Dual disorder: does expert clinical experience support the rationale for cariprazine use?

Comorbid substance use disorder (SUD) in patients with schizophrenia (dual disorder, DD) is a frequent occurrence in the psychiatric clinical practice and is positively associated with poorer outcomes. Despite a very high co-prevalence, clinical guidelines for SUD and severe mental illnesses tend to give limited consideration to co-existing disorders regarding diagnosis and management. This article is the result of a meeting held in February 2023 to discuss common challenges and best clinical practice initiatives for patients with schizophrenia and DD in different treatment settings. The authors identified issues in the clinical approach to DD in schizophrenia spectrum disorders and suggested the most suitable management based on their experience as a group of experts, identifying possible improvement areas. In conclusion, the panel recommends that individuals with DD should be cared for in a single center. Pharmacologic treatment in individuals with DD needing both control of symptoms related to schizophrenia spectrum disorders and substance withdrawal should ideally be based on using a non-sedative antipsychotic with anti-craving activity.

[Prisoners in Greek prisons: Correlation of demographic and psychosocial data with committed crimes].

Previous literature shows an association between several psychosocial factors or life events in general and delinquency. Factors such as gender, cannabis and drugs use are firmly connected to delinquency. Similarly, interpersonal violent behavior appears to be more frequent in people with lower socioeconomic status and people with lower education. The association of these factors with the violent or non-violent crimes, especially in Greek research literature, is very limited. The present study is an attempt to examine in a Greek prison population the correlation of demographic and psychosocial factors with violent and non-violent crime. The prison population sample comprised of 308 males from a total of 1300 prisoners, aged between 18 and 77 years old. The survey was conducted from January 2012 until August 2013 in Korydallos and Domokos prisons. In our prison population sample most of the crimes were non-violent. The prisoners were urban dwellers, of young age, were not married and were in short-term relationships on average. They had completed their military obligations, were not live alone, and have been working in the last six months before being imprisoned, in manual labor. They had low-grade education and poor school achievements, had been brawling with classmates and had history of antisocial behavior (liked to "put fire" and abuse animals). They report good relationships with their parents; however, they had experienced violence in parental relationships and some kind of violence, mainly by the father and secondarily by the mother. They have not been involved in gangs necessarily and have a history from a young age, of alcohol, cannabis and drugs use. Cannabis use history was reported by 208 prisoners (67.5%) and 133 (63.9%) of them started using at the age of 10-15 years old. A total of 179 prisoners (58.5%) reported a history of drug use, about half of them (50.3%) reported being addicted to a combination of drugs. For 40.8% (n=73) drug use was initiated in the age of 10-15 years old, while the largest percentage (46.4%) of prisoners mentioned as starting age 16-20 years old. Although the above features underline the great differences between prison population and the general population, there are no significant associations of these factors with violent or non-violent crime. However, the prisoners with drug use history were 65% less likely to have been sentenced for violent crime. Also, the prisoners exempted from their military duties, were 49% less likely to have committed violent crime.

Stigma and self-esteem: A case of HIV-positive sex-workers.

Stigma associated with sex work and HIV can be easily recognized in public reactions towards the members of discriminated groups. Nevertheless, there are only a few studies examining the impact of discrimination to the self-esteem of individuals who suffer the coexistence of multiple stigmatizing conditions. In our case, the unprecedented stigmatization of sex workers through the media as a menace of public health as well as criminals due to their seropositivity should be examined with respect and scientificity. The sample consisted of the 27 women found to be HIV positive. The small number of subject and the uniqueness of the situation made necessary the use of qualitative research method. Data were collected of through a semi-structured interview during which personal and medical history was taken and Rosenberg self-esteem scale was completed. Information for each domain of interest was systematically collected from multiple interview guide items. Interpretive Phenomenological Analysis was used to analyze data derived from qualitative interview (IPA). Four main categories emerged from the horizontal analysis of the interviews referring to the mechanism used by those women in order to cope with stigma and protect their self-esteem, a description of their felt stigma and feelings about seropositivity, as well as the existence of self-destructive behaviors. The existence of a normal self-esteem on the majority of those women is well explained by the use of certain coping strategies in order to confront the enacted stigma, such as the avoidance of self-blame for their condition (HIV-positive), the disregard of public's discriminating comments and behaviors, the acknowledge of their competence in specific issues they have to deal with in their everyday life, in common with the existence of a strongly supportive network. Despite those women's felt stigma, structured by community's discriminating approach of their families and their feelings of helplessness and incompetence to protect their beloved, their self-esteem is not harmed and the frequency of selfdestructive behaviors remained stable, possibly as a result of those coping mechanisms developed early in their lives. The circle of stigmatization that emerged through the stories of those women is not an isolated social phenomenon related only to prostitution and drug use. This is the reason why educational programs, access to HIV care services and efforts towards de-stigmatization would benefit the society in multiple levels, and would ultimately strengthen the effort of combating the global AIDS epidemic.