Substance Use among Homeless Individuals with Schizophrenia and Bipolar Disorder

Mental illness and substance use are over represented within urban homeless populations. This paper compared substance use patterns between homeless individuals diagnosed with schizophrenia spectrum (SS) and bipolar disorders (BD) using the Mini-International Neuropsychiatric Interview. 

From a sample of 497 subjects drawn from Vancouver, Canada who participated in the At Home/Chez Soi study, 146 and 94 homeless individuals were identified as BD and SS, respectively. In the previous 12 months, a greater proportion of BD homeless reported greater use of cocaine, amphetamines, opiates, hallucinogens, cannabinoids, and tranquilizers compared to SS. Cocaine and opiates were significantly associated with BD homeless. 

The present study illustrates the relationship between substance use and BD in a vulnerable urban population of homeless, affected by adverse psychosocial factors and severe psychiatric conditions.

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By:  Maremmani AG1, Bacciardi S, Gehring ND, Cambioli L, Schütz C, Jang K, Krausz M.

• 1*"Vincent P. Dole" Dual Diagnosis Unit, Department of Clinical and Experimental Medicine, University of Pisa; †Association for the Application of Neuroscientific Knowledge to Social Aims (AU-CNS), Pietrasanta, Lucca, Italy; ‡Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada; §Medical University of Vienna, Neuroimaging Labs, Austria; ∥Institute of Mental Health, Department of Psychiatry, and ¶Department of Psychiatry, University of British Columbia; #Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital; and **School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada. 

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From Positive Screen to Engagement in Treatment: A Preliminary Study of ihe Impact of a New Model of Care for Prisoners with Serious Mental Illness

BACKGROUND:

The high prevalence of serious mental illness (SMI) in prisons remains a challenge for mental health services. Many prisoners with SMI do not receive care. Screening tools have been developed but better detection has not translated to higher rates of treatment. In New Zealand a Prison Model of Care (PMOC) was developed by forensic mental health and correctional services to address this challenge. The PMOC broadened triggers for referrals to mental health teams. Referrals were triaged by mental health nurses leading to multidisciplinary team assessment within specified timeframes. This pathway for screening, referral and assessment was introduced within existing resources.

METHOD:

The PMOC was implemented across four prisons. An AB research design was used to explore the extent to which mentally ill prisoners were referred to and accepted by prison in-reach mental health teams and to determine the proportion of prison population receiving specialist mental health care.

RESULTS:

The number of prisoners in the study in the year before the PMOC (n = 19,349) was similar to the year after (n = 19,421). 24.6 % of prisoners were screened as per the PMOC in the post period. Referrals increased from 491 to 734 in the post period (Z = -7.23, p < 0.0001). A greater number of triage assessments occurred after the introduction of the PMOC (pre = 458; post = 613, Z = 4.74, p < 0.0001) leading to a significant increase in the numbers accepted onto in-reach caseloads (pre = 338; post = 426, Z = 3.16, p < 0.01). Numbers of triage assessments completed within specified time frames showed no statistically significant difference before or after implementation. The proportion of prison population on in-reach caseloads increased from 5.6 % in the pre period to 7.0 % in the year post implementation while diagnostic patterns did not change, indicating more prisoners with SMI were identified and engaged in treatment.

CONCLUSIONS:

The PMOC led to increased prisoner numbers across screening, referral, treatment and engagement. Gains were achieved without extra resources by consistent processes and improved clarity of professional roles and tasks. The PMOC described a more effective pathway to specialist care for people with SMI entering prison.

Below:  The Prison Model of Care Referral and Treatment Pathway

Below:  Diagnostic cumulative composition of in-reach case load under treatment over 12 month study period

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By:  Pillai K1, Rouse P2, McKenna B3, Skipworth J4, Cavney J5, Tapsell R6, Simpson A7, Madell D8.

• 1Auckland Regional Forensic Psychiatry Services, Waitemata District Health Board, Auckland, New Zealand. Krishna.Pillai@waitematadhb.govt.nz.
• 2The University of Auckland, Auckland, New Zealand. p.rouse@auckland.ac.nz.
• 3Australian Catholic University and NorthWestern Mental Health, Level 1 North, City Campus, The Royal Melbourne Hospital, Grattan Street, Parkville, VIC, Australia, 3050. Brian.McKenna@mh.org.au.
• 4Auckland Regional Forensic Psychiatry Services, Waitemata District Health Board, Auckland, New Zealand. Jeremy.Skipworthi@waitematadhb.govt.nz.
• 5Auckland Regional Forensic Psychiatry Services, Waitemata District Health Board, Auckland, New Zealand. James.Cavney@waitematadhb.govt.nz.
• 6Midlands Regional Forensic Psychiatric Service, Waikato District Health Board, Hamilton, New Zealand. Rees.Tapsell@waikatodhb.health.nz.
• 7Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada. Sandy.Simpson@camh.ca.
• 8The University of Auckland, Auckland, New Zealand. Dominic.Madell@middlemore.co.nz.
• BMC Psychiatry. 2016 Jan 15;16(1):9. doi: 10.1186/s12888-016-0711-2.

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Substance Use Is a Risk Factor for Violent Behavior in Male Patients with Bipolar Disorder

BACKGROUND:

To determine the factors involved in violent behavior in patients with bipolar disorder (BD) and to investigate the relationship between violence and substance use disorder (SUD).

METHODS:

A sample of 100 male inpatients diagnosed with BD type I who were experiencing a current mood episode participated in the study. Violent behavior was defined as physical aggression against others. All patients were evaluated using the Young Mania Rating Scale (YMRS), Hamilton Depression Rating Scale (HDRS), Positive and Negative Syndrome Scale-positive subscale (PANSS-p), Barratt Impulsivity Scale-11 (BIS-11), Buss-Perry Aggression Questionnaire (BPAQ) and Overt Aggression Scale (OAS). Lifetime SUD and current use of substances were evaluated. Logistic regression analysis was conducted to predict violent behavior.

RESULTS:

Current substance use (CSU) rather than lifetime SUD was found to be related to violent behavior in patients with BD, and CSU was associated with a threefold increase in the risk of violence. The rate of lifetime SUD in our sample was 59%, and the rate of CSU was 39%. The most commonly abused substances were cannabis and alcohol, followed by synthetic cannabinoids, in both groups of patients with lifetime SUD and CSU. Individuals abusing any substance were more likely to have a criminal record and history of incarceration than other patients. One of the most significant risk factors for violence was a previous history of violent behavior.

LIMITATIONS:

The sample was limited to male patients. Data on some participants' recent substance use from standard urine analysis was not obtained. The data on the use of synthetic cannabinoids was obtained from patients and their families owing to the lack of equipment for detecting synthetic cannabinoids using laboratory analysis.

CONCLUSIONS:

CSU appears to be a significant predictive factor in violent behavior in male patients. Further investigation of co-occurrence of violence with CSU and improvement in treatment strategies might reduce or prevent violence in patients with BD.

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By:  Alnıak İ1, Erkıran M2, Mutlu E3.

• 1Bakırköy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Turkey. Electronic address: dr_izgi@hotmail.com.
• 2Bakırköy Prof. Dr. Mazhar Osman Training and Research Hospital for Psychiatry, Neurology and Neurosurgery, Turkey. Electronic address: muraterkiran@gmail.com.
• 3İstanbul Gelişim University, Department of Psychology, Turkey. Electronic address: elifmutlu@yahoo.com.
• J Affect Disord. 2015 Dec 30;193:89-93. doi: 10.1016/j.jad.2015.12.059. 

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