Co-morbidity Across Levels of Hospital Security

This study explores the prevalence of co-morbid mental illness and substance abuse across three levels of hospital security (non-secure, medium and high secure). The medical records of 428 individuals with a mental illness were examined for evidence of a history of co-morbid substance abuse and criminal convictions. Abuse of solvents, hallucinogens, cocaine and poly-substance abuse were all found to be more likely in the high secure mentally ill population compared to the non-forensic (non-secure) mentally ill population. Therefore not only was the prevalence of co-morbidity greater at higher levels of security but the type of substances abused by high secure patients were also different from the types abused by non-forensic patients. There were some unexpected findings, most notably high secure patients were significantly less likely to abuse alcohol than non-forensic patients. The validity of these findings is discussed. Across the whole sample violent crime was particularly associated with abuse of cannabis, solvents, hallucinogens and poly-substance abuse. However even after controlling for violent crime, significantly higher levels of substance abuse were found at higher levels of hospital security.     

Police perceptions of the mental health services and the mentally ill

AIM: To explore police officers' perceptions of the mentally ill and of their working relationship with mental health services. METHOD: A survey of 200 randomly selected front-line police officers was carried out over the summer of 1996/1997. RESULTS: The survey revealed that police identified people in the community as mentally ill, dealt with those so identified and related to the mental health services in a variety of ways. However, the survey uncovered a degree of frustration at the limitations of the Mental Health Act 1992 and the limited options available to the police in cases where individuals can not be committed. In addition, the survey suggests that many incidents involving the police and a person with a mental illness do not involve crime. CONCLUSIONS: Although the police are generally happy with the dealings they have with providers of mental health services, when police are dealing with those identified as mentally ill they are placed in the dilemma of having to liaise with other agencies and bodies about something that is not a police problem and for which they have little training. It would appear that there is some merit in identifying, or lobbying for, agencies who could provide support for those people who require help but who do not fulfil committal criteria.     

Contingent reinforcement of marijuana abstinence among individuals with serious mental illness: a feasibility study

The feasibility of using monetary incentives to promote abstinence from marijuana use among individuals with serious mental illness was examined by using a within-subjects experimental design. Participants were 18 adults with schizophrenia or other serious mental illness who reported regular marijuana use. During 2 baseline conditions, participants received payment for submitting urine specimens independent of urinalysis results. During 3 incentive conditions, participants received varying amounts of money if urinalysis results were negative for recent marijuana use. The number of marijuana-negative specimens obtained was significantly greater during incentive than baseline conditions. These results provide evidence that marijuana use among at least some mentally ill individuals is sensitive to contingent reinforcement and support the potential feasibility of using contingency-management interventions to reduce substance abuse among the mentally ill.     

A review of the pharmacological and psychopharmacological aspects of smoking and smoking cessation in psychiatric patients

The data reviewed confirm that mentally ill patients smoke twice as many cigarettes as patients without mental illness. The secretion of neurotransmitters such as noradrenaline, serotonin, dopamine, acetylcholine, gamma-amino-butyric acid and glutamate is increased by the binding of nicotine to central nicotine receptors. There are also data showing that serotonin formation and secretion in patients with mental illness are influenced by chronic smoking. Cigarette smoke inhibits the activity of monoamine oxidase B, which is responsible for the catabolism of several brain neurotransmitters. Patients suffering from major depression show a comorbidity between heavy smoking and the disease. In patients with schizophrenia treated with neuroleptics, increased cigarette smoking reduces adverse reactions to the drug therapy presumably because of an increase in metabolism of the neuroleptics. There is also evidence suggesting that quitting smoking is more difficult for mentally ill patients than patients without psychiatric disease. Several studies have been carried out on smoking cessation in psychiatric patients. The alternative method of harm reduction, e.g. reducing the number of cigarettes smoked using nicotine patches or chewing gum, is necessary in patients not able to quit. The data indicate that strategies such as the coupling of smoking prohibition with administration of nicotine preparations are useful in smoking cessation. A no-smoking policy in psychiatric clinics, even when this leads to withdrawal symptoms in the patients affected, has no negative effect on mental illness. Because patients with mental diseases are particularly vulnerable to the marketing strategies of the tobacco industry, this chronically ill section of the population requires special protection by the law-makers.     

Pharmacists' perceptions of mental health care, psychiatrists, and mentally ill patients

The attitudes of hospital pharmacists in Texas toward mental health care, psychiatrists, and mentally ill patients were evaluated. The pretested survey instrument contained 33 statements, which the respondents graded on a five-step Likert scale. These questionnaires were mailed to a random sample of 300 pharmacists. In general, the 170 respondents perceived psychiatrists and mentally ill patients in a positive manner. The psychiatrist was viewed as a true professional with legitimate expertise, and mentally ill patients were considered to be basically similar to normal individuals, generally rational, nondangerous, and without blame for their disease. The pharmacists showed more negative attitudes toward hospitals for mentally ill patients. They supported statements that depicted mental hospitals as understaffed, too drug oriented, and at times insensitive to individual needs. The surveyed hospital pharmacists generally demonstrated healthy, unprejudiced views toward psychiatrists and mentally ill patients; however, their attitudes toward mental hospitals were skewed in the negative direction.     

Violence among comorbid and noncomorbid severely mentally ill adults: A pilot study

This pilot study examined the relationship between substance dependence and violence in a sample of severely mentally ill adults. Subjects were 42 psychiatric outpatients enrolled in a clinical case management program in San Francisco, California. Almost 40% of the participants reported perpetrating at least one violent act in the past 12 months. Comorbid participants were over 4% times more likely to commit a violent act in the past 12 months than noncomorbid participants. Substance dependence was also more frequently associated with perpetration of a violent act by female than by male participants and by Caucasian than by African American participants. Comorbid mentally ill participants appear more likely to perpetrate violent acts than those with mental illness alone. The dangers of substance dependence in terms of the perpetration of violence may not be in mental illness or substance dependence alone but in their co‐occurrence. Further investigation is needed to assess risk factors for violence and victimization in multiple environmental and situational domains. It will be important to explore the moderating effects of gender and race on the co‐occurrence of mental illness, substance dependence, and the perpetration of violent acts.     

Violence Among Comorbid and Noncomorbid Severely Mentally Ill Adults: A Pilot Study

This pilot study examined the relationship between substance dependence and violence in a sample of severely mentally ill adults. Subjects were 42 psychiatric outpatients enrolled in a clinical case management program in San Francisco, California. Almost 40% of the participants reported perpetrating at least one violent act in the past 12 months. Comorbid participants were over 4 1/2 times more likely to commit a violent act in the past 12 months than noncomorbid participants. Substance dependence was also more frequently associated with perpetration of a violent act by female than by male participants and by Caucasian than by African American participants. Comorbid mentally ill participants appear more likely to perpetrate violent acts than those with mental illness alone. The dangers of substance dependence in terms of the perpetration of violence may not be in mental illness or substance dependence alone but in their co-occurrence. Further investigation is needed to assess risk factors for violence and victimization in multiple environmental and situational domains. It will be important to explore the moderating effects of gender and race on the co-occurrence of mental illness, substance dependence, and the perpetration of violent acts.     

Substance abuse and the need for money management assistance among psychiatric inpatients

Patients who mismanage their funds may benefit from financial advice, case management or the involuntary assignment of a payee who restricts direct access to funds. Data from a survey of psychiatric inpatients at four VA hospitals (N = 236) was used to evaluate the relationship between substance abuse and clinician-rated need for money management assistance. Multivariate analytic techniques were used to control for sociodemographic factors and psychopathology. Alcohol and drug use severity both were modestly associated with need for assistance. The effect of substance use severity was greater in patients who were also diagnosed with a major mental illness. Clinicians indicated that 27 patients (11% of the sample) required an involuntary payee and 21 of the 27 (78%) had a Substance Abuse diagnosis. Only drug use severity was significantly associated with need for a payee. These data describe a substantial unmet need for money management assistance in psychiatric inpatients, particularly among those with substance abuse disorders. There is a need to examine the process by which the Social Security and Veterans Benefits Administrations assign payees to determine whether patients with co-morbid substance abuse are not being assigned a payee in spite of their discernible need for one.     

Substance abuse and psychiatric disorders in HIV-positive patients: epidemiology and impact on antiretroviral therapy

There is a high prevalence of substance abuse and psychiatric disorders among HIV-infected individuals. Importantly, drug and alcohol-use disorders are frequently co-morbid with depression, anxiety and severe mental illness. Not only do these disorders increase the risk of contracting HIV, they have also been associated with decreased highly active antiretroviral therapy (HAART) utilisation, adherence and virological suppression. The literature evaluating the relationship between substance abuse and HIV outcomes has primarily focused on injection drug users, although there has been increasing interest in alcohol, cocaine and marijuana. Similarly, the mental health literature has focused largely on depression, with a lesser focus on severe mental illness or anxiety. To date, there is little literature evaluating the association between co-occurring HIV, substance abuse and mental illness on HAART uptake, adherence and virological suppression. Adherence interventions in these populations have demonstrated mixed efficacy. Both directly observed therapy and pharmacist-assisted interventions appear promising, as do integrated behavioural interventions. However, the current intervention literature has several limitations: few of these studies are randomised, controlled trials; the sample sizes have generally been small; and co-occurring substance abuse and mental illness has not specifically been targeted in these studies. Future studies examining individual substances of abuse, psychiatric disorders and co-occurring substance abuse and psychiatric disorders on HIV outcomes will inform targeted adherence interventions.     

Correlates of HIV transmission risk factors and considerations for interventions in homeless,chemically addicted and mentally ill patients

A study was conducted to ascertain correlates of HIV high risk behaviors and attitudes toward HIV. A questionnaire was administered to 103 men living in a modified therapeutic community (TC) for homeless, chemically addicted and mentally ill men. The psychiatric diagnoses of the sample population included psychotic disorders (48%), depressive disorders (36%), and bipolar disorders (16%). Forty-two percent reported that their primary substance of abuse was cocaine and another 40% named alcohol as the substance to which they were most addicted. Two logistic regression analyses were conducted, one with needle sharing as the outcome measure and one with endorsement of the need for lifestyle changes to reduce risk of HIV transmission. Cocaine users were 3.4 times more likely to have shared needles than the rest of the sample. Patients who had a history of sexually transmitted diseases (STDs) were 17 times more likely to endorse the need for lifestyle changes. The level of HIV transmission knowledge was unrelated to HIV risk behaviors or attitudes.     

Methods of changing patterns of substance use among individuals with co-occurring schizophrenia and substance use disorder.

Individuals with a severe mental illness and substance use disorder tend to have medical and social problems and to make slower progress in treatment than those who have either disorder alone. Nevertheless, little attention has been paid to the discovery of effective methods of modifying substance use in the severely mentally ill (SMI). The purpose of this study was to collect qualitative data as a way to help identify techniques that might help to change patterns of substance use in the SMI. The participants were 21 men and women who were psychiatric clinic outpatients and who had a current schizophrenia spectrum diagnosis. A total of 18 participants had a lifetime diagnosis of alcohol abuse or dependence, and 21 lifetime other drug diagnoses were recorded for the sample. These individuals participated in focus group discussions about topics related to substance use and people's experiences with trying to quit. The results showed that participants identified several therapeutic and extratherapeutic factors that helped them to initiate and maintain changes in their substance use, as well as factors that hindered change. The findings are related to knowledge about the effectiveness of substance use disorder treatment techniques in general, and implications of the data are discussed for the conduct of integrated treatment of individuals with severe mental illness and a substance use disorder.     

Travel Illness and the Family Practitioner: A Retrospective Assessment of Travel-Induced Illness in General Practice and the Effect of a Travel Illness Clinic

Background: As the recognition of the discipline of Travel Medicine grows with increased international travel, an examination of both the value of pretravel advice as well as the general practitioner's role in preparation for, care during, and diagnosis and treatment after travel is necessary. This study was conducted to determine the incidence of travel-related illness in a typical urban population in Scotland and to examine the efficacy of our pretravel clinic related to reduction of illness, preparedness of our patients for travel, and the effects of our travel clinic on the workload generated by the returning ill in our practice.
Methods: In this retrospective study, 1568 patients, presenting within a 1-year period from 1992–1993 at a medical practice and 100 patients at a travel clinic were studied. Their morbidity rates and, therefore, the effect of the travel clinic on prophylaxis and pretravel advice were determined.
Results: In the practice sample, 42% of travelers became ill while abroad, with 48% of ill travelers returning to consult their family doctor at home. Travelers to Africa and Asia were shown to have the highest rates of illness. Travel clinic attendees were more likely to be traveling to high-risk destinations, but were better prepared, experiencing a significantly lower rate of illness during travel (22%). Clinic attendees were less likely to consult their doctor on return home, preferring instead to resolve their illness by self-medication.
Conclusions : The results suggest that travel clinics significantly reduce the morbidity of illness for travelers and that the burden on general practices could be reduced with the pretravel advice and prophylaxis that travel clinics provide.     

A survey of psychotropic medications in the United States.

The range of psychotropic medications available in the U.S. for the treatment of serious mental illnesses is limited. Many agents have been "me too" drugs, offering primarily side-effect differences, instead of new indications or mechanisms. As a result, patients refractory to the original drugs are not helped. Other patient populations (both mentally ill and addicted) have "fallen through the cracks" of the current U.S. psychotropic drug development process. The recent approval of chlorimipramine and clozapine demonstrates that real benefits for U.S. patients can be realized from judicious introduction of non-U.S. drugs. Many more psychotropic drugs developed and used in other countries are not available in the United States. Industrial and regulatory obstacles could be surmounted by the legislative innovation proposed. This survey identifies some specific non-U.S. drugs of interest.     

Media portrayal of mental illness and its treatments: what effect does it have on people with mental illness?

This article reviews dominant media portrayals of mental illness, the mentally ill and mental health interventions, and examines what social, emotional and treatment-related effects these may have. Studies consistently show that both entertainment and news media provide overwhelmingly dramatic and distorted images of mental illness that emphasise dangerousness, criminality and unpredictability. They also model negative reactions to the mentally ill, including fear, rejection, derision and ridicule. The consequences of negative media images for people who have a mental illness are profound. They impair self-esteem, help-seeking behaviours, medication adherence and overall recovery. Mental health advocates blame the media for promoting stigma and discrimination toward people with a mental illness. However, the media may also be an important ally in challenging public prejudices, initiating public debate, and projecting positive, human interest stories about people who live with mental illness. Media lobbying and press liaison should take on a central role for mental health professionals, not only as a way of speaking out for patients who may not be able to speak out for themselves, but as a means of improving public education and awareness. Also, given the consistency of research findings in this field, it may now be time to shift attention away from further cataloguing of media representations of mental illness to the more challenging prospect of how to use the media to improve the life chances and recovery possibilities for the one in four people living with mental disorders.     

Attitudes of pharmacy students toward mental illness

Undergraduate pharmacy students' attitudes toward mental illness were measured by a questionnaire that also included questions about students' demographic variables and previous exposure to mental illness. Baccalaureate pharmacy students entering their first week of clinical rotations were asked to voluntarily complete a questionnaire that included Whatley's social distance scale and Morrison's Client Attitude Questionnaire version B (CAQ-B). Information was also sought about demographics, socio-economic factors, and prior exposure to mental illness. Possible total scores for Whatley's social distance scale range from 8 to 24, with lower scores implying more favorable attitudes toward mentally ill patients. Possible total scores for the CAQ-B range from 20 to 60, with scores lower than 40 indicative of a medical-model orientation and scores higher than 46 indicative of a psychosocial-model orientation. A total of 250 students completed the questionnaire. The first 85 students received Morrison's CAQ-B; the other 165 students completed both scales. The mean +/- S.D. score of 13.6 +/- 3.5 on the social distance scale indicates that the pharmacy students generally had favorable attitudes towards patients with mental illness. The mean +/- S.D. score of 32.8 +/- 3.6 on the CAQ-B indicates that the pharmacy students accepted a medical-model orientation. Students reporting a family history of psychiatric diagnoses and hospitalizations, a personal psychiatric diagnosis, or a history of visiting a psychiatric hospital had more favorable attitudes toward mentally ill patients. Female students and students who had a family history of psychiatric hospitalizations and diagnoses were significantly more oriented toward the medical model than students without this history.(ABSTRACT TRUNCATED AT 250 WORDS)     

Smoking among in-patients with drug-related problems in an Australian psychiatric hospital

Despite the high prevalence of smoking among people with mental illnesses, interventions for tobacco dependence have not typically been offered as part of treatment regimens. Data on the prevalence of smoking among 160 people with coexisting alcohol or other drug problems admitted to acute wards of a public psychiatric hospital are presented. Associations between level of smoking, diagnosis, socio-demographic variables and readiness to quit smoking are examined. Reasons for smoking are also reported. Over 90% of the sample were regular smokers, with a mean cigarette consumption of 22.09 cigarettes per day, which was not related to type of psychiatric illness, gender or relationship status. Daily cigarette consumption was higher among older smokers and those with a diagnosis of alcohol dependence. It is suggested that interventions for tobacco dependence among people with co-existing alcohol or other drug problems and mental illnesses should be conducted by mental health staff and aim to increase or consolidate motivation to quit smoking; provide nicotine replacement; address any concurrent alcohol abuse; identify and challenge dysfunctional beliefs about smoking; and address stress management, boredom and lifestyle.     

927例女性城市流浪精神病患者情况分析与护理对策

目的调查分析女性城市流浪精神病患者情况,并提出相应的护理对策。方法对我院2010年1月至2012年5月收治的927例女性城市流浪精神病患者进行调查、总结、分析情况。结果多数患者难以沟通,无法获得基本情况（57．8％）;外伤及皮肤感染（60％）、传染病（14．2％）、受性侵犯（39．1％）甚至怀孕等情况较为严重。结论女性城市流浪精神病患者来源复杂,存在严重的问题,要高度重视,要针对其存在的问题的特殊性,有的放矢地采取措施,更好地救护患者、保护医护人员。     

农村重性精神疾病患者应急处置机制探讨

精神疾病患者在发病状态下精神能力受损,无法理智地作出决策或控制自身行为,合理的处置不仅涉及患者权益保护,同时有益于公众安全。针对精神障碍的特殊性,积极适应精神卫生法的实施,探讨在农村建立有效的重性精神疾病患者应急处置机制,对潜在隐患及对可能发生的突发事件做到早发现早处置,从重性精神疾病应急处置的应对策略、应急处理措施中着手,针对应急处置实施过程中出现的问题,提出基层医疗卫生机构日常工作方式方法的建议,实现理论和实践的有效结合,为国家建立农村县级卫生事件提前介入预防处置机制提供有益的策略依据。     

Flourishing,languishing and moderate mental health: Prevalence and change in mental health during recovery from drug and alcohol problems

The aim was to explore the utility of Keyes’ concept of mental health in a substance addiction context. Mental health is considered the presence of emotional wellbeing in conjunction with high levels of social and psychological functioning. Using Keyes' measure, the frequency of languishing and flourishing is compared between clients who became abstinent and those continuing to use substances following treatment. It was hypothesised that there would be a significant interaction between substance use and levels of mental health over time. Participants were 794 individuals (79.5% male) attending residential substance abuse treatment provided by The Australian Salvation Army. The current sample was drawn from a larger longitudinal study evaluating routine client outcomes. At entry to treatment there were higher rates of languishing compared to population estimates, yet greater rates of flourishing at all time points compared to community normative data. There was a significant interaction between continuous mental health and substance use status. Mental health was rated significantly higher by individuals who were abstinent than those who had used substances at 3-month post-discharge follow-up. The comorbidity of mental illness and substance misuse has previously been investigated, but this is the first study to investigate the prevalence of mental health. While participants who remained abstinent achieved the highest levels of flourishing, at follow-up there were lower rates of languishing than found in a general community sample. Additionally, results suggested that improved mental health was a consequence of reduced severity of alcohol and other drug abuse, and followed reductions in cravings.     

Prevalence of substance abuse in a psychiatric evaluation unit.

The prevalence of substance abuse and psychiatric illness was studied in a Psychiatric Evaluations Unit. Twenty-six percent of the subjects received a psychiatric diagnosis only with no concomitant substance use disorder. Thirty-four percent were diagnosed with a substance use disorder but with no other psychiatric disorders. Thirty-nine percent of the subjects had a history of both psychiatric and substance use disorder; 62% of these substance abusers with a psychiatric illness reported using drugs (including alcohol) the week before the interview; 56% used illicit drugs while 44% used alcohol only. Differences among substance abusers with a psychiatric illness, those with a substance abuse diagnosis alone, and those with a psychiatric diagnosis alone are presented.