ISSN:1022-6877    

DOI:10.1159/000259094

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

A short review of research on the relationship between crime, substance abuse and mental disorders is given. A majority of studies unequivocally support the conclusion that abusers of psychotropic substances commit a vast amount of crime, partly related to the need for purchasing drugs but also involving other criminal behaviours including serious violent crimes and homicide. It is still frequently overlooked that multiple disorders together with a complex variety of other conditions and circumstances are characteristic among criminal offenders. The modern forensic psychiatric assessment of responsibility requires a multiaxial polydiagnostic approach including all aspects of comorbidity. From 1989 to 1994, in the Basel Forensic Psychiatric University Service, 450 offenders were assessed for responsibility, and 83% showed a substance-related disorder. 38% of them had two diagnoses, 29% three diagnoses and 10% more than three diagnoses. The most frequent comorbidities were combinations of substance-related disorders with personality disorders and schizophrenia. We found a clear connection of comorbidity and likelihood of diminished responsibility or irresponsibility. The scope and requirements for future research on comorbidity in forensic psychiatry are discussed.

ISSN:1022-6877    

DOI:10.1159/000259095

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The coincidence of substance abuse and schizophrenia is about 47% according to US American studies. European studies on the prevalence, consumption, behaviour and pattern are rare. Using a representative sample of the psychiatric patients in a large German city, a comparable lifetime prevalence of substance abuse was shown among schizophrenics. Substances consumed were mainly alcohol and cannabis. A specific consumption of substances could not be confirmed.

ISSN:1022-6877    

DOI:10.1159/000259096

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The aim of this study is to analyze psychiatric comorbidity of alcohol dependence with respect to prevalence rates, time of onset and indications for the course of alcoholism. 100 hospitalized alcohol-dependent patients were investigated. They were diagnosed according to the criteria of ICD-10 assessed by the Composite International Diagnostic Interview (CIDI). In 54% of the patients, at least one additional psychiatric disorder was diagnosed (lifetime). The current prevalence rates for all diagnoses were 49% (1 year) and 38% (2 weeks), respectively. In 71.2% the onset of comorbidity disorders preceded the onset of alcoholism by more than 1 year. In patients with secondary depressive disorders, alcohol-related problems had manifested significantly earlier than in primary depressive patients, but no differences were found in the maximum amount of drinking, the age of onset of excessive drinking and the amount of drinking during the year before the present study. ICD-10 comorbidity rates on the basis of the CIDI are in agreement with former DSM-III-R results based on the DIS. Psychiatric comorbidity seems to play a role in the early stages of alcoholism but not in the later course.

ISSN:1022-6877    

DOI:10.1159/000259097

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Stimulant-dependent subjects have been reported to have higher rates of comorbid major depression and higher mood ratings of depression than the normal population, while patients with depression have been found to have an increased lifetime prevalence of stimulant abuse. These reports have led some investigators to postulate that there is an interaction between affective disorders and stimulant dependence. We evaluated two independent cohorts of patients hospitalized with major depression or stimulant dependence. Both groups underwent identical psychiatric evaluations of their mood and comorbid lifetime psychiatric diagnoses. These two groups differed significantly in Hamilton Depression Rating Scale, Beck Depression Inventory, Brief Psychiatric Rating Scale, and Profile of Mood State scores and types of comorbid diagnoses. They had similar demographic measures and similar, relatively low, frequencies of lifetime comorbid stimulant dependence and depression. Thus, patients with major depression and stimulant dependence differed markedly with respect to their current clinical characteristics and lifetime comorbid diagnoses.

ISSN:1022-6877    

DOI:10.1159/000259098

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Alcoholism and depressive disorders co-occur far more commonly than would be expected. The great prevalence of depression in alcoholics constitutes an important clinical issue, because alcoholic subjects with a coexisting depression exhibit heavier alcohol abuse, severer physical damage and greater liability to both psychotropic drug abuse and overdose behaviour than non-depressive alcoholics. The former also experience more frequent and severer relapses and are at greater risk of suicide. The nature of the relationship between alcohol dependence and depressive disorders is of considerable theoretical significance. Three possible non-mutually exclusive types of association are discussed: (1) the ingestion of alcohol may be an attempt at self-medication of depressive symptoms; (2) depression and alcohol abuse may, independently of each other, be attributable to an underlying, possibly genetic, factor; (3) depression may be a result of alcoholism: either induced by heavy alcohol consumption, as a consequence of alcohol withdrawal or as a psychoreactive phenomenon. Clinical guidelines for pharmaco- and psychotherapy of depression in patients suffering from alcoholism are outlined.

ISSN:1022-6877    

DOI:10.1159/000259099

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

Recent major epidemiological surveys in general population samples throughout the world have demonstrated that substance use disorders are among the most frequent forms of mental disorders in the community, and are also frequently associated with other forms of mental disorders. This paper briefly reviews the concept of comorbidity and summarizes more recent data concerning the frequency of comorbidity of substance use disorders. The review is limited to studies in the general population using standardized diagnostic interviews. Specific emphasis is laid upon the most recent data from the National Comorbidity Survey, that specifically addressed comorbidity issues in detail. The clear majority of subjects with a definite substance use disorder according to the strict DSM-III-R definition has or has had at least one other comorbid mental disorder. Comorbidity rates between specific substance use disorders and other mental disorders will be compared and discussed in light of several other international epidemiological studies. Furthermore time sequences of substance use disorders and comorbid disorders are presented. Potential pathogenetic and clinical implications are addressed.

ISSN:1022-6877    

DOI:10.1159/000259100

出版商:S. Karger AG    

年代:1996

数据来源: Karger

ISSN:1022-6877    

DOI:10.1159/000259101

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

A 5-year follow-up of Australian methadone patients was conducted to identify factors associated with risk of premature death in a population of heroin addicts not infected with HIV. While only 93 of 227 subjects gave a history of benzodiazepine or barbiturate dependence on admission, they comprised 9 of the 11 dead (OR 7.0, 95% CI 1.6–48.7). A Cox regression of time from admission to date of death found that, while allowing for the effect of sex, age and employment status on admission, subjects giving a history of benzodiazepine or barbiturate dependence were 8 times as likely to die as other methadone maintenance patients (95% CI RR 1.6–

ISSN:1022-6877    

DOI:10.1159/000259102

出版商:S. Karger AG    

年代:1996

数据来源: Karger

摘要:

The effects of an inpatient psychotherapy program based on a psychodynamically orientated group psychotherapeutic approach in a psychiatric hospital were investigated in benzodiazepine-dependent and nondependent patients. 114 matched patients with neurotic and personality disorders were assessed at the beginning of a 4- to 8-week period: the patients were retested after 10 days and at the end of the program. The results of benzodiazepine-dependent (n = 40) and non-benzodiazepine-dependent (n = 74) patients were compared with regard to effect- and course-related variables. For the evaluation of benzodiazepine-related dissociative symptoms, the Dissociative Experience Scale was used. The effects of psychotherapy were measured with the Symptom Check List 90 (SCL-90) and the Questionnaire for the Measurement of Motivation for Psychotherapy (FMP). The results show significant differences concerning the severity of symptoms and the symptom-related course in the two groups: in most dimensions of the SCL-90, the addicted group shows significantly higher scores than the control group. These differences were accentuated on retest after 10 days, which can be accounted for by the withdrawal syndrome of the benzodiazepine-dependent group. Nevertheless, the psychotherapeutic outcome, measured by the difference between the initial and the final scores, shows no significant difference. The results are discussed with regard to the importance of benzodiazepine addiction and dissociative phenomena during inpatient psychotherapy.

ISSN:1022-6877    

DOI:10.1159/000259103

出版商:S. Karger AG    

年代:1996

数据来源: Karger