This 3-year follow-up study compares background variables, extent of criminality and criminal recidivism in the form of all court convictions, the use of inpatient care, and number of early deaths in Swedish institutionalized adolescents (N=100) with comorbid substance use disorders (SUD) and Attention-Deficit/Hyperactivity Disorder (ADHD) (n=25) versus those with SUD but no ADHD (n=30), and those without SUD (n=45). In addition it aims to identify whether potential risk factors related to these groups are associated with persistence in violent criminality. Results showed almost no significant differences between the three diagnostic groups, but the SUD plus ADHD group displayed a somewhat more negative outcome with regard to criminality, and the non-SUD group stood out with very few drug related treatment episodes. However, the rate of criminal recidivism was strikingly high in all three groups, and the use of inpatient care as well as the number of untimely deaths recorded in the study population was dramatically increased compared to a age matched general population group. Finally, age at first conviction emerged as the only significant predictor of persistence in violent criminality with an AUC of .69 (CI (95%) .54-.84, p=.02). Regardless of whether SUD, with or without ADHD, is at hand or not, institutionalized adolescents describe a negative course with extensive criminality and frequent episodes of inpatient treatment, and thus requires a more effective treatment than present youth institutions seem to offer today. However, the few differences found between the three groups, do give some support that those with comorbid SUD and ADHD have the worst prognosis with regard to criminality, health, and untimely death, and as such are in need of even more extensive treatment interventions.
Gamma-hydroxybutyrate (GHB) is naturally present in the human body, but may also be used as an intoxicating drug. Information from several sources has suggested its increased availability and use in Norway. There have also been reports of an increasing use of the chemical precursor gamma-butyrolactone (GBL).There is currently a need for knowledge on symptoms, addictiveness and overdoses, as well as targeted preventive measures.
The article is based on a discretionary selection of articles resulting from a literature search in PubMed, as well as reports from Norwegian and European authorities and research institutions.
An intake of small amounts of GHB produces an intoxicating effect, whereas higher doses can result in poisoning. Deaths have been reported. The effect may be variable, due to a steep dose-response curve and interaction with alcohol and other intoxicants. Treatment of poisoning is symptomatic and supportive. Treatment of abstinence is also supportive, while delirium may be treated as delirium tremens.
Preventive measures should be tailored specifically to potential user-groups.
Is the abuse of psychoactive drugs in psychotic patients linked to social adjustment?
Fifty-five psychotic men from a detention centre or a psychiatric hospital were assessed with the Social Adjustment Scale (SAS-II) and a French version of the Phillips Rating Scale of Premorbid Adjustment in Schizophrenia.
In psychotic patients, the abuse of psychoactive drugs is linked to some indicators of social adjustment and premorbid sexual adaptation.
Differences were found in some aspects of social functioning, but it is difficult to establish an overall assessment of social adjustment.
The objective of the study was to determine the prevalence and comorbidity of persisting attention-deficit hyperactivity disorder (ADHD) in adult psychiatric outpatients. Consecutive patients, first visits excluded, at a general psychiatric outpatient clinic were offered a screening for childhood ADHD with the Wender Utah Rating Scale (WURS). One hundred and forty-one patients out of 398 (35%) completed and returned the scale. Patients above or near cut-off for ADHD (n=57) were offered an extensive clinical evaluation with psychiatric as well as neuropsychological examination. The attrition was analysed regarding age, sex and clinical diagnoses. Out of the screened sample, 40% had scores indicating possible childhood ADHD. These 57 patients were invited to the clinical part of the study, but 10 declined assessment, leaving 47 (37 women and 10 men) who were actually examined. Thirty of these (21 women and nine men) met diagnostic criteria for ADHD at the time of examination. Among the patients with ADHD, affective disorders were the most common psychiatric diagnoses. The rate of alcohol and/or substance abuse, as noted in the medical records, was also high in the ADHD group. In the WURS-screened group, 22% (30 patients assessed as part of this study and one person with ADHD previously clinically diagnosed) were shown to have persisting ADHD. Therefore, it is clearly relevant for psychiatrists working in general adult psychiatry to have ADHD in mind as a diagnostic option, either as the patient's main problem or as a functional impairment predisposing for other psychiatric disorders.
Women prisoners are known to suffer from an accumulation of factors known to increase the risk for several major health problems. This study examines the prevalence of adverse childhood experiences (ACE) and the relationship between such experiences and suicide attempts and drug use among incarcerated women in Norway.
A total of 141 women inmates (75% of all eligible) were interviewed using a structured interview guide covering information on demographics and a range of ACE related to abuse and neglect, and household dysfunction. The main outcome variables were attempted suicide and adult drug abuse.
Emotional, physical and sexual abuse during childhood was experienced by 39%, 36% and 19%, respectively, and emotional and physical neglect by 31% and 33%, respectively. Looking at the full range of ACE, 17% reported having experienced none, while 34% reported having experienced more than five ACEs. After controlling for age, immigrant background and marital status, the number of ACEs significantly increased the risk of attempted suicide and current drug abuse.
The associations observed between early life trauma and later health risk behaviour indicate the need for early prevention. The findings also emphasize the important role of prison health services in secondary prevention among women inmates.
To examine the relationship between remission of psychiatric disorders and age.
We interviewed 3258 randomly selected adult residents of Edmonton using the Diagnostic Interview Schedule (DIS), which yielded DIS/DSM-III diagnoses. Remission was defined as being free of symptoms of the index lifetime disorder in the year preceding the interview, this being the difference between the lifetime and one-year prevalence. For each age group, the proportion of cases with and without symptoms in the preceding year was calculated. Numbers and proportions of cases were estimated after adjusting to the census population and weighting for household size. Only the more common disorders were examined; any comorbidities were ignored.
Drug abuse or dependence, antisocial personality disorder (in both sexes), and alcohol abuse or dependence (in men) all showed remission rates that increased with age. Panic disorder and obsessive-compulsive disorder (OCD) showed a decreased likelihood of remission with increasing age. Major depression and phobias showed little tendency to remission with age. Considering all disorders together, the one-year remission rate for all ages combined was only 33.2%, with a tendency for lower remission rates to be found in those aged 55 to 64.
As may be expected, antisocial personality, drug abuse or dependence, and alcohol abuse or dependence tend to show increased remission rates with increasing age. In OCD and panic disorder, the low rates of remission found in all age groups indicate that these disorders produce significant long-term morbidity. For depression, which had an overall remission rate of less than 50%, the stable low rate of remission probably indicates not only the difficulties of treatment but also the low rates at which cases get treated.
Center for Primary Health Care Research, Lund University, Jan Waldenströmsgata 35, CRC, building 28, floor 11, entrance 72, Malmö University Hospital, Malmö, S-205 02, Sweden. Electronic address: email@example.com.
The societal consequences of drug abuse (DA) are severe and well documented, the World Health Organization recommending tracking of population trends for effective policy responses in treatment of DA and delivery of health care services. However, to correctly identify possible sources of DA change, one must first disentangle three different time-related influences on the need for treatment due to DA: age effects, period effects and cohort effects.
We constructed our main Swedish national DA database (spanning four decades) by linking healthcare data from the Swedish Hospital Discharge Register to individuals, which included hospitalisations in Sweden for 1975-2010. All hospitalized DA cases were identified by ICD codes. Our Swedish national sample consisted of 3078,129 men and 2921,816 women. We employed a cross-classified multilevel logistic regression model to disentangle any net age, period and cohort effects on DA hospitalization rates.
We found distinct net age, period and cohort effects, each influencing the predicted probability of hospitalisation for DA in men and women. Peak age for DA in both sexes was 33-35 years; net period effects showed an increase in hospitalisation for DA from 1996 to 2001; and in birth cohorts 1968-1974, we saw a considerable reduction (around 75%) in predicted probability of hospitalisation for DA.
The use of hospital admissions could be regarded as a proxy of the population's health service use for DA. Our results may thus constitute a basis for effective prevention planning, treatment and other appropriate policy responses.
Three groups of subjects (N = 95) consisting or rapists, child molesters, and a comparison group of violent offenders were examined with reference to history of alcohol abuse, history of drug abuse, intimacy deficits, and emotionally based coping strategies. No differences were found between the two groups of sex offenders on any of the measures examined. Sex offenders were found to be significantly older than the comparison group. When age was entered as a covariate sex offenders were found to have significantly more difficulties with alcohol use as measured by the Michigan Alcohol Screening Test (MAST) and were significantly more likely to use emotionally based coping strategies as measured by the Coping Inventory for Stressful Situations (CISS). No differences were found between any of the groups with reference to drug abuse as measured by the Drug Abuse Screening Test (DAST). Results are discussed in terms of Marshall's theory of intimacy deficits in sexual offenders.