Under-reporting of drug use among individuals with schizophrenia: prevalence and predictors.

BACKGROUND: Illicit drug use is common in individuals with schizophrenia, and it has been suspected that many individuals under-report their use of substances, leading to significant barriers to treatment. This study sought to examine the degree to which individuals with schizophrenia disclose their use of drugs on self-rated assessments, compared to laboratory assays, and to determine the contributors of under-reported drug use in this population. METHOD: A total of 1042 individuals with schizophrenia who participated in screening/baseline procedures for the Clinical Antipsychotic Trials of Intervention Effectiveness (CATIE) completed self-rated assessments of substance use and laboratory drug testing. Laboratory tests assayed cannabis, cocaine and methamphetamine use; the procedures included radioimmunoassay (RIA) and urine drug screens. RESULTS: A significant proportion of participants tested positive for drug use on laboratory measures (n = 397; 38%), and more than half (n = 229; 58%) did not report using these drugs. Logistic regression models confirmed that patients who were most likely to conceal their use tended to be older, and presented with greater neurocognitive deficits. Patients who accurately reported drug use tended to have greater involvement with the criminal justice system. Illness severity and psychopathology were not associated with whether patients disclosed drug use. CONCLUSIONS: Rates of under-reported drug use are considerable among individuals with schizophrenia when compared to laboratory assays, and the exclusive reliance on self-rated assessments should be used with caution. Patients who under-report their drug use are more likely to manifest neurocognitive deficits, which could be improved by interventions attempting to optimize treatment.

A Clinical Trial to Test the Feasibility of a Telehealth Psychoeducational Intervention for Persons With Schizophrenia and Their Families: Intervention and 3-Month Findings.

OBJECTIVE: To evaluate the feasibility of a telehealth psychoeducation intervention for persons with schizophrenia and their family members. STUDY DESIGN: Randomized controlled trial. PARTICIPANTS: 30 persons with schizophrenia and 21 family members or other informal support persons. INTERVENTIONS: Web-based psychoeducation program that provided online group therapy and education. MAIN OUTCOME MEASURES: Measures for persons with schizophrenia included perceived stress and perceived social support; for family members, they included disease-related distress and perceived social support. RESULTS: At 3 months, participants with schizophrenia in the intervention group reported lower perceived stress (p = .04) and showed a trend for a higher perceived level of social support (p = .06). CONCLUSIONS: The findings demonstrate the feasibility and impact of providing telehealth-based psychosocial treatments, including online therapy groups, to persons with schizophrenia and their families.

Identifying human remains following an air disaster: the role of social work.

An area of disaster response with high risk of inducing trauma in response workers is recovering and identifying human remains. Following a review of the literature addressing the significant stressors associated with handling dead bodies, we present a case study which describes professional social work intervention and support to disaster response workers and volunteers assigned to the morgue following a major air disaster. A primary task was helping workers cope with the unique stresses associated with recovering dead bodies. Opportunities for social workers to use their professional skills for disaster response work is discussed along with recommendations for social work education.

Characteristics of violence in the community by female patients seen in a psychiatric emergency service.

OBJECTIVE: This study examined differences in factors associated with violence toward others by female and male patients evaluated in a psychiatric emergency service. METHODS: A sample of 812 psychiatric patients recruited in the emergency service of an urban psychiatric hospital were followed in the community over a six-month period. Patients provided self-reports of violent incidents, and collateral informants also provided reports of the incidents. Official records were also reviewed. During the followup period, 369 patients (213 male and 156 female patients) engaged in violence, defined as laying hands on another person in a threatening manner or threatening another person with a weapon. RESULTS: Male and female patients did not differ significantly in frequency and seriousness of violence, but they did differ on who the co-combatant was and where the incident took place. CONCLUSIONS: Gender is not a strong predictor of involvement in violence by psychiatric patients. The observed gender differences in location in which violence took place and identity of the co-combatant may be related to differences in the social worlds of men and women, with men having more opportunity for public violence with strangers.

Police referral to psychiatric emergency services and its effect on disposition decisions.

OBJECTIVE: Some clinicians and researchers have questioned the appropriateness of police referrals to psychiatric emergency services and have suggested that police exercise undue influence on hospital admission decisions. The purpose of this study was to test these assertions. METHODS: Research clinicians in nine emergency services in California observed staff evaluations of 772 cases and rated patients' symptom severity, danger to self or others, and grave disability. They also reviewed the criminal justice records of these patients both before and for 18 months after the index evaluation. A total of 186 patients referred by police were compared with 577 patients not referred by police. RESULTS: Patients brought by police were more likely to be subsequently hospitalized, but they were also more psychiatrically disturbed. They were more dangerous to others and more gravely disabled. They were no more likely to have a criminal record than patients not referred by police. CONCLUSIONS: Police did not exercise undue influence on dispositions nor were the patients they brought in more "criminal" than others.

The role of culture in the development of paranoid symptomatology.

The impact and role of cultural factors in the development of paranoid symptomatology are explored and illustrated by clinical vignettes. General principles of intervention, with emphasis on cultural sensitivity, are discussed and suggestions for improving mental health services to a multicultural clientele are proposed.