Samenvatting
Summary Taak 6 comorbiditeit
- Instelling
- Maastricht University (UM)
Taak 6 van het vak verslaving. Het vak wordt gegeven in het 3e jaar van de bachelor gezondheidswetenschappen.
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Taak 6 comorbiditeitBeide kanten op 50%, maar mentale stoornis naar verslaving grote varieteit 20-65%
Lieb epidemiological Perspectives on Comorbidity Between Substance Use disorders and
Other Mental Disorders
- Comorbidity: any distinct additional clinical entity that has existed or that may occur
during the clinical course of a patient who has the index disease under study.
- 2 scenarios
o The two (or more) comorbid disorders are causally linked; for the comorbidity
of substance use and other mental disorders, this means (a) The substance use
disorder can cause the temporally secondary other mental disorder (e.a.,
through biological processes introduced by substance use); (b) The other
mental disorder can cause the temporally secondary substance use ar disorder
(e.g., as a means of self-medication).
o The substance use disorders) and the other mental disorders) share
diseaserelated Factors, for instance, risk factors, causal factors, triggers, or
abnormalities in the same brain regions.
- Almost 1 S million people (3.4%) are affected by alcohol dependence. More than one
million adult Europeans are affected by drug dependence (opioid or cannabis
dependence; prevalence rates: 0.1-1.8%).
- Among people who fulfilled DSM-IV diagnostic criteria for alcohol abuse or alcohol
dependence, about half (55.1%) presented this 1s a "pure" disorder (i.e., did not fulfill
criteria for 1ny other mental disorder). More than 20 %fulfilled diagnostic criteria for
one other mental disorder, 7.8% the criteria for two other diagnoses, and 14.4 %the
diagnostic criteria for three or even more additional diagnose. Among people who
fulfilled diagnostic criteria for drug abuse or drug dependence, even a higher
proportion were comorbid (tota154.7%). Here, 29.0% fulfilled criteria for one
additional diagnosis, 12.9% for two additional diagnoses, and 12.9%for three or more
additional diagnoses (within the same 12-month interval).
- substance use disorders are the less frequently treated disorders. Among people with
substance abuse or dependence, only about a quarter (23.0%for alcohol
abuse/dependence to 25%for illicit drug abuse/dependence) received at least a
"minimal intervention" for their condition
- alcohol use disorder: these people, 18%fulfilled criteria for an affective disorder, 24
%, for personality disorder, 8%for psychotic disorder, 7%for anxiety disorder, and
16% for drug abuse.
- Nicotine dependence: 19.5%fulfilled criteria for another substance use disorder
(abuse/dependence). A comparable rate (19.2%) fulfilled criteria for any affective
disorder and almost one quarter the criteria for any DSM-IV anxiety disorder (24.4%).
- the high-risk period for first manifestation of disorders ma}' also be a high-risk period
for the manifestation of comorbidity.
- positive associations between all included DSM-IV anxiety disorders and the
investigated alcohol outcomes. In the predictive analyses, only baseline social phobia
and panic disorder predicted subsequent alcohol use disorders, while the other anxiety
disorders (agoraphobia, specific phobia, GAD) did not
- For alcohol dependence, the group reported associations to any anxiety disorders,
affective disorders, conduct disorder, and adult antisocial behavior.
- smoking and nicotine dependence increase the risk specifically for subsequent panic
disorder end GAD. With the exception of obsessive compulsive disorder (OCD), all
other anxiety disorders (agoraphobia, social phobia, specific phobia, GAD, and
posttraumatic stress disorder, or PTSD) were associated with nicotine dependence
1
, (ORs between 1.9 and 7.4), but in general not with lower smoking categories. not only
anxiety disorders but also suicide ideation and suicide attempts were strongly
associated with occasional smoking, regular smoking, and nicotine dependence.
- comorbidity between cannabis use or cannabis use disorders and psychotic or affective
outcomes. associations between the overall group of drug dependence and affective
disorders, anxiety disorders, conduct disorder, and adults' antisocial behavior.
continued cannabis use might increase the risk for psychotic disorder by impacting on
the persistence of symptoms. Mental disorders seem to increase the risk for cannabis
outcomes and conversely, cannabis use/disorder seems to increase the risk for mental
disorders.
Carra Comorbid Addiction and Major Mental Illness in Europe
- Background: Most evidence about comorbid addiction and major mental illness comes
from the USA, since this literature remains relatively limited in many European
countries. The purpose of this review was to examine prevalence, policies, and
treatment systems of comorbid substance misuse and psychotic illness in Europe,
illustrating differences and similarities with US findings. Methods: Based on
computerized main databases searches, a narrative review was performed. Results:
The availability of substances but also the social contexts in terms of individual and
local issues are factors likely to explain different dual diagnosis prevalence rates in
Europe as compared with the USA. Conclusions: Integrated models implemented
following US example might perform differently within the context of well-
established European Union (EU) community mental health services. Such programs
would require additional resources and radical redesign of service delivery systems.
Prevalence Rates of Pure and Comorbid Drug and Alcohol Disorders: Europe Versus USA
- Alcohol (3.4%), opioid (0.1–0.4%), and cannabis (0.3–1.8%) dependence are among
the most prevalent substance-related disorders in the general population of EU
member states
- differences were found between USA and UK in prevalence of active drug
dependence, which was estimated as 1.4% in the USA and 0.5% in the UK
- being male, unmarried, of a low socioeconomic status, and living in an urban setting
were associated with an increased occurrence of drug dependence.
- In the USA, rates of substance misuse disorders in people with severe mental illness
are on average higher than in Europe. roughly half of respondents who met criteria for
a substance use disorder at some time in their life also met criteria for one or more
lifetime mental disorders.
- different rates of comorbidity may be explained by some methodological issues
European Policies
- EU drugs action plans have been developed to provide a framework that national drug
strategies should fit. These plans set out the actions that should be implemented,
including drug demand and supply reduction, coordination, international cooperation,
and information, research, monitoring, and evaluation. They emphasize the need to
ensure adequate consultation with a broad group of partners, raising the public
awareness of all aspects of substances use
- Only the EU action plan on drugs 2013–2016 acknowledged the need to target drug
use through an integrated health care approach addressing—inter alia—psychiatric
comorbidity and to develop and expand integrated models of care, covering needs
related to mental health– and/or physical health–related problems, rehabilitation, and
social support in order to improve and increase the health and social situation, social
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