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.

[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.

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.

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.

Ibero-American initiative for dual disorders to improve public treatment programs / Iniciativa iberoamericana en patología dual para el mejoramiento de los programas públicos de tratamiento

Abstract Introduction: Dual disorders (DD) are defined as the co-occurrence of substance use disorders with other psychiatric disorders across the lifespan. DD represent a diagnostic dimension with clinical peculiarities and specific healthcare needs, which raises the need to implement integrative treatment algorithms. However, worldwide, most programs address this condition through serial or parallel approaches. In Latin America, as in the rest of the world, there is no health care network that adequately addresses this problem. Objective: To describe the development of the initiative for the integral treatment of DD in Latin America. Method: The Organización Panamericana de la Salud (Pan American Health Organization), together with other collaborating organizations, implemented a three-stage plan for developing a regional initiative: 1. meeting of DD experts, 2. review of the literature on DD, and 3. identification of services for DD care in Latin America. Results: The creation of the Iniciativa Iberoamericana para la Patología Dual (Ibero-American Initiative for Dual Disorders) seeks to implement four lines of action to improve of public services: a) build a theoretical-conceptual consensus on DD, b) propose a treatment model, c) develop skills-based training, and d) create collaborative networks for research on DD. Discussion and conclusion: The following actions include the formation of working groups to create a regional collaborative network, discuss the role of participating organizations and establish guidelines for the implementation of the initiative.

Resumen Introducción: La patología dual (PD) se define como la coocurrencia de trastornos por uso de sustancias con otros trastornos psiquiátricos a lo largo del ciclo vital. La PD representa una dimensión diagnóstica con peculiaridades clínicas y necesidades asistenciales específicas, lo que implica la necesidad de implementar algoritmos de tratamiento integrativos. Sin embargo, la mayoría de los programas en el mundo ofrecen sólo modelos que atienden de forma serial o paralela esta condición. En Latinoamérica, como en el resto del mundo, no se cuenta con una red de atención sanitaria que aborde correctamente esta problemática. Objetivo: Presentar el desarrollo de la iniciativa para el abordaje integral de la PD en Latinoamérica. Método: La Organización Panamericana de la Salud, junto con otras organizaciones colaboradoras, implementó un plan de trabajo de tres etapas para generar una iniciativa regional: 1. reunión de expertos en PD, 2. revisión de la literatura sobre PD, y 3. identificar los servicios para atender la PD en Latinoamérica. Resultados: Se generó una Iniciativa Iberoamericana para la Patología Dual. Ésta pretende implementar cuatro líneas de acción para mejorar los servicios públicos: a) generar un consenso teórico-conceptual sobre PD, b) proponer un modelo de tratamiento, c) desarrollar un entrenamiento basado en competencias, y d) crear redes de colaboración para la investigación en PD. Discusión y conclusión: Las siguientes acciones incluyen la conformación de grupos de trabajo para crear una red colaborativa regional, discutir el rol de las organizaciones participantes y establecer lineamientos para la implementación de la iniciativa.

Abuso o dependencia a la cocaína y otros trastornos psiquiátricos. Estudio Madrid sobre la prevalencia de la patología dual / Cocaine abuse or dependency and other psychiatric disorders. Madrid study on dual pathology

Objetivos: El objetivo de este estudio es analizar el subgrupo de adictos (criterios de abuso o dependencia) a la cocaína procedentes del estudio Madrid sobre prevalencia de diagnóstico dual en varios dispositivos asistenciales. Material y métodos: La muestra está constituida por 837 sujetos en tratamiento en la red de salud mental o en la red de drogas de la Comunidad de Madrid, de los cuáles 488 tenían un diagnóstico de abuso o dependencia de cocaína a lo largo de la vida y 222 tenían otros trastornos por uso de sustancias distintos de la cocaína. Se usó la entrevista Mini Internacional Neuropsychiatric Interview (MINI), para el diagnóstico de los trastornos mentales del eje i y el cuestionario Personality Disorder Questionnaire (PDQ), para la valoración de los trastornos de personalidad. Resultados: Se consideró que un 73,4% de los adictos a la cocaína tenían un diagnóstico dual en el momento actual, destacando la prevalencia de los trastornos del estado de ánimo y de ansiedad. El 49,6% de los adictos a la cocaína tenían un diagnóstico de trastorno de la personalidad. Un 94,9% de estos adictos a la cocaína tenían otros diagnósticos asociados de trastornos por uso de sustancias. El subgrupo de adictos a la cocaína no tenía mayor prevalencia de diagnóstico dual que el resto de los adictos. El subgrupo de adictos con abuso o dependencia de la cocaína tenían mayor prevalencia de trastorno antisocial de la personalidad, agorafobia y trastorno por estrés postraumático, que los adictos no consumidores de cocaína, y habían iniciado de forma más precoz el consumo de alcohol y cannabis. Conclusiones: La presencia de diagnóstico dual no es más elevada en adictos a la cocaína en tratamiento, que en otros adictos, aunque han iniciado más precozmente otros consumos y se asocia más que el resto de adictos a ciertos trastornos mentales específicos(AU)

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 posttraumatic 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(AU)

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 / Madrid study on the prevalence and characteristics of outpatients with dual pathology in community mental health and substance misuse services

Se valora la prevalencia y características de los pacientes de patología dual (diagnóstico actual de un trastorno mental y de un trastorno por uso de sustancias (TUS)): en las redes asistenciales de Salud Mental y Drogodependencias de la Comunidad de Madrid. Se consigue una muestra de 837 sujetos (208 de la red de Salud Mental y 629 de la red de Drogodependencias). Se usó la entrevista MINI (Mini International Neuropsychiatric Interview) y el cuestionario PDQ4+ (Personality Disorder Questionnaire) para la valoración de los trastornos del eje I y II. Se hallaron 517 (61,8%) pacientes con patología dual (un 36,1% en la red de salud mental y un 70,3% en la red de drogas). Al compararlos con el grupo de sujetos con TUS sin patología dual (n=194), había entre los duales menos varones y peor situación laboral, siendo las drogas más consumidas el alcohol y cannabis. Al compararlos con el grupo de trastornos mentales sin uso de sustancias (n=126), encontramos diferencias en todas las características sociodemográficas analizadas y los casos de patología dual son diagnosticados más frecuentemente como trastorno bipolar, agorafobia, trastorno por ansiedad generalizada, trastorno por estrés postraumático, mayor riesgo de suicidio y distintos trastornos de personalidad. Por lo tanto, la presencia de patología dual es elevada en sujetos en tratamiento y presentan unas características diferenciales, tales como mayor riesgo de suicidio y situación laboral precaria que hacen pensar en un peor pronóstico, cuestión a considerar para el desarrollo de recursos asistenciales adecuados (AU)

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 (AU)

Abuso o dependencia al cannabis y otros trastornos psiquiátricos. Estudio Madrid sobre prevalencia de patología dual / Abuse or dependence on cannabis and other psychiatric disorders. Madrid study on dual pathology prevalence

Objetivos. El consumo de cannabis se ha asociado con una amplia variedad de trastornos mentales, destacando el posible papel causal de dicho consumo en la etiología de trastornos mentales graves como la esquizofrenia o el trastorno bipolar. Además el sistema cannabinoide está implicado en la regulación emocional, por lo que el consumo de cannabis también puede alterar dicha regulación y asociarse con trastornos de ansiedad y depresivos. El objetivo de este estudio es analizar el subgrupo de adictos a cannabis procedentes del estudio Madrid sobre prevalencia de patología dual en varios dispositivos asistenciales. Material y métodos. La muestra está constituida por 837 sujetos en tratamiento en la red de salud mental o en la red de drogas de la Comunidad de Madrid, de los cuáles 353 tenían un diagnóstico de abuso o dependencia de cannabis a lo largo de la vida y 357 tenían otros trastornos por uso desustancias pero no cannabis. Se uso la entrevista MINI (Mini Internacional Neuropsychiatric Interview) para el diagnóstico de los trastornos mentales del eje I y el cuestionario PDQ (Personality Disorder Questionnaire) para la valoración de los trastornos de personalidad. Resultados. Se consideró que un 76,5% de los adictos al cannabis tenían un diagnóstico dual en el momento actual, destacando la prevalencia de los trastornos del humor y de ansiedad. El 51% de los adictos a cannabis tenían un diagnóstico de trastorno de la personalidad. La mayoría tenían varios diagnósticos de trastornos por uso de sustancias. Los sujetos con abuso o dependencia de cannabis tenían un inicio más precoz en el consumo de otras drogas como el alcohol, la cocaína y el tabaco que el resto de los adictos. Igualmente este subgrupo se diferenció del resto de los adictos por su asociación con el trastorno antisocial de la personalidad, el trastorno bipolar, la psicosis y la agorafobia. La presencia de estos trastornos mentales se asoció de forma significativa con una edad de inicio más precoz en el consumo de cannabis. Conclusiones. La presencia de patología dual es muy elevada en adictos en tratamiento que tienen dependencia de cannabis y dicho consumo, posiblemente en el contexto de un patrón de poli consumo, se asocia con trastornos mentales graves como la psicosis y el trastorno bipolar. Una edad de inicio más precoz en el consumo de cannabis se asocia con más riesgo de presentar dichos trastornos mentales (AU)

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 837outpatients 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 poly substance 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 (AU)