Results of a screening survey for co-morbid substance misuse amongst patients in treatment for psychotic disorders: prevalence and service needs in an inner London borough

Background: There is great concern in the UK, and other countries, about the clinical management of psychosis and substance misuse co-morbidity. However, relatively little is known about the UK prevalence and management of co-morbidity. Method: We implemented a screening survey of patients who were in treatment with an inner London adult mental health service and measured the prevalence of substance misuse amongst 851 psychotic patients. Caseworkers reported substance misuse and assessed clinical management arrangements. Results: Current prevalence of substance misuse was 24.4 % (95% CI: 21.3–27.1). Rates of co-morbidity were higher in males (31 % vs 16 %, χ² 1df=26.0, P < 0.001) and patients over 51 (χ² 3df=50.1, P < 0.001). Adjusted odds of co-morbidity in patients under 51 were 0.19 (95 % CI: 0.10–0.34) and 0.47 for females (95 % CI: 0.32–0.69). Substance misuse interventions were provided to 20 % of co-morbid patients – Only 5 % were compliant. Conclusions: The findings suggest substance misuse may be highly prevalent amongst psychotic patients. Most co-morbid patients do not receive appropriate treatment. The development of evidence-based interventions should be a priority. Accepted: 2 April 2001     

Neurologic manifestations of human immunodeficiency virus-2: dementia,myelopathy, and neuropathy in West Africa

While well documented in human immunodeficiency virus (HIV)-1, neurologic sequelae have not been systematically evaluated in HIV-2. After excluding for confounding comorbidities, 67 individuals from a rural cohort in Guinea-Bissau (22 HIV-2 participants, 45 seronegative controls) were evaluated. HIV + individuals were divided into CD4 < 350 and CD4 ≥ 350 for analysis. HIV-associated neurocognitive disorders (HAND), assessed by the International HIV Dementia Scale (IHDS), distal sensory polyneuropathy (DSPN), and myelopathy were the main outcome variables. In univariate analysis, there was no difference in IHDS scores among groups. When analyzed by primary education attainment, IHDS scores were nonsignificantly higher (p = 0.06) with more education. There was no significant difference in DSPN prevalence among groups; overall, 45% of participants had DSPN. There were no cases of myelopathy. In multivariate linear regression, higher IHDS scores were significantly correlated with older age (coefficient = −0.11, p < 0.001). Logistic regression analysis showed that older age (odds ratio (OR) 95% CI 1.04–1.20), lower CD4 count (OR 95% CI 0.996–0.999), and higher BMI (OR 95% CI 1.02–1.43) significantly predicted the presence of DSPN. While a significant increase in cognitive impairment was not observed in HIV-2-infected individuals, the study suggests the IHDS may be a less effective screening tool for HAND in settings of lower educational attainment as encountered in rural Guinea-Bissau. Similar to HIV-1, DSPN seems to occur with lower CD4 counts in HIV-2. Further study of the viral–host interactions in HIV-2 and its consequent neurological diseases may provide an avenue for understanding the epidemic problems of HIV-1.     

Polymorphisms of RANTES and IL-4 Genes in Cerebral Infarction

Chemoattractant peptides (chemokines) and cytokines have been shown to play a key role in the inflammatory development and progression of cerebrovascular disease. The effect of polymorphisms in regulated upon activation, normal T cells expressed, and secreted (RANTES) and interleukin-4 (IL-4) genes on cerebral infarction (CI) is evaluated in this study. Patients with CI (n = 320) and healthy controls (n = 481) were genotyped for RANTES-403 and IL-4 variable number of tandem repeat (VNTR) polymorphisms using polymerase chain reaction (PCR) or PCR-restriction fragment length polymorphism. A significant difference was observed between the CI group and controls in subjects with the RANTES AA genotype in IL-4 A3− carriers (18.6% vs. 13.1%, P = 0.035, odds ratio = 1.5, 95% confidence interval = 1.03–2.25). These findings suggest that the RANTES G-403A allele increased the relative risk for CI in the subjects without the IL-4 VNTR allele 3.     

Lagos “Area Boys”, Substance Usage and Potential Risk Factors

The current study explores the rate at which members of Lagos’ “area boys” engage in drug and alcohol use, and determines the predictive roles of parental and neighbourhood characteristics in the gang patterns of psychoactive substance misuse behaviour. The study approached gang members (N = 129) aged from 18 to 38 years (M = 25.83, SD = 4.82) through a snowballing (non probability) sampling method. Adopting a quantitative analytic technique, the results showed cannabis and alcohol as substance of choice with other improvised local drug concoctions being taken by some participants. The role of parental and neighbourhood characteristics as probable risk factors are described. The implications of the findings for rehabilitation service for the gang members are discussed.     

CYP1A1 and GSTM1/T1 Genetic Variation in Predicting Risk for Cerebral Infarction

Cytochrome P450 1A1 (CYP1A1) is involved in the production of arachidonic acid-derived vasoactive substance. We hypothesized that CYP1A1 polymorphism might be related to pathological conditions associated with cerebral infarction (CI). We investigated the effect of genetic polymorphism in the 3′-flanking region (T6235C) of CYP1A1 gene in 353 patients with CI and 376 controls. The distributions of T6235C CYP1A1 genotypes in patients with (TT: 36.0%; TC/CT: 64.0%; n = 353) and without CI (TT: 44.7%; TC/CT: 55.3%; n = 376) indicate that the C allele is associated with CI (P = 0.017, odds ratio (O.R.) = 1.44; 95% confidence interval (C. I.) = 1.07–1.94). Furthermore, we examined whether the glutathione S-transferase (GST) gene, which is one of detoxification enzyme, influence the risk of CI. GST M1 null genotype increased the relative risk for the CI in the subjects with the CYP1A1 C allele (P = 0.015, O.R. = 1.47; C. I. = 1.08–2.00). We conclude that T6235C CYP1A1 polymorphism is a risk factor for the development of CI and suggest that GST polymorphism contribute to the odds of CI.     

Association of NAD(P)H:Quinone Oxidoreductase 1 Polymorphism and Alzheimer’s Disease in Chinese

Several lines of evidence support a role of oxidative stress in the pathology of Alzheimer’s disease (AD). NAD(P)H:quinone oxidoreductase 1 (NQO1) catalyzes the two-electron reduction of quinones, preventing their participation in redox cycling and subsequent generation of reactive oxygen species. We examined association between the NQO1 C609T gene polymorphism and sporadic AD in a Chinese population comprising 311 AD patients and 330 controls. Our results showed a higher T-allele frequency in the AD cases compared with the controls. The difference was close to but did not reach statistically significant level [p = 0.059; odds ratio (OR) T versus C = 1.236; 95% confidence interval (95% CI), 0.992–1.540]. A significantly low C/C genotype frequency in the AD cases compared with the controls was detected (p = 0.025; OR C/C versus C/T + T/T = 0.674; 95% CI, 1.049–2.098) and APOE ε4 status analysis revealed significant difference in the APOE ε4 non-carriers (p = 0.036; OR = 0.633; 95% CI, 1.027–2.427). In the ≥65 years samples, significantly low C/C frequency in the AD cases in comparison with the controls was observed in the APOE ε4 non-carriers (p = 0.045; OR = 0.595; 95% CI, 1.010–2.794). These results indicated that the C/C genotype had a possible protective effect against AD development, and the T allele might be a weak risk factor for late onset AD. J-T Bian and H-L Zhao contributed equally to the work.     

Neck pain in chronic whiplash syndrome treated with botulinum toxin. A double-blind,placebo-controlled clinical trial

Objectives Neck pain in chronic whiplash syndrome is a major burden for patients, healthcare providers and insurance companies. Randomized data on treatment of botulinum toxin in chronic whiplash syndrome are scarce. We conducted a randomized, placebo-controlled clinical trial to prove efficacy of botulinum toxin for neck pain in chronic whiplash syndrome. Methods 40 patients with chronic whiplash syndrome (whiplash associated disorders grade 1 and 2) were randomly assigned to receive botulinum toxin (maximum 100 units) or placebo (saline) in muscles with increased tenderness. Results After 12 weeks there was no significant difference between the two treatment groups in decrease of neck pain intensity on VAS (−7.0 mm, 95% confidence interval (CI) [−20.7 to +6.7]), mean number of neck pain days (−1%; 95% CI [−15% to +13%]), neck pain hours per day (−0.14; 95% CI [−3.0 to +2.7]), days on which symptomatic treatment was taken (−0.7%; 95% CI [−15% to +13%]) number of analgesics taken per day (−0.14; 95% CI [−0.6 to +0.4]) and total cervical range of motion (−11 degrees; 95% CI [−40 to +17]). There also was no significant difference in patient’s assessment of improvement after week 4, 8 and 12. Conclusions Botulinum toxin was not proven effective in treatment of neck pain in chronic whiplash syndrome. Increased muscle tenderness alone might not be the major cause of neck pain in whiplash syndrome. Received in revised form: 7 June 2006     

Effects of a Home-based Exercise Intervention on Fatigue in Postpartum Depressed Women: Results of a Randomized Controlled Trial

Background Fatigue is prevalent during the postpartum period and may be heightened in postpartum depressed women. Purpose To evaluate the efficacy of a home-based exercise intervention in reducing physical and mental fatigue scores in postpartum depressed women. Methods Eighty-eight women in the postpartum (4–38 weeks) obtaining a score ≥10 on the Edinburgh Postnatal Depression Scale (EPDS) were randomly assigned to a 12-week individualized home-based intervention (n = 46) or a control group (n = 42). All participants completed a cardiovascular fitness test at baseline. Outcomes were physical and mental fatigue scores and were measured at baseline, posttreatment and 3 months posttreatment. Results On the basis of intent-to-treat analyses, compared to the control group, women in the exercise group showed significantly greater reduction in physical fatigue at posttreatment [mean change =  −4.07, (95% CI, (−5.15, −2.98)] and 3 months posttreatment [mean change = −4.24, (95% CI, (−5.36, −3.12)]. Significant reductions in mental fatigue with exercise were observed at posttreatment for women reporting lower physical fatigue at baseline. Conclusions Fatigue is a common symptom experienced in the postpartum that can be heightened by depression. The findings show that home-based exercise can reduce physical and mental fatigue in postpartum depressed women. This study was funded by an operating grant from the Fonds de recherche en santé du Québec (#024018).     

Suicide rates, life satisfaction and happiness as markers for population mental health

Objective To examine the association of variables from survey data on well-being with suicide rates and other markers of population mental health in Europe. Design Ecological study correlating (Spearman’s rank correlation) life satisfaction and happiness (European Values Survey 1999/2000) in 32 countries with suicide rates (WHO Mortality Database), rates of hospital discharge for mental and behavioural disorders and prevalence of mental disorders based on registered mental patients (WHO Regional Office for Europe) and Mental Health Index (MHI)-5 survey data (European Opinion Research Group). Results An inverse association exists between suicide rates and life satisfaction (r=−0.44; 95% CI: −0.68, −0.11) and happiness (r=−0.42; 95% CI: −0.67, −0.08). Similar though weaker associations were seen with hospital discharge data and MHI−5 data but not with the prevalence of mental disorders. The association between suicide rates and life satisfaction was weaker amongst 15–44 year olds (r=−0.31; 95% CI: −0.59, 0.04) than amongst 45–64 year olds (r=−0.47; 95% CI: −0.70, −0.14). It was strongest in the 65+ age group (r=−0.54; 95% CI: −0.75, −0.23). A similar pattern was observed for the association with happiness. In a subgroup analysis, the association between suicide and life satisfaction in Eastern Europe was similar to that in the whole dataset (r=−0.35) but a positive association was seen in Western Europe (r=0.47). Conclusions Life satisfaction and happiness were modestly associated with other indicators of population mental health. Since all such markers have their limitations, surveys of well-being may be useful indicators of population mental health.     

Decreased β-Cell Function is Associated with Cardiovascular Autonomic Neuropathy in Chinese Patients Newly Diagnosed with Type 2 Diabetes

The influence of β-cell function on cardiovascular autonomic neuropathy (CAN), an important diabetes-related complication, is still unclear. In this study, we aimed to investigate the association between residual β-cell function and CAN in patients newly diagnosed with type 2 diabetes. We enrolled 90 newly-diagnosed type 2 diabetic patients and 37 participants with normal glucose tolerance as controls. The patients were divided into a CAN+ group (diabetic patients with CAN, n = 20) and a CAN− group (diabetic patients without CAN, n = 70) according to the standard Ewing battery of tests. Fasting and postprandial plasma glucose, insulin, and C-peptide were measured. Homeostasis model assessment-beta cells (HOMA-B) and HOMA-insulin resistance (IR) were calculated. The prevalence of CAN in this population was 22.2%. Compared with the CAN− group, the CAN+ group had significantly lower fasting plasma insulin (6.60 ± 4.39 vs 10.45 ± 7.82 μ/L, P = 0.029), fasting C-peptide (0.51 ± 0.20 vs 0.82 ± 0.51 nmol/L, P = 0.004), and HOMA-B (21.44 ± 17.06 vs 44.17 ± 38.49, P = 0.002). Fasting C-peptide was correlated with the Valsalva ratio (r = 0.24, P = 0.043) and the 30:15 test (r = 0.26, P = 0.023). Further analysis showed that fasting C-peptide (OR: 0.041, 95% CI 0.003–0.501, P = 0.012) and HOMA-B (OR: 0.965, 95% CI 0.934–0.996, P = 0.028) were independently associated with cardiovascular autonomic nerve function in this population. The patients with fasting C-peptide values < 0.67 nmol/L were more likely to have CAN than those with C-peptide levels ≥0.67 nmol/L (OR: 6.00, 95% CI 1.815–19.830, P = 0.003). A high prevalence of CAN was found in patients with newly-diagnosed type 2 diabetes. Decreased β-cell function was closely associated with CAN in this population.     

Comparing Psychosocial Predictors of Physical Activity Adoption and Maintenance

Background   Most health behavior models do not distinguish between determinants of behavior adoption and maintenance. Purpose   This study compared psychosocial predictors of physical activity (PA) adoption and predictors of PA maintenance among 205 initially sedentary adults enrolled in a home-based PA promotion trial. Methods   Psychosocial variables were measured at 6 months (at which point 107 participants remained inactive and 98 participants adopted regular PA) and used to predict 12-month PA status (an indicator of PA adoption among those inactive at 6 months and an indicator of PA maintenance among those active at 6 months). Results   Six-month PA status moderated the relationships between 6-month measures of home access to PA equipment (p = .049), self-efficacy (p = .086), and perceived satisfaction (p = .062) and 12-month PA status. Simple effects analyses revealed that home access to PA equipment was predictive of PA adoption (OR = 1.73; 95% CI: 1.05, 2.85), but not PA maintenance (OR = 0.88; 95% CI: 0.58, 1.35), whereas self-efficacy and perceived satisfaction were predictive of PA maintenance (OR = 2.65; 95% CI: 1.55, 4.52; OR = 1.95; 95% CI: 0.93, 4.06), but not PA adoption (OR = 1.50; 95% CI: 0.87, 2.57; OR = 0.82, CI: 0.44, 1.52). Conclusion   Results suggest that these psychosocial variables may operate differently in predicting PA adoption versus maintenance.     

Prevalence of substance misuse among individuals with severe mental illness in São Paulo

Abstract.Objectives: The aims of this study were to estimate the prevalence of substance misuse among people with severe mental illness in a large urban centre of a developing country, and to investigate which are the individual characteristics associated with such comorbidity.Method: A cross-sectional study was carried out in São Paulo, Brazil, with all mental health services that covered a defined geographical area. Eligible individuals had had any contact with such mental health services, had clinical diagnoses of functional psychoses, and were resident in the areas defined for the study. Use of alcohol, illegal and non-prescribed drugs, and criteria for substance misuse were assessed with a standardised clinical interview, the SCAN. Psychopathology and social adjustment were also assessed with standardised instruments.Results: One hundred and ninety-two subjects were included. The prevalence of substance misuse was 10.4 % (95 % CI: 6.5–15.6), with 7.3 % fulfilling criteria for alcohol abuse or dependence, and 4.7 % fulfilling criteria for abuse or dependence of illegal or non-prescribed substances. Subjects with any abuse or dependence had lower scores for negative symptoms. Male subjects and those with a diagnosis of non-affective psychosis other than schizophrenia had higher probability of being cases of misuse of illegal or non-prescribed substances.Conclusions: Prevalence of substance misuse was lower than that found in developed countries. The lack of social policies for those suffering from severe mental illnesses, with consequent dependence on family support must play a major role. Cultural factors also seem to contribute to the prevalence of substance misuse.     

Suicide attempts by psychiatric patients in acute inpatient, long-stay inpatient and community care

Background: This study examined rates of and risk factors associated with suicide attempts by psychiatric patients under active care. It was especially focussed on the relative rates across three standard treatment settings: acute inpatient care, long-stay inpatient care and community-based care. Methods: A total of 12,229 patients in 13,632 episodes of care were rated on the Health of the Nation Outcome Scales (HoNOS) Item 2. For the purposes of the current investigation, a score of 4 was deemed to indicate a suicide attempt. Results: Incidence densities per 1000 episode days were 5.4 (95% CI = 4.8–6.1) for patients under care in acute inpatient settings, 0.6 (95% CI = 0.5–0.8) for patients under care in long-stay inpatient settings, and 0.5 (95% CI = 0.5–0.6) for patients under care in community-based arrangements. Predictors varied by treatment setting. Risk was elevated for personality disorders across all settings: 22.7 attempts per 1000 episode days (95% CI = 17.2–30.0) in acute inpatient care; 2.1 (95% CI = 1.0–4.5) in long-stay inpatient care; and 2.3 (95% CI = 1.7–3.0) in community-based care. This effect remained after adjustment for demographics. Conclusion: Rates of suicide attempts among psychiatric patients are a major issue facing contemporary mental health care systems, and risk factors vary across different treatment settings. Accepted: 8 October 1999     

“You don't give me flowers anymore”: an analysis of gift-giving to medical and psychiatric inpatients

Background: If someone is admitted to hospital, it is customary for them to receive gifts from their friends and relatives. To assess the degree to which the mentally ill receive this type of support, this study set out to assess the level of gift-giving to the mentally ill compared with the physically ill during hospital admissions. Method: Subjects were 33 psychiatric and 23 medical female inpatients. Assessment was with a short interview on the subject of gifts received. Confounders were controlled for, in particular the number of family members who knew of the admission. Results: Medical patients received significantly more flowers: odds ratio 8.8 (95% confidence interval 1.6–64.2, P = 0.004); get-well-soon cards: OR 5.7 (95% CI 1.4–25.3, P = 0.006) and other gifts: OR 5.7 (95% CI 1.4–23.6, P = 0.004). Adjustment for the potential confounders did not significantly affect the associations. Conclusions: The results suggested that during hospital admissions, the behaviour of relatives and friends of mentally ill patients is rejecting. The authors suggest that more education for relatives may help to improve this picture. Accepted: 2 July 1998     

<Emphasis Type="Italic">PEMT</Emphasis> G523A (V175M) Is Associated with Sporadic Alzheimer's Disease in a Chinese Population

There is evidence that increased concentrations of circulating homocysteine are associated with Alzheimer's disease (AD). Phosphatidylethanolamine N-methyltransferase (PEMT) is an important catalyst involved in the production of homocysteine. We investigated the association of a functional single nucleotide polymorphism (rs7946) in PEMT with sporadic AD risk in a Han Chinese population that included 386 AD patients and 366 controls. PEMT G523A was genotyped by either sequencing or PCR-restriction fragment length polymorphism analysis. The plasma homocysteine concentrations of 210 subjects were determined by high-performance liquid chromatography. Significant higher frequency of the A allele was detected in AD cases than in controls (A vs. G, p = 0.007, OR = 1.482, 95% CI 1.114–1.972). After adjusting for gender, age/age at onset, and APOE ε4 status, logistic analysis showed rs7946 was associated with AD in a dominant model (AA + GA vs. GG, p = 0.007, OR = 1.596, 95% CI 1.138–2.240). When stratified by APOE ε4 status or gender, the significant difference was only observed in the APOE ε4 non-carriers and in the female subjects, respectively. We did not find a relationship of this polymorphism with plasma homocysteine levels. These results suggested that PEMT G523A is associated with AD and that the A allele is an APOE ε4-independent risk factor for AD among Han Chinese women.     

(AAT)n repeat in the cannabinoid receptor gene, CNR1: association with schizophrenia in a Spanish population

The cannabinoid receptor 1 gene (CNR1) has been associated with addictive disorders and schizophrenia in different studies. We have compared the frequencies of the alleles for the 3′-UTR CNR1 microsatellite in a sample of 113 Spanish schizophrenic patients, including 68 with comorbid substance abuse, and 111 healthy controls. We report that the frequency of the allele 4 of this microsatellite is significantly lower in schizophrenia patients when compared with controls (χ² = 7.858; df 1; P = 0.005). No differences have been found with respect to substance abuse. Thus, the allele 4 represents, in our sample, a protective factor against schizophrenia (odds ratio 0.468, 95% confidence interval (CI) 0.27–0.79). The population attributable genetic risk for the allele 4 absence is 30% (95% CI = 17–41%) and the attributable risk for the allele 4 absence in those with schizophrenia is 53% (95% CI = 20–73%). Our results suggest that, independent of substance abuse, differences in the cannabinoid system function could be involved in the vulnerability to schizophrenia in Spanish population. Drs. Martínez-Gras and Hoenicka contributed equally to this work     

Clinical and prognostic characteristics associated with addictive comorbidity in hospitalized psychiatric patients

The aims of this study were to estimate: 1) the prevalence of substance use disorder, 2) the social and clinical characteristics associated to such a comorbid disorder in patients hospitalised in psychiatry. METHOD: Patients consecutively hospitalised for a non-addictive disorder were included in the present survey. A standardised method was used to collect information on clinical and social characteristics. DSM IV diagnoses, including those of substance use, were made using a structured diagnostic interview and all available clinical and historical informations collected during the hospital stay. RESULTS: We have included 127 patients fulfilling the diagnostic criteria for affective disorders (n = 61), non-affective psychotic disorder (schizophrenia, schizoaffective disorder, delusional disorder, other psychotic disorders, n = 50) and personality disorder (n = 16). Among these patients, 11.8% presented with a current abuse/dependence to alcohol (lifetime prevalence: 25.2%), 11% to cannabis (lifetime prevalence: 22.8%). The lifetime prevalence for any other substance disorder was 2.4%. The subjects presenting with an abuse/dependence to alcohol had a higher rate of psychiatric hospitalisation (OR = 2.9; 95% CI 1.0-8.1; p = 0.04) and had more frequently a history of attempted suicide (OR = 2.6; 95% CI 1.0-6.5; p = 0.04). The cannabis misuse was associated with medication noncompliance (OR = 3.1; 95% CI 1.1-9.1; p = 0.04) and more frequent penal problems (OR = 15.0; 95% CI 2.9-78.7; p = 0.001). CONCLUSION: Cannabis and alcohol misuse have a negative, but different, impact on social adaptation and clinical outcome in subjects with psychiatric disorder. These results confirm the necessity to systematically assess this type of comorbid disorder and to distinguish the different substances.     

Risk factors for suicidal ideation in psychiatric patients

Sociodemographic and clinical risk factors for suicidal ideation have been less studied than risk factors for parasuicide and suicide. No reports on associations between therapy satisfaction and suicidal ideation among psychiatric patients have been published. In this study we compared a group of patients with suicidal ideation (n= 84) with a randomly selected group of nonsuicidal patients (n = 166) in community-based psychiatric services. Patients with suicidal ideation felt a need for psychiatric treatment more often than nonsuicidal patients. They were also more likely to receive antidepressive medication, and weekly therapy sessions were more common among them. A wish to change therapist (OR 15.6, 95% CI 3.6–67.8), hopeless future orientation (OR 14.8, 95% CI 4.5–48.9), severe depression as evaluated by the Beck Depression Inventory (OR 14.0, 95% CI 4.3–45.2) and dysthymia (OR 12.8, 95% CI 1.7–97.3) were the factors most strongly associated with suicidal ideation in multivariate analysis. A wish to change therapist is an expression of therapy dissatisfaction, which may therefore be among the factors most strongly associated with suicidal ideation in psychiatric patients. To help prevent suicidality among psychiatric patients special attention to therapy factors is needed. Accepted: 15 September 1997     

Variations in rates of comorbid substance use in psychosis between mental health settings and geographical areas in the UK

Background  Comorbid substance misuse in psychosis is associated with significant clinical, social and legal problems. An epidemiologically informed approach to planning service delivery requires an understanding of which clinical populations are at particularly high risk for such ‘dual diagnosis’. Evidence has now been accumulating in the UK since the early 1990s, and allows a relatively comprehensive comparison of rates between service settings, geographical areas and social contexts in terms of ethnic background. Methods  A literature search was carried out with the aim of investigating: (a) comorbid alcohol and drug misuse rates in people with established psychosis in different mental health and addiction settings in the UK, (b) variations in such rates between different population groups. Results  There are wide variations in reported drug and alcohol misuse rates in psychosis. Most recent UK studies report rates between 20 and 37% in mental health settings, while figures in addiction settings are less clear (6–15%). Rates are generally not as high as in US studies, but appear to be especially high in inpatient and crisis team settings (38–50%) and forensic settings. In terms of geography, rates appear highest in inner city areas. Some ethnic groups are over-represented among clinical populations of people with dual diagnosis. Conclusions  Rates of substance misuse in psychosis are likely to be influenced by service setting, population composition and geography. Acute and forensic settings are especially appropriate for the development of targeted interventions.