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Brems, Christiane; Johnson, Mark E.; Wells, Rebecca S.; Burns, Randall; Kletti, Nicholas (2002)
Publisher: Co-Action Publishing
Journal: International Journal of Circumpolar Health
Languages: English
Types: Article
Subjects: comorbidity, dual diagnosis, mental health, MICA, substance use
Objectives: Despite a growing body of investigations documenting the coexistence of substance use and other psychiatric disorders in a variety of patient populations, no data about comorbidity in the inpatient mental health system in Alaska have been published in scientific journals, and only limited data exist nationwide about coexistence rates in public psychiatric hospitals. Method: A retrospective population based study was performed on the entire population of psychiatric patients hospitalized at Alaska Psychiatric Institute (API) between 1993 and 2001. To explore rates of comorbidity, 5,862 patients (who accrued 10,656 visits) were classified according to their diagnostic status; to explore clinical and socio-demographic difference between patients with and without coexisting disorder, univariate analyses were calculated. Results: The study revealed startlingly high rates of comorbidity that have been rising steadily since the early 1990’s. In fact, comorbidity has become the rule, not the exception, among patients receiving services at API, with over 60% presenting with coexisting substance use symptoms. Complicating issues even further, these comorbid patients presented with more complex social and interpersonal circumstances, more complex clinical issues, different courses of treatment, and greater symptom complexity than psychiatric-only patients. Conclusions: 1.) Individual patient level - Providers for psychiatric inpatients must become more prepared to deal with coexisting substance abuse symptoms; policy makers must become more aware of the need for such patients to have smooth transitions from mental health to substance abuse treatment systems. 2.) Systemic-administrative level - Educators must better prepare providers to deal with this challenging clientele.(Int J Circumpolar Health 2002; 61(3):224-244)Keywords: comorbidity, dual diagnosis, mental health, MICA, substance use
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • 29. AHmillsJHP.syDcuhiaaltdryia1gn9o9s5i;s:1E5v2a:l3u5a8ti-n3g64an.d Comorbid patients appear to have a different course treating comorbid disorders. Am Psychol of treatment. They have significantly shor ter mean stays Assoc Div 50 Newsletter 1995; 17-19, 25. than psychiatric-only patients, staying an average of about
    • 30. Hoff RA, Rosenheck RA.The cost of treating nine days as compared to 17 days for the psychiatric-only scuobmstoarnbcied adbisuosredpeartsi.ePnstyscwhiitahtraSnedrvw1it9h9o9u;t patients. Median lengths of stay are also shor ter, with four 50:1309-1315. days versus seven days. They have more visits than psychi-
    • 31. American Society of Addiction Medicine. atric-only patients but a lesser total number of days in the aPdudbilcictivpeolaincyd sptsaytcehmiaetnrticodniscoor-doecrcsu.rJrAindgdict hospital across the years. Thus, it appears that they are Dis 2001; 20:121-123. admitted more often and discharged more quickly. Their
    • 32. Galanter M, Egelko S, Edwards H,Vergaray readmissions occur slightly more quickly than readmissions pMs.yAchtiaretraitcmaenndtasdydstiectmivefoirllcnoemss.bAindeddiction for psychiatric-only patients, generally occurring within 1994; 89:1227-1235. about eight months as compared to within about 10
    • 33. Galanter M. Self-help treatment for combined months for psychiatric-only patients. addiction and mental illness. Psychiatr Serv With regard to socio-demographic characteristics, this
    • 34. 2T0im00k;o5C1,:9L7e7s-a9r7M9., Engelbrekt M, Moos RH. study confirmed several prior findings as well. Specifically, Changes in services and structure in commu- comorbid patients are more likely to be male and dinity residential treatment facilities for vorced, separated, or widowed. They are more likely to be s5u1b:4st9a4n-c4e9a8b.use patients. Psychiatr Serv 2000; unemployed and have a significantly lower annual income
    • 35. American Psychiatric Association. Diagnostic than psychiatric-only patients. With regard to living situaand Statistical Manual of Mental Disorders tion, comorbid patients appear to have more difficult ar-
    • 36. (A3mrdeerdic).aAnuPtshyocrh:iWatraischAinsgstoocnia,tDioCn.1D9i8a7g.nostic rangements, being more likely to live with friends, be and Statistical Manual of Mental Disorders (4th homeless, or claim the correctional systems as their most ed). Author:Washington, DC 1994. recent place of housing. On the other hand, they are less
    • 37. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders (4th likely than psychiatric-only patients to claim their most reed - Text Revision). Author:Washington, DC cent residence to have been within a treatment setting 2000. (e.g., psychiatric hospital, respite care, super vised apar t-
    • 38. Johnson ME, Brems C, Fisher DG. Unmet ment). However, comorbid and psychiatric-only patients tCroeartrmeleatnetsnaeneddssoocfiedtraulgcousstesr.sCinirAculamskpao:lar are equally likely to come from rural or urban areas. CoHealth 1998; 96:467-473. morbid patients are less likely than psychiatric-only pa-
    • 39. Brems C, Johnson ME, Bowers L, Lauver B, tients to have a third-par ty payor for their hospital stay, sMtaotnegpesayucVhiLa.trCicohmoosrpbitiadli.tAydtrmainPionlgicnyeMedesnatt a having to rely more on state grants to fund their ser vices. Health. In press. They are more likely to be Vietnam- or post-Vietnam vet-
    • 40. Hellerstein DJ, Rosenthal RN, Miner CR. erans. Integrating services for schizophrenia and With regard to clinical characteristics, comorbid pas3u0b6s.tance abuse. Psychiatr Q 2001; 72:291- tients appear to present with greater symptom complexity.
    • 41. Zimberg S. Introduction and general concepts Specifically, they are extremely likely to present at admisof dual diagnosis. In: Solomon J, Zimberg S, sion with symptoms of recent substance use. In fact, 80% SThreoalltamr eEn,te,dTsr.aDinuinagl,DainadgnPorsoigs:raEmvaDlueavtieolno,p- to 90% of all patients who present with symptoms of rement. NewYork: Plenum Medical Book 1993; cent substance use when they present for admission are 4-22. patients with formally diagnosed coexisting substance use
    • 42. dZuwael-bdeinagJnEo.sIissspuaetsieinntt.hIen:trWeaatlmlaceentBo,fetdh.eThe disorders. Their symptom complexity is increased by the Chemically Dependent: Phases of Treatment coexistence of psychiatric disorders. Most commonly, coand Recovery. NewYork: Brunner/Mazel morbid patients present with coexisting depression, per1992; 298-309. sonality disorder, adjustment disorder, schizophrenia, or bi-
    • 43. hRoiespsiRta,lRstuasyssoaJn,dWminogreerrsaopnidDi,metpraol.vSehmoerntetr polar disorders. All in all comorbid patients have more
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