Treatment of nicotine dependence in the chronic mentally ill.

Since rates of smoking cessation in psychiatric patients are low, the manner in which information on the importance of abstinence is presented and the scope of the treatment provided to psychiatric patients who have decided not to smoke are very important. This article will describe the development and implementation of a smoking-cessation group for chronic mentally ill patients. Components of the program are described and a detailed case example is provided. The smoking behavior of patients who participated in the first year of programming is reviewed, along with patient evaluation of program effectiveness. Our experience demonstrates the importance of psychoeducation for chronic psychiatric patients who tend not to have received formal education on the dangers of smoking and the possibility of addiction. Our findings indicate that patients are willing to learn more about smoking and the consequences of this behavior, even though many of them were not able to set quit dates. The provision of information through education groups increases the possibility of moving patients to the precontemplation stage.

Efficiency and validity of commonly used substance abuse screening instruments in public psychiatric patients.

BACKGROUND: The more commonly used screening instruments for substance abuse were largely developed for addictive populations. We compared several alcohol and drug abuse scales to determine their efficiency and validity for psychiatric patients. METHOD: The subjects were 100 consecutively admitted patients to a public psychiatric facility. DSM-III-R diagnoses, obtained from the alcohol and drug scales of the SCID-P, were the criterion measure. Methods of reliability included inter-rater agreement, estimates of internal consistency, and repeat test administration. Sensitivity, specificity and more infrequently used accuracy indices, such as likelihood ratios and Receiver Operating Characteristic (ROC) analysis, were utilized to assess scale validity. RESULTS: First, the reliability of all scales was high. Second, the instruments generally demonstrated highly acceptable levels of screening accuracy. Third, the intake evaluation was as reliable and valid as screening after admission on the unit. Finally, instruments were least discriminating for current problems (past 30 days). CONCLUSIONS: Lifetime measures were found to be reliable and valid for public psychiatric patients but further research is need on increasing the accuracy of screening for current substance abuse problems and the effectiveness of multiple screening approaches.

The impact of substance use screening on a public psychiatric inpatient population.

OBJECTIVE: This study sought to determine the impact of a formal screening program for substance use disorders among psychiatric inpatients. Both identification of these disorders and referrals to aftercare were measured. METHODS: A total of 193 patients admitted to a state psychiatric facility during a two-month period before screening was initiated were compared with 183 patients admitted during the same two months a year later when screening was in place. Patients were screened using the Chemical Use, Abuse, and Dependence Scale. Data were collected from hospital and statewide computerized files. RESULTS: Consistent with findings of previous studies, the formal screening procedure increased the identification of substance use disorders, even among those who were not screened during the screening period. However, despite heightened awareness of staff, referrals to outpatient treatment in the community after discharge did not increase. In fact, patients who did not have a comorbid substance use disorder were more frequently referred to aftercare than were dually diagnosed patients. CONCLUSIONS: Access to services for dually diagnosed patients may be limited by both staff and patient barriers. Underdiagnosis may be partly overcome by formal screening procedures, but staff bias may influence use of screening tools as well as aftercare referrals. In turn, individuals with a comorbid disorder who are not referred to aftercare may be more resistant to treatment and follow-up care. These issues must be clinically addressed by educating and sensitizing staff, as well as by administrative means.

Assessing substance use in multiproblem patients: reliability and validity of the Addiction Severity Index in a mental hospital population.

The Addiction Severity Index (ASI) is the most widely used measure of substance use in the field. Its reputation has been supported by reliability and validity studies. Despite its success, the psychometric properties of the ASI have not been examined in mental hospital populations. Our intent was to replicate prior studies and expand upon the validity of the ASI in a sample of 100 public psychiatric patients selected for a larger study. Findings revealed that a) reliability was acceptable, but there was only moderate agreement on the psychiatric scale severity score; b) the relationship between extent of rater training and reliability requires further study; c) despite some overlap, the scales were largely independent of each other; d) modification of the employment scale was necessary because of low correlations between the composite and severity score; e) raters are more responsive to client subjective ratings in psychiatric settings; f) ASI drug and alcohol scales correlate well with other substance use instruments and with DSM-III-R diagnoses; and g) the ASI can identify meaningful types of patient problems through cluster analysis. These findings, on the whole, support the use of the ASI drug and alcohol scales in public psychiatric hospitals.

Utility of the chemical use, abuse, and dependence scale in screening patients with severe mental illness.

The Chemical Use, Abuse, and Dependence (CUAD) Scale was administered with other scales to 100 consecutive admissions to a psychiatric hospital. Moderately high correlations with other measures of drug and alcohol use were obtained. Although more research with the CUAD is necessary, it may be potentially useful in screening for substance use among severely mentally ill patients.

Failure of a binaural comprehension deficit to select responders to earplug use in schizophrenia.

Previous studies have suggested that on the Auditory Comprehension Test, a significant proportion of schizophrenics demonstrate a binaural comprehension deficit. To test whether wearing an earplug in their more poorly performing ear would be beneficial, we studied 34 in-patient schizophrenics and noted a binaural deficit in 12 (35%). Of these, eight patients subsequently wore an earplug in each ear for at least one week. We found no effect of the earplug on psychopathology.