الفهرس | Only 14 pages are availabe for public view |
Abstract Dual diagnosis is one of the major problems confronting the mental health field. Individuals with psychiatric disorders are at increased risk for having a comorbid substance abuse disorder, and vice versa. The present study was concerned with the prevalence of comorbid psychiatric disorders among substance abuser subjects, and studying the relationship between the type of substance and the comorbid psychiatric disorder occurred and searching for specific risk factors that can cause this comorbidity. The studied group was 120 Egyptian subjects. Their age range between 18-50 years old and both sexes were included. They were fulfilling the criteria for substance abuse according to DSM-IV-TR criteria. They were selected from both inpatients of the Addiction Centre and from psychiatric outpatient clinic of Neuro-Psychiatry Department in Menoufia University Hospitals. The study was a cross sectional study that was conducted in the context of time frame of 18 months (starting on the 1st of July, 2011 till the end of December of 2012) After taking oral consent from each subject under the study, the participants were evaluated through using semi structured interview sheet that gather general data as well as the drug habits of the patients (type of drug, route of administration, dose…etc.), Fahmy and El-Sherbini’s Social Classification Scale that evaluate the social class, Structured Clinical Interview for DSM-IV (SCID I) to diagnose psychiatric disorders, Structured Clinical Interview for DSM-IV axis II disorders (SCID II) to assess the DSM IV personality disorders, Addiction severity Index scale to provide a multidimensional assessment for the problems presented by patients with substance abuse disorder and a urine screening for substances of abuse. SUMMARY 138 The main findings of the present study were as follow: • Descriptive data: The mean age of onset of substance abuse was 25 years. The prevalence of substance abuse was as follow: opiods abuse (especially tramadol tablets) were the most prevalent substance of abuse both currently and lifetime. Followed by polydrugs abuse then sedatives abuse, cannabis abuse, and alcohol abuse both currently and lifetime. The least frequent substance of abuse was inhalant abuse. The severity of substance abuse according to Addiction Severity Index Scale was as follow: Psychological dimension was the most considerable problem in studied subjects followed by drug use dimension, family & social dimension and legal dimension. While employment& support and medical status were the least considerable problem in various dimensions of the ASI scale. Regarding the prevalence of psychiatric disorders among studied group according to Structured Clinical Interview for DSM-IV (SCID I& SCID II); 63 % had comorbid psychiatric disorder. The prevalence of mood disorders was as follow; 20% had substance induced mood disorders, 10% had major depressive disorders and 3-5 % had bipolar disorders. The prevalence of anxiety disorders was as follow; 17% had substance induced anxiety disorder, 7% had generalized anxiety disorder (GAD) and 7% had lifetime O.C.D. the prevalence of psychotic disorders was as follow; 7-12% had substance Induced psychotic disorder and 3% had schizophrenia. The prevalence of personality disorders, 63 % had comorbid personality disorders (35 % had antisocial PD, 17% had borderline PD, 3 % had passive aggressive PD, 2 % had dependant PD, and 3 % had depressive PD). • The relation between type of abused substance and the comorbid psychiatric disorders The study showed highly significant relationship between alcohol abuse and substance induced anxiety disorders, generalized anxiety disorder, obsessive compulsive disorder and antisocial PD. There were significant relationship between cannabis abuse and major depressive disorder, dysthymia, substance induced psychotic disorders, schizophrenia, and substance induced anxiety disorders, somatization disorder and dependent PD. Also, significant relationships were found between opioid abuse and major depressive disorders, bipolar II disorders and both borderline PD and antisocial PD. There were significant relationships between sedatives abuse and substance induced anxiety disorder, obsessive compulsive disorder, generalized anxiety disorder, panic disorders and borderline PD. Also, a significant relationship was found between polysubstance abuse and substance induced anxiety disorder. • Comparison between subjects having comorbid Axis-I and subjects without comorbid Axis-I Substance abuse subjects with comorbid Axis-I disorders have significant young age (<25 years old) , family history of alchol abuse , higher affection of family & social dimensions of addiction severity Index scale and most of them are single compared to subjects without comorbid Axis-I disorders. • Comparison between subjects having comorbid Axis-II and subjects without comorbid Axis-II In the present study, the most prevalent personality disorders were Borderline PD and Antisocial PD. Illiteracy and higher affection in legal dimension in addiction severity index scale were significantly higher among subjects with comorbid borderline PD than those without comorbid personality disorders. Substance abuse subjects with comorbid antisocial P.D. disorder have significant young age (<25 years old), low social class, higher prevalence of outpatient treatment programs, higher affection in family & social dimensions of addiction severity Index scale and most of them are single and illiterate compared to subjects without comorbid personality disorders. • Risk factors for different substance abuse. On studying risk factors for different substance abuse in studied subjects, mood disorders especially major depressive disorders were the strongest predictor of alcohol abuse, followed by Anxiety disorders. Also, dependent personality disorder was the strongest predictor of cannabis abuse followed by schizophrenia. Also, mood disorders especially major depressive disorders were the strongest predictor of opioid abuse followed by borderline personality disorders. Also, substance induced anxiety disorder was the strongest predictor of sedative abuse followed by borderline personality disorder. • Risk factors for comorbid psychiatric disorders (axisI& axisII) On studying risk factors for comorbid psychiatric disorders in studied subjects , younger age(less than twenty five years old) was the strongest predictor of comorbid axis I disorders followed by higher severity of family & social dimensions in ASI scale then single subjects (marital status). Also, male sex and younger age (less than twenty five years old) were independent risk factor for comorbid antisocial personality disorders followed by low social class. Also, higher severity of legal and psychiatric dimension in addiction severity index scale was independent risk factor for comorbid borderline personality disorders followed by illiteracy . |