Is there such a thing as gambling dual disorder? Preliminary evidence and clinical profiles.

Patients with gambling disorder (GD) frequently present other mental disorders, such as substance use disorder (SUDs), attention deficit/hyperactivity disorder (ADHD), mood disorders, and impulse-control disorders. We propose that GD should not be conceptualized as a single nosological entity, but rather as a gambling dual disorder (GDD). This study aims to provide further evidence of the co-occurrence of GD and other mental disorders in routine clinical practice and to identify different clinical profiles of severity. This descriptive, cross-sectional, and observational study included 116 patients with GD who were undergoing treatment in a specialized center. The MULTICAGE-CAD 4 and South Oaks gambling screen questionnaires confirmed the presence of GD in 97.4% and 100% of the patients, respectively. Other addictive behaviors such as compulsive spending, Internet, video games, or SUD (59.5%, 27.6%, 11.2%, and 13.8%, respectively) were also identified. The most used substances were tobacco (42.2%) and alcohol (5.2%). Half of the patients suffered from ADHD, 30.2% showed moderate or severe depression, and 17.2% suffered from a social anxiety problem. The majority (76.7%) also presented a phenotype with high impulsiveness. The cluster analysis identified two different clinical profiles of severity in patients with GDD. One profile showed higher severity of other mental disorders (ADHD, depression, anxiety, SUD, or insomnia), impulsivity, general psychopathological burden, and disability. In conclusion, our study provides further evidence on the co-occurrence of GD and other mental disorders supporting the GDD existence, shows impulsiveness as a vulnerability factor for GD, and identifies two clinical severity profiles.

Gambling Dual Disorder: A Dual Disorder and Clinical Neuroscience Perspective.

Several behaviors, including compulsive gambling, have been considered non-substance-related addictive disorders. Categorical mental disorders (e.g., DSM-5) are usually accompanied by very different symptomatic expressions (affective, behavioral, cognitive, substance abuse, personality traits). When these mental disorders occur with addictive disorders, either concomitantly or sequentially over the life span, this clinical condition is called a dual disorder. Gambling disorder (GD) has been associated with other categorical psychiatric diagnoses: attention deficit hyperactivity disorder, depression, bipolar disorder, social anxiety, schizophrenia, substance use disorder, antisocial personality disorder; and dimensional symptoms including higher impulsivity, poorer emotional wellbeing, cognitive distortion, psychosis, deficient self-regulation, suicide, poorer family environment, and greater mental distress. We are calling this clinical condition Gambling Dual Disorder. From a clinical perspective, it is clear that Gambling Dual Disorder is not the exception but rather the expectation, and this holds true not just for GD, but also for other mental disorders including other addictions. Mental disorders are viewed as biological disorders that involve brain circuits that implicate specific domains of cognition, emotion, and behavior. This narrative review presents the state of the art with respect to GD in order to address current matters from a dual disorder, precision psychiatry, and clinical neuroscience perspective, rather than the more subjective approach of symptomatology and clinical presentation. This review also presents Gambling Dual Disorder as a brain and neurodevelopmental disorder, including from the perspectives of evolutionary psychiatry, genetics, impulsivity as an endophenotype, the self-medication hypothesis, and sexual biological differences. The wide vision of the disease advances a paradigm shift, highlighting how GD and dual disorders should be conceptualized, diagnosed, and treated. Rethinking GD as part of a dual disorder is crucial for its appropriate conceptualization from the perspective of clinical neuroscience and precision psychiatry.

Coexistence between personality disorders and substance use disorder. Madrid study about prevalence of dual pathology.

INTRODUCTION: Personality disorders (PD) and substance use disorders (SUD) have a high prevalence and an important health and socioeconomic impact so, it is interesting to study the relationship between them. The objectives of the study are: to compare the prevalence of SUD between patients with and without diagnosis of PD, to analyze if any PD is related to the SUD, and if a specific PD is associated with a specific SUD. MATERIAL AND METHODS: Cross-sectional study in 837 patients from centers of attention to drug addiction and mental health in Madrid, Spain. The Mini International Neuropsychiatric Interview (MINI) and the Personality Diagnostic Questionnaire-4+ (PDQ4+) are used to detect mental disorder and PD, respectively. RESULTS: SUD is significantly higher in antisocial PD (p<0.01); sedative (p<0.01) and alcohol (p<0.05) use disorder in borderline PD; cocaine (p<0.05) and alcohol (p<0.01) use disorder in paranoid PD; and alcohol use disorder in histrionic PD (p<0.01). The SUD for cocaine is lower in obsessive- compulsive PD (p<0.05) and depressive PD (p<0.01). There is a positive correlation between the number of PD of a subject and the number of SUD that it presents. The risk of an alcohol [OR of 1,08 CI (1,01-1,16)] or sedatives [OR of 1,08 CI (1,001-1,17)] use disorders increases if an individual presents more than one type of PD. CONCLUSIONS: There is not differences of SUD prevalence between PD and not PD groups. We found an association between SUD and PD of cluster B (antisocial, borderline and histrionic) and also with paranoid PD. The SUD are more common among man with the exception of sedatives.

Coexistencia entre los trastornos de personalidad y el trastorno por uso de sustancias. Estudio Madrid sobre prevalencia de patologia dual / Coexistence between personality disorders and substance use disorder. Madrid study about prevalence of dual pathology

INTRODUCCIÓN: Los trastornos de personalidad (TP) y los trastornos por uso de sustancias (TUS) presentan una alta prevalencia y un impacto sanitario y socioeconómico importante. Por este motivo es interesante estudiar la posible relación entre ambos trastornos. Los objetivos del trabajo son: comparar la prevalencia de TUS entre pacientes con y sin diagnóstico de TP, analizar si algún TP se relaciona con el TUS, y si algún TP específico se asocia con un TUS concreto. MATERIAL Y MÉTODOS: Estudio transversal en 837 pacientes procedentes de centros de atención a drogodependencias y de salud mental de Madrid, España. Se utiliza la Mini International Neuropsychiatric Interview (MINI) y el cuestionario Personality Diagnostic Questionnaire-4+ (PDQ4+) para detectar trastorno mental y TP respectivamente. RESULTADOS: No se encuentran diferencias en la prevalencia de TUS entre los sujetos con TP y sin él. Dentro de los sujetos con TP son más frecuentes los TUS en el TP antisocial (p < 0,01). En el TP límite es más prevalente el trastorno por uso de sedantes (p < 0,01) y de alcohol (p < 0,05); en el TP paranoide el trastorno por uso de cocaína (p < 0,05) y de alcohol (p < 0,01); y en el TP histriónico el trastorno por uso de alcohol (p < 0,01). El TUS de cocaína es menor en el TP obsesivo-compulsivo (p < 0,05) y depresivo (p < 0,01). El riesgo de un trastorno por uso de alcohol [OR de 1,08 IC (1,01-1,16)] y sedantes [OR de 1,08 IC (1,001-1,17)] aumenta si un individuo presenta más de un tipo de TP. CONCLUSIONES: No se encuentran mayor prevalencia de TUS en los TP que en los no TP. Encontramos asociación entre los TUS y los TP del clúster B (antisocial, límite e histriónico) y con el TP paranoide. Todos los TUS son más prevalentes entre varones, salvo el TUS de hipnóticos

INTRODUCTION: Personality disorders (PD) and substance use disorders (SUD) have ahigh prevalence and an important health and socioeconomic impact so, it is interesting to study the relationship between them. The objectives of the study are: to compare the prevalence of SUD between patients with and without diagnosis of PD, to analyze if any PD is related to the SUD, and if a specific PD is associated with a specific SUD. MATERIAL AND METHODS: Cross-sectional study in 837 patients from centers of attention to drug addiction and mental health in Madrid, Spain. The Mini International Neu-ropsychiatric Interview (MINI) and the Personality Diagnostic Questionnaire-4+ (PDQ4+) are used to detect mental disorder and PD, respectively. RESULTS: SUD is significantly higher in antisocial PD (p < 0.01); sedative (p < 0.01) and alcohol (p < 0.05) use disor-der in borderline PD; cocaine (p < 0.05) and alcohol (p < 0.01) use disorder in paranoid PD; and alcohol use disorder in histrionic PD (p < 0.01). The SUD for cocaine is lower in obsessive-compulsive PD (p < 0.05) and depressive PD (p < 0.01). There is a positive correlation between the number of PD of a subject and the number of SUD that it presents. The risk of an-alcohol [OR of 1,08 CI (1,01-1,16)] or sedatives [OR of 1,08 CI (1,001-1,17)] use disorders increases if an individual presents more than one type of PD. CONCLUSIONS: There is not differences of SUD prevalence between PD and not PD groups. We found an association between SUD and PD of cluster B (antisocial, borderline and histrionic) and also with paranoid PD. The SUD are more common among man with the exception of sedatives

Effect of ageing and time since first heroin and cocaine use on mortality from external and natural causes in a Spanish cohort of drug users.

BACKGROUND: We aimed to assess the effect of ageing and time since first heroin/cocaine use on cause-specific mortality risk and age disparities in excess mortality among heroin (HUs) and cocaine users (CUs) in Spain. METHODS: A cohort of 15,305 HUs and 11,905 CUs aged 15-49 starting drug treatment during 1997-2007 in Madrid and Barcelona was followed until December 2008. Effects of ageing and time since first heroin/cocaine use were estimated using a competing risk Cox model and the relative and absolute excess mortality compared to the general population through directly age-sex standardized rate ratios (SRRs) and differences (SRDs), respectively. RESULTS: Mortality risk from natural causes increased with time since first heroin use, whereas that from overdose declined after having peaked in the first quinquennium. Significant effects of time since first cocaine use were not identified, although fatal overdose risk seemed higher in CUs after five years. Mortality risk from natural causes (HUs and CUs), injuries (HUs), and overdoses (CUs) increased with age, the latter without reaching statistical significance. Crude mortality rates from overdoses and injuries remained very high at age 40-59 among both HUs (595 and 217 deaths/100,000 person-years, respectively) and CUs (191 and 88 deaths/100,000 person-years). SRDs from all and natural causes were much higher at age 40-59 than 15-29 in both HUs (2134 vs. 834 deaths/100,000 person-years) and CUs (927 vs. 221 deaths/100,000 person-years), while the opposite occurred with SRRs. CONCLUSION: The high mortality risk among HUs and CUs at all ages from both external and natural causes, and increased SRDs with ageing, suggest that high-level healthcare and harm reduction services should be established early and maintained throughout the lifetime of these populations.

Dual disorders in individuals under treatment for both alcohol and cocaine: Madrid study on the prevalence of dual disorders / Patología dual en individuos en tratamiento por uso de cocaína y alcohol: estudio Madrid sobre prevalencia de patología dual

Abstract: Introduction: Descriptive data about co-occurrence of alcohol and cocaine consumption is scarce, despite its important prevalence. Dual disordes shows high prevalence in clinical samples, and patients report worse evolution and need more health services. Objective: To compare psychopathology in patients in treatment with lifetime alcohol and cocaine (Alc + Coc) substance use disorder (SUD) with subjects with alcohol but not cocaine (Alc) lifetime SUD and cocaine but not alcohol (Coc) SUD. Method: The sample consisted of 837 outpatients from Madrid, Spain, under treatment in substance misuse or mental health units. Two analyses were made: we compared subjects in the Alc + Coc (n = 366) to the Alc group (n = 162), and then to the Coc group (n = 122). Socio-demographic variables were addressed by interview. The Mini International Neuropsychiatric Interview (MINI) was used to evaluate Axis I disorders and the Personality Disorder Questionnaire (PDQ) to evaluate Personality Disorders (PD). Results: Compared to Alc group, patients in the Alc + Coc group were younger, had different socio-demographic characteristics, had more proportion of cannabis and opioid SUD, had less proportion of major depressive disorder, obsessive and depressive PD, more proportion of antisocial PD and lower suicide risk. Compared to the Coc group, they had more cannabis SUD and lower opioid SUD, showed higher prevalence of bipolar disorder, general anxiety disorder, paranoid, histrionic and dependent PD. Discussion and conclusion: We present a cross-sectional study describing comorbidity of dual disordes on treatment-seeking concurrent alcohol and cocaine problematic users. This concurrence showed different dual disordes prevalence profile than single users in some specific mental disorders.

Resumen: Introducción: La patología dual presenta una alta prevalencia en muestras clínicas. Estos pacientes sufren mayor comorbilidad y requieren más servicios. Existen escasos datos de comorbilidad por alcohol y cocaína. Objetivo: Valorar datos sociodemográficos, prevalencias de trastorno por uso de sustancias (TUS), trastorno mental y trastornos de personalidad en pacientes con trastorno por uso de alcohol y cocaína frente a pacientes con uno de los dos TUS. Método: La muestra incluyó 837 pacientes procedentes de Centros de Salud Mental y Centros de Atención a Drogodependientes. Se realizaron dos análisis: se comparó el grupo de alcohol y cocaína (Alc + Coc, n = 366) con el grupo de alcohol (Alc, n = 162), y posteriormente con el grupo de cocaína (Coc, n = 122). Se recogieron variables sociodemográficas y sobre TUS mediante entrevista, diagnósticos de trastorno mental del eje I mediante la entrevista estructurada Mini International Neuropsychiatric Inerview (MINI) y los trastornos de personalidad mediante el Personality Disorder Questionnaire (PDQ). Resultados: Los pacientes del grupo Alc + Coc frente al grupo Alc presentaban diferencias sociodemográficas significativas, mayor prevalencia de TUS asociados, riesgo más alto de suicidio y mayor proporción de trastorno antisocial de personalidad. Además, tenían menor prevalencia de trastornos depresivos. Frente al grupo Coc presentaron mayor prevalencia de trastorno por consumo de cannabis, pero menor de opioides y mayor prevalencia de trastorno bipolar, trastorno de ansiedad generalizada y trastornos de personalidad. Discusión y conclusión: Los pacientes comórbidos para alcohol y cocaína presentaron un distinto perfil de prevalencia de algunos trastornos mentales específicos.

Bipolar disorder and substance use disorders. Madrid study on the prevalence of dual disorders/pathology. / Trastorno bipolar y trastorno por uso de sustancias. Estudio Madrid sobre prevalencia de patología dual.

Given its prevalence and impact on public health, the comorbidity of bipolar and substance use disorders is one of the most relevant of dual diagnoses. The objective was to evaluate the characteristics of patients from community mental health and substance abuse centres in Madrid. The sample consisted of 837 outpatients from mental health and substance abuse centres. We used the Mini International Neuropsychiatric Interview (MINI) and Personality Disorder Questionnaire (PDQ4+) to evaluate axis I and II disorders. Of these patients, 174 had a lifetime bipolar disorder, 83 had bipolar disorder type I and 91 had type II. Most patients had dual pathology. Of the 208 participants from the mental health centres, 21 had bipolar disorder and 13 (61.9%) were considered dually-diagnosed patients, while 33.2% of non-bipolar patients had a dual diagnoses (p = 0.03). Of the 629 participants from the substance abuse centres, 153 patients (24.3%) had a bipolar diagnosis. Bipolar dual patients had higher rates of alcohol and cocaine dependence than non-bipolar patients. Moreover, age at onset of alcohol use was earlier in bipolar duallydiagnosed patients than in other alcoholics. Bipolar dually-diagnosed patients had higher personality and anxiety disorder comorbidities and greater suicide risk. Thus, alcohol and cocaine are the drugs most associated with bipolar disorder. Given the nature of the study, the type of relationship between these disorders cannot be determined.

La comorbilidad entre trastorno bipolar y trastorno por uso de sustancias (TUS) es de las más relevantes dentro del espectro de la patología dual por su prevalencia y sus repercusiones evolutivas y sociosanitarias. Nuestro objetivo fue estudiar las características de los pacientes con diagnóstico de trastorno bipolar y trastorno por uso de sustancias procedentes del Estudio Madrid sobre prevalencia de patología dual en sujetos en tratamiento en el servicio sanitario público. La muestra procede de pacientes en tratamiento en las redes públicas de salud mental y de tratamiento para las adicciones de la Comunidad de Madrid. Los sujetos fueron evaluados con la entrevista Mini International Neuropsychiatric Interview (MINI) para el diagnóstico de los trastornos mentales y con la escala Personality Disorder Questionnaire (PDQ) para el diagnóstico de los trastornos de personalidad. De los 837 pacientes incluidos, 174 tenían un diagnóstico a lo largo de la vida de trastorno bipolar, 83 con trastorno bipolar tipo I y 91 del tipo II. La mayoría de ellos tenían algún diagnóstico de TUS. En la red de salud mental, de los 208 participantes, 21 tenían un diagnóstico de trastorno bipolar, de estos el 13 (61.9%) tenían un diagnóstico de TUS y se consideraron duales, mientras que en el resto de los pacientes de salud mental el 33.2% tenían un diagnóstico comórbido de TUS (p = 0.03). En los centros de drogas, de los 629 pacientes valorados, un 24.3% (n = 153) tenían un diagnóstico de trastorno bipolar. El subgrupo de pacientes con trastorno bipolar tenía mayor prevalencia de adicción al alcohol y a la cocaína que el resto de los pacientes. Además, la edad de inicio en el consumo de alcohol era más precoz entre los adictos bipolares que entre los adictos no bipolares. Los bipolares duales era un subgrupo con mayor comorbilidad con trastornos de personalidad, otros trastornos mentales como trastornos de ansiedad y mayor riesgo de suicidio. Estos datos apoyan que el alcohol principalmente y la cocaína son las drogas más relacionadas con la presencia de un trastorno bipolar, pero al ser un estudio transversal no se pueden extraer conclusiones etiológicas.

Trastorno bipolar y trastorno por uso de sustancias. Estudio Madrid sobre prevalencia de patología dual / Bipolar disorder and substance use disorders. Madrid study on the prevalence of dual disorders/pathology

La comorbilidad entre trastorno bipolar y trastorno por uso de sustancias (TUS) es de las más relevantes dentro del espectro de la patología dual por su prevalencia y sus repercusiones evolutivas y sociosanitarias. Nuestro objetivo fue estudiar las características de los pacientes con diagnóstico de trastorno bipolar y trastorno por uso de sustancias procedentes del Estudio Madrid sobre prevalencia de patología dual en sujetos en tratamiento en el servicio sanitario público. La muestra procede de pacientes en tratamiento en las redes públicas de salud mental y de tratamiento para las adicciones de la Comunidad de Madrid. Los sujetos fueron evaluados con la entrevista Mini International Neuropsychiatric Interview (MINI) para el diagnóstico de los trastornos mentales y con la escala Personality Disorder Questionnaire (PDQ) para el diagnóstico de los trastornos de personalidad. De los 837 pacientes incluidos, 174 tenían un diagnóstico a lo largo de la vida de trastorno bipolar, 83 con trastorno bipolar tipo I y 91 del tipo II. La mayoría de ellos tenían algún diagnóstico de TUS. En la red de salud mental, de los 208 participantes, 21 tenían un diagnóstico de trastorno bipolar, de estos el 13 (61.9%) tenían un diagnóstico de TUS y se consideraron duales, mientras que en el resto de los pacientes de salud mental el 33.2% tenían un diagnóstico comórbido de TUS (p = 0.03). En los centros de drogas, de los 629 pacientes valorados, un 24.3% (n = 153) tenían un diagnóstico de trastorno bipolar. El subgrupo de pacientes con trastorno bipolar tenía mayor prevalencia de adicción al alcohol y a la cocaína que el resto de los pacientes. Además, la edad de inicio en el consumo de alcohol era más precoz entre los adictos bipolares que entre los adictos no bipolares. Los bipolares duales era un subgrupo con mayor comorbilidad con trastornos de personalidad, otros trastornos mentales como trastornos de ansiedad y mayor riesgo de suicidio. Estos datos apoyan que el alcohol principalmente y la cocaína son las drogas más relacionadas con la presencia de un trastorno bipolar, pero al ser un estudio transversal no se pueden extraer conclusiones etiológicas

Given its prevalence and impact on public health, the comorbidity of bipolar and substance use disorders is one of the most relevant of dual diagnoses. The objective was to evaluate the characteristics of patients from community mental health and substance abuse centres in Madrid. The sample consisted of 837 outpatients from mental health and substance abuse centres. We used the Mini International Neuropsychiatric Interview (MINI) and Personality Disorder Questionnaire (PDQ4+) to evaluate axis I and II disorders. Of these patients, 174 had a lifetime bipolar disorder, 83 had bipolar disorder type I and 91 had type II. Most patients had dual pathology. Of the 208 participants from the mental health centres, 21 had bipolar disorder and 13 (61.9%) were considered dually-diagnosed patients, while 33.2% of non-bipolar patients had a dual diagnoses (p = 0.03). Of the 629 participants from the substance abuse centres, 153 patients (24.3%) had a bipolar diagnosis. Bipolar dual patients had higher rates of alcohol and cocaine dependence than non-bipolar patients. Moreover, age at onset of alcohol use was earlier in bipolar dually-diagnosed patients than in other alcoholics. Bipolar dually-diagnosed patients had higher personality and anxiety disorder comorbidities and greater suicide risk. Thus, alcohol and cocaine are the drugs most associated with bipolar disorder. Given the nature of the study, the type of relationship between these disorders cannot be determined

Assessing gender disparities in excess mortality of heroin or cocaine users compared to the general population.

BACKGROUND: Previous analyses of excess mortality in drug users compared with the general population have almost always been based on mortality ratios, reporting much higher figures in women than men. This study tests the hypothesis that being a heroin or cocaine user adds more death risk in women than men in Spain. METHODS: A retrospective cohort of 15,305 heroin users (HUs) and 11,905 cocaine users (CUs) aged 15-49 starting drug treatment in 1997-2007 was recruited in Spain and followed until December 2008 to determine vital status and cause of death. Excess mortality in men and women compared to the general population was assessed with directly age-standardized rate ratios (SRRs) and differences (SRDs). RESULTS: SRR was significantly higher in women than men for all causes (14.7 vs. 9.4), natural causes (8.7 vs. 6.2), overdose (331.6 vs. 163.9) and other external causes (46.9 vs. 11.8) among HUs; and for overdose (170.8 vs. 40.5) and other external causes (21.0 vs. 4.7) among CUs. However, the opposite happened with SRD for all causes (1294 vs. 1845 deaths/100,000 person-years), natural causes (675 vs. 1016 deaths/100,000 person-years) and overdose (331 vs. 619 deaths/100,000 person-years) among HUs, while no significant SRD gender disparities were observed among CUs. CONCLUSION: Compared with the general population, being a heroin user adds greater absolute risk in men than women, but this does not happen with cocaine users. Similar results would likely have been found in most published cohort studies if this indicator had been used; the exclusive use of relative indices of disparity as in previous meta-analysis can be extremely misleading.

Relevant Differences in Perception and Knowledge of Professionals in Different Spanish Autonomous Communities Regarding Availability of Resources for Patients with Dual disorders.

OBJECTIVES: To assess the knowledge of health professionals attending patients with dual disorders about specific resources for patients with this condition in different Spanish regions. METHODS: Observational, cross-sectional, multicenter study to compare the perceptions of healthcare professionals (n=659) with reality regarding specific resources available for patients with dual disorders in Spain. The professionals completed an online questionnaire. Nineteen commissioners and managers responsible for national and regional substance abuse programs also completed the questionnaire. RESULTS: A representative sample of professionals from each community (553 centers in 235 Spanish cities) participated in the study. Most participants (93.2%) felt that specific resources for patients with dual disorders are needed. High percentages of professionals thought that there were no specific workshops (88.4%), subacute units (83.1%), day hospitals (82.8%), specific day centers (78.5%), or outpatient programs (73.2%) for patients with dual disorders. The real knowledge of professionals regarding the existence of specific resources varied according to the type of resource and autonomous community. The professionals generally underestimated the number of units available in their communities. CONCLUSIONS: There were clear differences in the real knowledge that healthcare professionals had about the resources available for patients with dual disorders in relation to the autonomous community where they were practicing. Actions are needed to harmonize knowledge nationally, for example, a single registry, white paper, or a national program for patients with dual disorders.

Diferencias relevantes en la percepción y el grado de conocimiento de los profesionales de las distintas Comunidades Autónomas españolas sobre la existencia de recursos para pacientes con patología dual / Relevant Differences in Perception and Knowledge of Professionals in Different Spanish Autonomous Communities Regarding Availability of Resources for Patients with Dual disorders

Objetivos. Evaluar el grado de conocimiento de los profesionales sanitarios que atienden a pacientes con patología dual acerca de recursos específicos disponibles para esta patología en las diferentes comunidades autónomas españolas. Metodología. Estudio observacional, transversal y multicéntrico para comparar la percepción de los profesionales sanitarios (n=659) con la realidad en cuanto a los recursos específicos disponibles para los pacientes con patología dual en España, mediante un cuestionario on-line, que fue cumplimentado también por los 19 comisionados y gestores responsables de los planes nacionales y regionales de drogas. Resultados: Participó en el estudio una muestra representativa de profesionales de cada comunidad, procedentes de 553 centros de 235 ciudades españolas. La mayoría de participantes (93,2%) opinó que es necesaria la existencia de recursos específicos en patología dual. Porcentajes elevados de profesionales consideraron que no existían talleres específicos (88,4%), unidades de subagudos (83,1%), hospitales de día (82,8%), centros de día específicos (78,5%) o programas ambulatorios (73,2%). El grado de conocimiento sobre la existencia de recursos específicos varió en función del tipo de recursos y comunidad autónoma. En general, los profesionales subestimaban el número de unidades ofrecidas en sus comunidades. Conclusiones. Existen claras diferencias en el grado de conocimiento de los recursos para pacientes con patología dual entre los profesionales, en función de la comunidad autónoma donde ejercen. Son necesarias actuaciones de armonización a nivel nacional, como un registro unificado, un libro blanco o un plan nacional para patología dual

Objectives. To assess the knowledge of health professionals attending patients with dual disorders about specific resources for patients with this condition in different Spanish regions. Methods. Observational, cross-sectional, multicenter study to compare the perceptions of healthcare professionals (n=659) with reality regarding specific resources available for patients with dual disorders in Spain. The professionals completed an online questionnaire. Nineteen commissioners and managers responsible for national and regional substance abuse programs also completed the questionnaire. Results. A representative sample of professionals from each community (553 centers in 235 Spanish cities) participated in the study. Most participants (93.2%) felt that specific resources for patients with dual disorders are needed. High percentages of professionals thought that there were no specific workshops (88.4%), subacute units (83.1%), day hospitals (82.8%), specific day centers (78.5%), or outpatient programs (73.2%) for patients with dual disorders. The real knowledge of professionals regarding the existence of specific resources varied according to the type of resource and autonomous community. The professionals generally underestimated the number of units available in their communities. Conclusions. There were clear differences in the real knowledge that healthcare professionals had about the resources available for patients with dual disorders in relation to the autonomous community where they were practicing. Actions are needed to harmonize knowledge nationally, for example, a single registry, white paper, or a national program for patients with dual disorders

Dual diagnosis resource needs in Spain: a national survey of professionals.

OBJECTIVE: Since provision of integrated services for patients with dual pathology or dual disorders (coexistence of an addictive disorder and another mental health disorder) is an important challenge in mental health, this study assessed health care professionals' perceptions and knowledge of the current state of specific resources for patients with dual pathology in Spain. METHODS: We conducted a national survey of health care professionals seeing patients with dual pathology in treatment facilities throughout Spain. Participants completed a specific online questionnaire about the needs of and available resources for patients with dual pathology. RESULTS: A total of 659 professionals, mostly psychologists (n = 286, 43.4%) or psychiatrists (n = 217, 32.9%), participated in the study. Nearly all participants who responded to these items reported that specific resources for dual pathology were needed (n = 592/635, 93.2%); 76.7% (n = 487) identified intermediate resources, 68.8% (n = 437) acute detoxification units, and 64.6% (n = 410) medium-stay rehabilitation units as particularly necessary. In the opinion of 54.0% of respondents (n = 343), integrated mental health and addiction treatment services were available. Of the participants who answered these items, only a small proportion (n = 162/605, 26.8%) reported that there were appropriate outpatient programs for dual pathology, 30.4% (n = 184/605) specific hospitalization units, 16.9% (n = 99/587) subacute inpatient units, 34.2% (n = 201/587) outpatient intermediate resources, 15.5% (n = 91/587) day hospitals, and 21.5% (n = 126/587) day centers. Conversely, 62.5% (n = 378/587) of participants reported a greater presence of specific detoxification/withdrawal units, 47.3% (n = 286/587) psychiatric acute admission units, and 41.9% (n = 246/587) therapeutic communities. In the professionals' opinion, the presence of specialty programs was low; 11.6% of respondents (n = 68/587) reported that vocational programs and 16.7% (n = 98/587) reported that occupational rehabilitation programs were available. Employee turnover was common: 51.9% of respondents (n = 314/605) stated that employee turnover was occasional to frequent. CONCLUSIONS: According to the professionals surveyed, specific health care resources for the management of dual pathology are currently insufficient, underlining the need for additional efforts and strategies for treating individuals with comorbid disorders.

Professionals' perceptions about healthcare resources for co-occuring disorders in Spain.

BACKGROUND: Since provision of integrated services for patients with dual pathology or dual disorders (coexistence of an addictive disorder and other psychiatric disorders) constitutes an important challenge, this study compared the perceptions of health-care professionals with the existing, current state of specific resources for patients with dual pathology in Spain. METHODS: Epidemiological, observational, cross-sectional, multicenter study with a large, representative sample of health care professionals attending patients with dual pathology in treatment resources throughout Spain. Participants completed a specifically designed ad-hoc on-line questionnaire about their perceptions on the existence of available resources and treatment needs for patients with dual pathology. To compare professionals' perceptions with existing available resources, the same on-line questionnaire was also completed by commissioners and managers responsible for national and regional healthcare plans on drug abuse. RESULTS: A total of 659 professionals, mostly psychologists (43.40%) or psychiatrists (32.93%) agreed to participate in the study. The highest degree of concordance between the perceptions of professional and the actual situation was found regarding the existence of mental health and addiction networks (either separately or unified) (74.48%), followed by specific workshops (73.08%) and sub-acute inpatient units (67.38%), specific hospitalization units (66.26%), detoxification units (63.15%) and outpatient programs (60.73%). We detected a lower degree of agreement regarding specific occupational rehabilitation centers (59.34%) day hospitals (58.93%), day centers (57.88%), outpatient intermediate resources (48.87%), psychiatric acute admission units (46.54%) and therapeutic communities (43.77%). In addition, on average, health care professionals underestimated the number of resources present in their respective communities. CONCLUSIONS: Relevant differences exist between the perceptions of professional and existing available resources for dual pathology patients in Spain, thus supporting the need of additional efforts and strategies to establish a registry and clearly inform about available resources for patients with dual diagnosis.

Abuso o dependencia a la cocaína y otros trastornos psiquiátricos. Estudio Madrid sobre la prevalencia de la patología dual / Cocaine abuse or dependency and other psychiatric disorders. Madrid study on dual pathology

Objetivos: El objetivo de este estudio es analizar el subgrupo de adictos (criterios de abuso o dependencia) a la cocaína procedentes del estudio Madrid sobre prevalencia de diagnóstico dual en varios dispositivos asistenciales. Material y métodos: La muestra está constituida por 837 sujetos en tratamiento en la red de salud mental o en la red de drogas de la Comunidad de Madrid, de los cuáles 488 tenían un diagnóstico de abuso o dependencia de cocaína a lo largo de la vida y 222 tenían otros trastornos por uso de sustancias distintos de la cocaína. Se usó la entrevista Mini Internacional Neuropsychiatric Interview (MINI), para el diagnóstico de los trastornos mentales del eje i y el cuestionario Personality Disorder Questionnaire (PDQ), para la valoración de los trastornos de personalidad. Resultados: Se consideró que un 73,4% de los adictos a la cocaína tenían un diagnóstico dual en el momento actual, destacando la prevalencia de los trastornos del estado de ánimo y de ansiedad. El 49,6% de los adictos a la cocaína tenían un diagnóstico de trastorno de la personalidad. Un 94,9% de estos adictos a la cocaína tenían otros diagnósticos asociados de trastornos por uso de sustancias. El subgrupo de adictos a la cocaína no tenía mayor prevalencia de diagnóstico dual que el resto de los adictos. El subgrupo de adictos con abuso o dependencia de la cocaína tenían mayor prevalencia de trastorno antisocial de la personalidad, agorafobia y trastorno por estrés postraumático, que los adictos no consumidores de cocaína, y habían iniciado de forma más precoz el consumo de alcohol y cannabis. Conclusiones: La presencia de diagnóstico dual no es más elevada en adictos a la cocaína en tratamiento, que en otros adictos, aunque han iniciado más precozmente otros consumos y se asocia más que el resto de adictos a ciertos trastornos mentales específicos(AU)

Objectives: The main objective of this study was to analyse the cocaine addict subgroup from the Madrid study of prevalence of dual disorders in community mental health and substance misuse services. Material and methods: The sample consisted of 837 outpatients from Madrid, Spain. We compared 488 subjects who had a lifetime diagnosis of cocaine abuse or dependence, and 222 subjects who did not have a cocaine substance use disorder. We used the Mini International Neuropsychiatric Interview to evaluate axis I mental disorders, and the Personality Disorder Questionnaire to evaluate personality disorders. Results: Almost three-quarters (73.4%) of cocaine addicts had a current dual disorder. Most prevalent were mood and anxiety disorders. Almost half (49.6%) had a personality disorder. Most of them (94.9%) had other substance use disorders. Cocaine addicts did not have higher prevalence rates of dual pathology than addicts with no cocaine abuse or dependence. Cocaine addicts were associated to a diagnosis of antisocial personality disorder, agoraphobia, and posttraumatic stress disorder, and they had an early age of onset of alcohol and cannabis use. Conclusions: Dual pathology is no higher in cocaine addicts in treatment than in addicts who do not use cocaine, however cocaine addicts started other drugs earlier, and were associated with specific mental disorders(AU)

[Madrid study on the prevalence and characteristics of outpatients with dual pathology in community mental health and substance misuse services]. / Estudio Madrid sobre prevalencia y características de los pacientes con patología dual en tratamiento en las redes de salud mental y de atención al drogodependiente.

The objective was to quantify the prevalence of dual diagnosis and to evaluate the characteristics of these patients from community mental health and substance misuse services in Madrid. The sample consisted of 837 outpatients from Madrid, 208 from mental health services and 629 from substance misuse services. We used the Mini International Neuropsychiatric Interview (MINI) and Personality Disorder Questionnaire (PDQ4+) to evaluate disorders from axis I and II. It was considered that 517 (61.8%) patients had dual pathology (current diagnoses of axis I or II disorders and an addictive disorder): 36,1% in mental health services and 70,3% in substance misuse services. There were fewer males amongst the dual patients and it was also found that they had a worse employment situation, along with higher figures of alcohol and cannabis dependence than addicts without dual diagnoses (n=194). When comparing them with patients with mental disorder diagnoses only, excluding substance use disorder (n=126), there were differences in all socio-demographic characteristics analyzed, and dual patients were associated with diagnoses of bipolar disorder, agoraphobia, generalized anxiety disorder, post-traumatic stress disorder, and had more suicide risk and different personality disorders. Thus, dual pathology is higher in patients who are in treatment and have differential characteristics (higher suicide risk, worse employment situation) that suggest greater severity that could be of help in the planning of care resource policies for these patients.

Estudio Madrid sobre prevalencia y características de los pacientes con patología dual en tratamiento en las redes de salud mental y de atención al drogodependiente / Madrid study on the prevalence and characteristics of outpatients with dual pathology in community mental health and substance misuse services

Se valora la prevalencia y características de los pacientes de patología dual (diagnóstico actual de un trastorno mental y de un trastorno por uso de sustancias (TUS)): en las redes asistenciales de Salud Mental y Drogodependencias de la Comunidad de Madrid. Se consigue una muestra de 837 sujetos (208 de la red de Salud Mental y 629 de la red de Drogodependencias). Se usó la entrevista MINI (Mini International Neuropsychiatric Interview) y el cuestionario PDQ4+ (Personality Disorder Questionnaire) para la valoración de los trastornos del eje I y II. Se hallaron 517 (61,8%) pacientes con patología dual (un 36,1% en la red de salud mental y un 70,3% en la red de drogas). Al compararlos con el grupo de sujetos con TUS sin patología dual (n=194), había entre los duales menos varones y peor situación laboral, siendo las drogas más consumidas el alcohol y cannabis. Al compararlos con el grupo de trastornos mentales sin uso de sustancias (n=126), encontramos diferencias en todas las características sociodemográficas analizadas y los casos de patología dual son diagnosticados más frecuentemente como trastorno bipolar, agorafobia, trastorno por ansiedad generalizada, trastorno por estrés postraumático, mayor riesgo de suicidio y distintos trastornos de personalidad. Por lo tanto, la presencia de patología dual es elevada en sujetos en tratamiento y presentan unas características diferenciales, tales como mayor riesgo de suicidio y situación laboral precaria que hacen pensar en un peor pronóstico, cuestión a considerar para el desarrollo de recursos asistenciales adecuados (AU)

The objective was to quantify the prevalence of dual diagnosis and to evaluate the characteristics of these patients from community mental health and substance misuse services in Madrid. The sample consisted of 837 outpatients from Madrid, 208 from mental health services and 629 from substance misuse services. We used the Mini International Neuropsychiatric Interview (MINI) and Personality Disorder Questionnaire (PDQ4+) to evaluate disorders from axis I and II. It was considered that 517 (61.8%) patients had dual pathology (current diagnoses of axis I or II disorders and an addictive disorder): 36,1% in mental health services and 70,3% in substance misuse services. There were fewer males amongst the dual patients and it was also found that they had a worse employment situation, along with higher figures of alcohol and cannabis dependence than addicts without dual diagnoses (n=194). When comparing them with patients with mental disorder diagnoses only, excluding substance use disorder (n=126), there were differences in all socio-demographic characteristics analyzed, and dual patients were associated with diagnoses of bipolar disorder, agoraphobia, generalized anxiety disorder, post-traumatic stress disorder, and had more suicide risk and different personality disorders. Thus, dual pathology is higher in patients who are in treatment and have differential characteristics (higher suicide risk, worse employment situation) that suggest greater severity that could be of help in the planning of care resource policies for these patients (AU)

Abuse or dependence on cannabis and other psychiatric disorders. Madrid study on dual pathology prevalence.

OBJECTIVES: Cannabis use has been associated to a wide variety of mental disorders, the possible causal role of this use in the etiology of severe mental disorders as schizophrenia or bipolar disorder standing out. Moreover, the cannabinoid system is involved in emotional regulation, so cannabis use could disturb this process and provoke anxiety and mood disorders. The main objective of this study was to analyze the cannabis addict subgroup from Madrid study of prevalence of dual disorders in community mental health and substance misuse services. MATERIAL AND METHODS: The sample consisted of 837 outpatients under treatment in the mental health network or drug network of the Community of Madrid (Spain). Of these, 353 subjects had a lifetime diagnosis of cannabis abuse or dependence and 357 subjects did not have cannabis substance use disorder. We used the Mini International Neuropsychiatric Interview (MINI) to evaluate axis I mental disorders, and Personality Disorder Questionnaire to evaluate personality disorders. RESULTS: It was considered that 76.5% of the cannabis addicts had a current dual disorder. The most prevalent ones were mood and anxiety disorders. Of those addicted to cannabis, 51% had a personality disorder. Most of them had several substance use disorders. Cannabis abuse or dependence subjects had an earlier onset in consumption of other drugs such as alcohol, cocaine, and tobacco than addicts without cannabis abuse or dependence. The cannabis addicts also differed from the other addicts because of an association to antisocial personality disorder, bipolar disorder, psychosis and agoraphobia. The presence of these mental disorders was significantly associated to a lower age at initiation of cannabis use. CONCLUSIONS: Dual pathology is very high in cannabis addicts under treatment. Said consumption of cannabis, probably within a polysubstance use pattern, is associated to severe mental disorders as psychosis and bipolar disorder. An earlier age of onset in cannabis use is associated to a greater risk of said mental disorders.

Abuso o dependencia al cannabis y otros trastornos psiquiátricos. Estudio Madrid sobre prevalencia de patología dual / Abuse or dependence on cannabis and other psychiatric disorders. Madrid study on dual pathology prevalence

Objetivos. El consumo de cannabis se ha asociado con una amplia variedad de trastornos mentales, destacando el posible papel causal de dicho consumo en la etiología de trastornos mentales graves como la esquizofrenia o el trastorno bipolar. Además el sistema cannabinoide está implicado en la regulación emocional, por lo que el consumo de cannabis también puede alterar dicha regulación y asociarse con trastornos de ansiedad y depresivos. El objetivo de este estudio es analizar el subgrupo de adictos a cannabis procedentes del estudio Madrid sobre prevalencia de patología dual en varios dispositivos asistenciales. Material y métodos. La muestra está constituida por 837 sujetos en tratamiento en la red de salud mental o en la red de drogas de la Comunidad de Madrid, de los cuáles 353 tenían un diagnóstico de abuso o dependencia de cannabis a lo largo de la vida y 357 tenían otros trastornos por uso desustancias pero no cannabis. Se uso la entrevista MINI (Mini Internacional Neuropsychiatric Interview) para el diagnóstico de los trastornos mentales del eje I y el cuestionario PDQ (Personality Disorder Questionnaire) para la valoración de los trastornos de personalidad. Resultados. Se consideró que un 76,5% de los adictos al cannabis tenían un diagnóstico dual en el momento actual, destacando la prevalencia de los trastornos del humor y de ansiedad. El 51% de los adictos a cannabis tenían un diagnóstico de trastorno de la personalidad. La mayoría tenían varios diagnósticos de trastornos por uso de sustancias. Los sujetos con abuso o dependencia de cannabis tenían un inicio más precoz en el consumo de otras drogas como el alcohol, la cocaína y el tabaco que el resto de los adictos. Igualmente este subgrupo se diferenció del resto de los adictos por su asociación con el trastorno antisocial de la personalidad, el trastorno bipolar, la psicosis y la agorafobia. La presencia de estos trastornos mentales se asoció de forma significativa con una edad de inicio más precoz en el consumo de cannabis. Conclusiones. La presencia de patología dual es muy elevada en adictos en tratamiento que tienen dependencia de cannabis y dicho consumo, posiblemente en el contexto de un patrón de poli consumo, se asocia con trastornos mentales graves como la psicosis y el trastorno bipolar. Una edad de inicio más precoz en el consumo de cannabis se asocia con más riesgo de presentar dichos trastornos mentales (AU)

Objectives. Cannabis use has been associated to a wide variety of mental disorders, the possible causal role of this use in the etiology of severe mental disorders as schizophrenia or bipolar disorder standing out. Moreover, the cannabinoid system is involved in emotional regulation, so cannabis use could disturb this process and provoke anxiety and mood disorders. The main objective of this study was to analyze the cannabis addict subgroup from Madrid study of prevalence of dual disorders in community mental health and substance misuse services. Material and methods. The sample consisted of 837outpatients under treatment in the mental health network or drug network of the Community of Madrid (Spain). Of these, 353 subjects had a lifetime diagnosis of cannabis abuse or dependence and 357 subjects did not have cannabis substance use disorder. We used the Mini International Neuropsychiatric Interview (MINI) to evaluate axis I mental disorders, and Personality Disorder Questionnaire to evaluate personality disorders. Results. It was considered that 76.5% of the cannabis addicts had a current dual disorder. The most prevalent ones were mood and anxiety disorders. Of those addicted to cannabis, 51% had a personality disorder. Most of them had several substance use disorders. Cannabis abuse or dependence subjects had an earlier onset in consumption of other drugs such as alcohol, cocaine, and tobacco than addicts without cannabis abuse or dependence. The cannabis addicts also differed from the other addicts because of an association to antisocial personality disorder, bipolar disorder, psychosis and agoraphobia. The presence of these mental disorders was significantly associated to a lower age at initiation of cannabis use. Conclusions. Dual pathology is very high in cannabis addicts under treatment. Said consumption of cannabis, probably within a poly substance use pattern, is associated to severe mental disorders as psychosis and bipolar disorder. An earlier age of onset in cannabis use is associated to a greater risk of said mental disorders (AU)

Cocaine abuse or dependency and other pyschiatric disorders. Madrid study on dual pathology.

OBJECTIVES: The main objective of this study was to analyse the cocaine addict subgroup from the Madrid study of prevalence of dual disorders in community mental health and substance misuse services. MATERIAL AND METHODS: The sample consisted of 837 outpatients from Madrid, Spain. We compared 488 subjects who had a lifetime diagnosis of cocaine abuse or dependence, and 222 subjects who did not have a cocaine substance use disorder. We used the Mini International Neuropsychiatric Interview to evaluate axis I mental disorders, and the Personality Disorder Questionnaire to evaluate personality disorders. RESULTS: Almost three-quarters (73.4%) of cocaine addicts had a current dual disorder. Most prevalent were mood and anxiety disorders. Almost half (49.6%) had a personality disorder. Most of them (94.9%) had other substance use disorders. Cocaine addicts did not have higher prevalence rates of dual pathology than addicts with no cocaine abuse or dependence. Cocaine addicts were associated to a diagnosis of antisocial personality disorder, agoraphobia, and post-traumatic stress disorder, and they had an early age of onset of alcohol and cannabis use. CONCLUSIONS: Dual pathology is no higher in cocaine addicts in treatment than in addicts who do not use cocaine, however cocaine addicts started other drugs earlier, and were associated with specific mental disorders.

Dual diagnosis and suicide risk in a Spanish outpatient sample.

The present study compares dual-diagnosis patients with other groups of psychiatric patients to determine the differential characteristics in suicide risk and other clinical variables between them. During 2008 in Madrid, 837 outpatients were evaluated in addiction and mental health services. Three comparison groups were created according to current diagnosis: (i) dual patients, (ii) patients with substance use disorders but no other mental disorders, and (iii) patients with mental disorders but no substance use disorders. A multinomial logistic regression model was built to explore the risk associated with dual diagnosis. Criteria for dual diagnosis were met at the time of the study by 440 patients (52.6%). Dual patients showed several demographic and clinical differences and a higher risk for suicide than the other two comparison groups. Further research is needed to define suicide preventive strategies for dual patients.