ABSTRACT
Substance use in mentally ill patients is now a major problem that influences the course and outcome of psychosis. With prevalence ranging up to 60%, several theories were postulated to explain the link. It would be interesting to know if substances have different effects in persons with psychosis than in those without. This study aimed to explore patterns of symptomatology of dependence and comorbid psychiatric illness by comparing and contrasting it with a group suffering from pure substance dependence. Consecutively admitted patients who were matched for age, sex, and tobacco use were divided into 3 groups. These were substance dependence without any comorbid psychiatric disorder (SD; n = 32), schizophrenia with substance dependence (SC; n = 31), and bipolar disorder with substance dependence (BD; n = 31). Patients were administered the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and Mini International Neuropsychiatric Inventory (MINI) to evaluate the chronology of criterion of International Classification of Diseases (ICD)-10 dependence. Results showed that cannabis was the most common substance used by both the SC (100%) and BD (80%) groups. This was followed by alcohol as the most common substance used, with prevalence of 87% in SC and 77% in BD groups. There was a significant difference in the pattern of use of cannabis in patients with psychosis, who developed tolerance much faster (P = .018) and had longer durations of cannabis use (P = .001) than the SD group. The presence of "loss of control" over drug use criterion seems to be a specific marker predicting development of dependence and psychosis. Cannabis use is more strongly associated with development of psychosis than any other substance.
Subject(s)
Bipolar Disorder/complications , Disease Progression , Schizophrenia/complications , Substance-Related Disorders/complications , Adult , Age of Onset , Behavior, Addictive/diagnosis , Bipolar Disorder/diagnosis , Diagnosis, Dual (Psychiatry) , Female , Humans , Male , Schizophrenia/diagnosis , Substance-Related Disorders/diagnosisABSTRACT
OBJECTIVE: Western studies have identified the gateway patterns of substance use which lead the way from the so called "Soft Drugs" (like nicotine, etc.) to the "Hard Drugs" (like Opioids) [the Gateway hypothesis]. Nicotine and alcohol have been implicated as the most common initiating drugs in studies from different places, however, studies are lacking from this region. This study was designed to find the drugs of initiation and to understand the factors for initiation, maintenance, and relapse of these substances in persons dependent on them in Eastern India. METHOD: Seventy subjects with ICD 10 DCR diagnosis of substance dependence admitted consecutively in Center for Addiction Psychiatry, Central Institute of Psychiatry (CIP), Ranchi, were taken up for the study after taking written informed consent. A semistructured questionnaire including the substance use part of Mini International Neuropsychiatric Inventory (MINI) was administered. RESULTS: Alcohol and opioids were the most common drugs of dependence but nicotine and alcohol were found to be the most common initiating drugs in both alcohol and opioid groups. Persons dependent on opioids presented earlier for treatment, with earlier development of withdrawal symptoms and having completed lesser years of formal education, and had higher monthly incomes as compared to those dependent on alcohol. The most common psychosocial factors determining initiation and maintenance were peer pressure or curiosity. CONCLUSIONS: If adolescents and youth can be motivated to stay away even from the "gateway drugs" by targeting common initiation factors, it may lead to delay in dependence or possibly avoidance of development of dependence.
Subject(s)
Alcohol Drinking/epidemiology , Substance-Related Disorders/epidemiology , Tobacco Use Disorder/epidemiology , Adolescent , Adult , Age Factors , Alcohol Drinking/psychology , Alcoholism/epidemiology , Alcoholism/prevention & control , Alcoholism/psychology , Behavior, Addictive/epidemiology , Behavior, Addictive/prevention & control , Behavior, Addictive/psychology , Comorbidity , Exploratory Behavior , Humans , India/epidemiology , Male , Models, Psychological , Opioid-Related Disorders/epidemiology , Opioid-Related Disorders/prevention & control , Opioid-Related Disorders/psychology , Peer Group , Primary Prevention/methods , Psychology, Adolescent , Recurrence , Risk Factors , Substance-Related Disorders/prevention & control , Substance-Related Disorders/psychology , Tobacco Use Disorder/psychologyABSTRACT
PROBLEM: Program evaluation of the effectiveness of two continuing nursing education programs (CNE) in child psychiatry in India. METHODS: Pre- and postevaluation of a total of 51 nurses attending a 10-day CNE program, using a 30-item (six-domain) questionnaire according to CNE topics in child psychiatry. FINDINGS: The CNE program resulted in significant increase in the total scores as well as scores in several sub-domains in the field of child psychiatry. CONCLUSIONS: In a country that does not offer degree programs that integrate psychiatric nursing into the curriculum, CNE programs are an important educational option for nurses. The CNE program offered in this study, comprising lectures, discussion, interactive sessions, and case demonstrations totaling 60 hr across 10 days, was effective in improving the level of knowledge of nurses. It was equally beneficial for senior as well as less experienced nurses.
