcare resources for co-occuring disorders in Spain.

BACKGROUND: Since provision of integrated services for patients with dual pathology or dual disorders (coexistence of an addictive disorder and other psychiatric disorders) constitutes an important challenge, this study compared the perceptions of health-care professionals with the existing, current state of specific resources for patients with dual pathology in Spain. METHODS: Epidemiological, observational, cross-sectional, multicenter study with a large, representative sample of health care professionals attending patients with dual pathology in treatment resources throughout Spain. Participants completed a specifically designed ad-hoc on-line questionnaire about their perceptions on the existence of available resources and treatment needs for patients with dual pathology. To compare professionals' perceptions with existing available resources, the same on-line questionnaire was also completed by commissioners and managers responsible for national and regional healthcare plans on drug abuse. RESULTS: A total of 659 professionals, mostly psychologists (43.40%) or psychiatrists (32.93%) agreed to participate in the study. The highest degree of concordance between the perceptions of professional and the actual situation was found regarding the existence of mental health and addiction networks (either separately or unified) (74.48%), followed by specific workshops (73.08%) and sub-acute inpatient units (67.38%), specific hospitalization units (66.26%), detoxification units (63.15%) and outpatient programs (60.73%). We detected a lower degree of agreement regarding specific occupational rehabilitation centers (59.34%) day hospitals (58.93%), day centers (57.88%), outpatient intermediate resources (48.87%), psychiatric acute admission units (46.54%) and therapeutic communities (43.77%). In addition, on average, health care professionals underestimated the number of resources present in their respective communities. CONCLUSIONS: Relevant differences exist between the perceptions of professional and existing available resources for dual pathology patients in Spain, thus supporting the need of additional efforts and strategies to establish a registry and clearly inform about available resources for patients with dual diagnosis.

Patterns of mental health service utilization in a general hospital and outpatient mental health facilities: analysis of 365,262 psychiatric consultations.

PURPOSE: Mental health is one of the priorities of the European Commission. Studies of the use and cost of mental health facilities are needed in order to improve the planning and efficiey of mental health resources. We analyze the patterns of mental health service use in multiple clinical settings to identify factors associated with high cost. SUBJECTS AND METHODS: 22,859 patients received psychiatric care in the catchment area of a Spanish hospital (2000-2004). They had 365,262 psychiatric consultations in multiple settings. Two groups were selected that generated 80% of total costs: the medium cost group (N = 4,212; 50% of costs), and the high cost group (N = 236; 30% of costs). Statistical analyses were performed using univariate and multivariate techniques. Significant variables in univariate analyses were introduced as independent variables in a logistic regression analysis using "high cost" (>7,263$) as dependent variable. RESULTS: Costs were not evenly distributed throughout the sample. 19.4% of patients generated 80% of costs. The variables associated with high cost were: age group 1 (0-14 years) at the first evaluation, permanent disability, and ICD-10 diagnoses: Organic, including symptomatic, mental disorders; Mental and behavioural disorders due to psychoactive substance use; Schizophrenia, schizotypal and delusional disorders; Behavioural syndromes associated with physiological disturbances and physical factors; External causes of morbidity and mortality; and Factors influencing health status and contact with health services. DISCUSSION: Mental healthcare costs were not evenly distributed throughout the patient population. The highest costs are associated with early onset of the mental disorder, permanent disability, organic mental disorders, substance-related disorders, psychotic disorders, and external factors that influence the health status and contact with health services or cause morbidity and mortality. CONCLUSION: Variables related to psychiatric diagnoses and sociodemographic factors have influence on the cost of mental healthcare.

Diagnostic stability of psychiatric disorders in clinical practice.

BACKGROUND: Psychiatric disorders are among the top causes worldwide of disease burden and disability. A major criterion for validating diagnoses is stability over time. AIMS: To evaluate the long-term stability of the most prevalent psychiatric diagnoses in a variety of clinical settings. METHOD: A total of 34 368 patients received psychiatric care in the catchment area of one Spanish hospital (1992-2004). This study is based on 10 025 adult patients who were assessed on at least ten occasions (360 899 psychiatric consultations) in three settings: in-patient unit, 2000-2004 (n=546); psychiatric emergency room, 2000-2004 (n=1408); and out-patient psychiatric facilities, 1992-2004 (n=10 016). Prospective consistency, retrospective consistency and the proportion of patients who received each diagnosis in at least 75% of the evaluations were calculated for each diagnosis in each setting and across settings. RESULTS: The temporal consistency of mental disorders was poor, ranging from 29% for specific personality disorders to 70% for schizophrenia, with stability greatest for in-patient diagnoses and least for out-patient diagnoses. CONCLUSIONS: The findings are an indictment of our current psychiatric diagnostic practice.

Demand for psychiatric emergency services and immigration. Findings in a Spanish hospital during the year 2003.

BACKGROUND: The aim of this study is to investigate differences among immigrants and natives regarding access and pathways to psychiatric care, psychiatric admission rates, length of stay, continuity of care, and main diagnoses. METHODS: Psychiatric emergency visits (1511) and hospitalizations (410) were registered in a Spanish Hospital with a catchment area of 280 000 people (19.3% immigrants) during the year 2003. Motives for demanding emergency psychiatric care, pathways to care, admission rates, length of stay, continuity of care, and main diagnoses were compared among natives and immigrants. RESULTS: Immigrants accounted for 13.0% of consultations to the psychiatric emergency room (15.9% of patients) and 11.0% of admissions to the psychiatric hospitalization unit (13.5% of patients). The pathways to care were different for immigrants and natives. Immigrants had a lower rate of readmission to the psychiatric emergency room. Motives for consultation and hospitalization were also different among immigrants and natives. Immigrants showed more self-aggressive behaviours and neuroses, and lower rates of affective disorders and psychoses. CONCLUSIONS: Immigrants under-used psychiatric emergency and hospitalization services in comparison with natives. They did not consult because of psychoses or affective disorders, but mainly because of reactive conditions related to the stress of migration.