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Gómez Pérez LJ, Cardullo S, Zaffaina GC, Cuppone D, Chindamo S, Zattin A, Cellini N, Terraneo A, Gallimberti L. Prognostic factors of a multidisciplinary rtms-based treatment for cocaine use disorder: A large cohort study. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2025; 174:209706. [PMID: 40286859 DOI: 10.1016/j.josat.2025.209706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/18/2024] [Revised: 02/14/2025] [Accepted: 04/23/2025] [Indexed: 04/29/2025]
Abstract
INTRODUCTION This study investigated psychological and clinical factors influencing treatment outcomes for Cocaine Use Disorder (CocUD) patients undergoing a multidisciplinary approach, including repetitive Transcranial Magnetic Stimulation (rTMS), addiction counseling, pharmacological treatment, and psychotherapeutic support. Multidisciplinary treatments appear to be more effective than stand-alone programs in addiction recovery. METHODS This is a retrospective observational study of 1011 patients meeting DSM-5 criteria for CocUD undergoing a multidisciplinary treatment rTMS-based. The primary outcomes were (1) the time to the first lapse, (2) the time to dropout from the program, and (3) the monthly cocaine use pattern for up to one year since clinical admission. The secondary indices were the variations in the withdrawal symptoms. The influence of various factors on the time to first lapse and treatment dropout was analyzed using multivariate Cox proportional hazard models, which helps understand how different factors influence the time until an event, such as relapse or dropout, occurs. Concerning cocaine use patterns and secondary outcomes, linear mixed models were applied. RESULTS Protective factors comprise personal initiative in seeking treatment, starting with inpatient care, a higher number of high frequency rTMS over the left dorsolateral prefrontal cortex (DLPFC), and referral to psychotherapy. In contrast, risk factors were psychiatric comorbidity (e.g., personality disorder, other addictions, alcohol use disorder), craving intensity, last use before treatment admission, and number of pharmacological prescriptions. Moreover, an increase in the number of high frequency rTMS over the left DLPFC sessions was a significant predictor of the reduction of severity on self-reported measures of psychiatric symptoms. CONCLUSIONS Personal initiative in seeking treatment and psychotherapy emerged as protective factors along with high frequency rTMS over the left DLPFC in determining positive outcomes, including a reduction in the severity of co-occurring psychiatric CocUD symptoms, underlining the benefit of a multidimensional approach to treating CocUD.
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Affiliation(s)
| | - Stefano Cardullo
- Novella Fronda Foundation, Padua, Italy; Mental Health Centre, Department of Mental Health - AULSS 6 Euganea, Padua, Italy
| | | | | | | | | | - Nicola Cellini
- Department of General Psychology, University of Padova, Padua, Italy
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Lannoy S, Svikis DS, Stephenson M, Polak K, Kendler KS, Edwards AC. Personality correlates of past-year alcohol use in individuals with severe alcohol use disorder and a lifetime history of involvement in alcoholics anonymous. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:1168-1175. [PMID: 38627204 PMCID: PMC11178444 DOI: 10.1111/acer.15330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Revised: 03/29/2024] [Accepted: 04/02/2024] [Indexed: 04/30/2024]
Abstract
BACKGROUND Alcohol use disorder (AUD) is a highly impairing condition with important public health impacts. Despite the availability of treatment options for AUD, research shows that few people receive treatment, and even fewer can maintain abstinence/low-drinking levels. This study investigated the role of personality traits in past-year alcohol use among individuals with severe AUD who ever attended Alcoholics Anonymous (AA), a widespread and easily accessible self-help group for alcohol problems. METHODS Univariable and multivariable regressions were performed separately in females and males with alcohol consumption as an outcome. Socioeconomic factors, genetic liability, and psychopathology were included as covariates in the analyses. RESULTS Results from the multivariable model indicated that in females who attended AA, greater alcohol use was related to both positive and negative urgency and low sensation seeking, while in males, greater alcohol use was related to positive urgency. Results also showed that, in both sexes, younger age and lower educational levels were associated with greater alcohol use. Moreover, single males and individuals with lower AUD severity were at higher risk of using alcohol in the past year. CONCLUSIONS These findings highlight sex-specific correlates of drinking in individuals with AUD who engaged in self-help groups. These findings may help to improve treatment options, as personality encompasses modifiable traits that can be targeted in psychological interventions.
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Affiliation(s)
- Séverine Lannoy
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, US
| | - Dace S. Svikis
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, US
- Department of Psychology, Virginia Commonwealth University, Richmond, VA, USA
- Institute for Women’s Health, Virginia Commonwealth University, Richmond,VA, USA
| | - Mallory Stephenson
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, US
| | - Kathryn Polak
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, US
| | - Kenneth S. Kendler
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, US
| | - Alexis C. Edwards
- Department of Psychiatry, Virginia Institute for Psychiatric and Behavioral Genetics, Virginia Commonwealth University School of Medicine, Richmond, VA, US
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Luoto KE, Lassila A, Leinonen E, Kampman O. Predictors of short-term response and the role of heavy alcohol use in treatment of depression. BMC Psychiatry 2023; 23:880. [PMID: 38012573 PMCID: PMC10680330 DOI: 10.1186/s12888-023-05366-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Accepted: 11/09/2023] [Indexed: 11/29/2023] Open
Abstract
BACKGROUND Depression and alcohol use disorders frequently co-occur. However, research on psychosocial interventions for treating this dual pathology is limited. The Ostrobothnian Depression Study (ODS) aimed to increase the systematic use of evidence-based methods, particularly among patients with comorbid depression and substance use in a naturalistic setting. This is a secondary analysis of the ODS study. The aim of the present study was to explore the predictors of a response to treatment during the first six months of the ODS intervention with a specific focus on the role of comorbid heavy alcohol use. METHODS The study sample (n = 242) comprised psychiatric specialist care patients with depression (Beck Depression Inventory score ≥ 17) at baseline. Patients with a baseline Alcohol Use Disorders Identification Test (AUDIT) score > 10 (n = 99) were assigned to the AUD (Alcohol Use Disorder) group in this study. The ODS intervention comprised behavioral activation (BA) for all and additional motivational interviewing (MI) for those in AUD group. The predictors of response to treatment (minimum of 50% reduction in depressive symptoms) during the first six months were analyzed with logistic regression models. RESULTS In the total sample at six months (n = 150), predictors of response to treatment were more severe depression (OR 1.10, CI 1.02-1.18), larger amounts of alcohol consumed (OR = 1.16, CI 1.03-1.31) and antipsychotic medication "not in use" (OR = 0.17, CI 0.07-0.44). In the non-AUD group (n = 100), more severe depression (OR 1.12, CI 1.01-1.25) and antipsychotics "not in use" (OR 0.20, CI 0.06-0.67) also predicted a positive response. Among AUD group patients (n = 50), larger amounts of alcohol consumed (OR 1.54, CI 1.04-2.27) and antipsychotic medication "not in use" (OR 0.12, CI 0.02-0.60) predicted a response to the treatment intervention. CONCLUSIONS The severity of symptoms and comorbid disorders were found to predict better treatment response, suggesting that the intervention was more effective in patients with severe symptoms. Patients with depression should be treated effectively regardless of having concomitant AUD. The results of this study suggest that BA combined with MI should be one of the treatment options for this dual pathology. TRIAL REGISTRATION ClinicalTrials.gov Identifier NCT02520271 (11/08/2015).
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Affiliation(s)
- Kaisa E Luoto
- Department of Psychiatry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland.
- Department of Psychiatry, Tampere University Hospital, The Wellbeing Services County of Pirkanmaa, Tampere, Finland.
- Department of Psychiatry, Seinäjoki Central Hospital, The Wellbeing Services County of South Ostrobothnia, Seinäjoki, Finland.
| | - Antero Lassila
- Department of Psychiatry, Seinäjoki Central Hospital, The Wellbeing Services County of South Ostrobothnia, Seinäjoki, Finland
| | - Esa Leinonen
- Department of Psychiatry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Psychiatry, Tampere University Hospital, The Wellbeing Services County of Pirkanmaa, Tampere, Finland
| | - Olli Kampman
- Department of Psychiatry, Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
- Department of Psychiatry, Tampere University Hospital, The Wellbeing Services County of Pirkanmaa, Tampere, Finland
- Department of Clinical Sciences, Psychiatry, Umeå University, Umeå, Sweden
- Department of Clinical Medicine (Psychiatry), Faculty of Medicine, University of Turku, Turku, Finland
- Department of Psychiatry, The Wellbeing Services County of Ostrobothnia, Vaasa, Finland
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Liu Y, Liu Y, Cheng J, Pang LJ, Zhang XL. Correlation analysis of mental health conditions and personality of patients with alcohol addiction. World J Psychiatry 2023; 13:893-902. [DOI: 10.5498/wjp.v13.i11.893] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Revised: 08/25/2023] [Accepted: 09/22/2023] [Indexed: 11/17/2023] Open
Abstract
BACKGROUND Alcohol addiction, or alcohol dependence, refers to a psychological state of strong craving for alcohol caused by drinking when both the drinking times and alcohol consumption reach a certain level. Alcohol addiction can cause irreversible damage, leading to mental illness or mental disorders, negative changes in their original personality, and a tendency to safety incidents such as committing suicide or violent attacks on others. Significant attention needs to be given to the mental health of alcohol addicts, which could reflect their abnormal personality traits. However, only a few papers on this issue have been reported in China.
AIM To investigate the correlation between mental health and personality in patients with alcohol addiction.
METHODS In this single-center observational study, we selected 80 patients with alcohol addiction as the research subjects, according to the criteria of the K10 scale to evaluate the mental health of patients with alcohol addiction, and divided these patients into four groups based on the evaluation results: Good, average, relatively poor and bad. And then analyzed the correlation between mental health conditions and personality characteristics from these four groups of patients.
RESULTS The average score of the K10 scale (Kessler 10 Simple Psychological Status Assessment Scale) in 80 patients with alcohol addiction was 25.45 points, the median score was 25 points, the highest score was 50 points, and the lowest score was 11 points. Pearson's analysis showed that the K10 score was positively correlated with the scores of these two subscales, such as the P-subscale and the N-subscale (P < 0.05). In contrast, the K10 score had no significant correlation with the scores from the E-subscale and the L-subscale (P > 0.05).
CONCLUSION The mental health conditions of patients with alcohol addiction are positively correlated with their personality characteristics.
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Affiliation(s)
- Yu Liu
- Department of Material Dependence, Affiliated Psychological Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Yang Liu
- Department of Material Dependence, Affiliated Psychological Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Jun Cheng
- Department of Material Dependence, Hefei Fourth People’s Hospital, Hefei 230022, Anhui Province, China
| | - Liang-Jun Pang
- Department of Material Dependence, Affiliated Psychological Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
| | - Xu-Lai Zhang
- Department of Geriatric Psychology, Affiliated Psychological Hospital of Anhui Medical University, Hefei 230022, Anhui Province, China
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Subramanian Y, Barrett J, Kim S, Carey C, Barry H, MacHale S. A comparison of daytime and out of hour mental health presentations to Beaumont Hospital Emergency Department between 2018 and 2020. Ir J Med Sci 2023; 192:2475-2481. [PMID: 36588147 PMCID: PMC9805908 DOI: 10.1007/s11845-022-03249-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Accepted: 12/01/2022] [Indexed: 01/03/2023]
Abstract
BACKGROUND In 2018, there were more than 12,000 self-harm presentations to emergency departments (EDs) in Ireland with 50% occurring between 7p.m. and 3a.m. There is evidence that the assessment quality and follow-up is variable across clinicians. To address this, The National Clinical Programme for the Management of Self-Harm in the ED (NCPSH 2016) was developed to set clear standards. AIM Our aim was to compare diagnosis and management of patients presenting to Beaumont Hospital (BH) ED, across a 3-year period, by the on-site Liaison Psychiatry Service, during normal working hours, to the off-site on call service outside of normal working hours (OOH). METHODS This is a retrospective audit of BH ED patients referred for psychiatric assessment between 2018 and 2020, using patient electronic records for data collection, and Pearson's chi square testing for group differences. Post hoc analysis was performed using adjusted residuals and Bonferroni correction. RESULTS Of 3659 psychiatric referrals to Beaumont ED from 2018 to 2020, alcohol-related disorders were the most common diagnosis and were diagnosed more frequently during normal working hours (n = 592, 16.2%; 22.9% normal hours vs 8.5% OOH, p < 0.001), while personality disorder was diagnosed more frequently out of hours. (n = 432, 11.8%; 9.6% normal hours vs 14.4% out of hours, p < 0.001). There was a statistically significant difference in referral to voluntary services out of hours (7.2% normal hours vs 0.3% OOH). CONCLUSION In contrast to previous findings, our study found higher rates of alcohol-related disorders diagnosed during normal hours vs OOH. Furthermore, voluntary and addiction services were under-utilised OOH and this presents an important teaching opportunity.
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Affiliation(s)
| | | | - San Kim
- Beaumont Hospital, Dublin 9, Ireland
| | - Cornelia Carey
- South Meath Mental Health Services, Ashbourne, Co. Meath Ireland
| | - Helen Barry
- Department of Liaison Psychiatry, Beaumont Hospital, Dublin, Ireland
| | - Siobhan MacHale
- Department of Liaison Psychiatry, Beaumont Hospital, Dublin, Ireland
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Alcohol use patterns and disorders among individuals with personality disorders in the Sao Paulo Metropolitan Area. PLoS One 2021; 16:e0248403. [PMID: 33755679 PMCID: PMC7987194 DOI: 10.1371/journal.pone.0248403] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2020] [Accepted: 02/25/2021] [Indexed: 12/11/2022] Open
Abstract
Introduction Alcohol Use Disorders are frequently comorbid with personality disorders. However, the heterogeneity of the prevalence estimates is high, and most data come from high income countries. Our aim is to estimate the prevalence and association between alcohol use outcomes and the three DSM-5 clusters of personality disorders in a representative sample of the São Paulo Metropolitan Area. Materials and methods A representative household sample of 2,942 adults was interviewed using the WHO Composite International Diagnostic Interview and the International Personality Disorder Examination Screening Questionnaire. Lifetime PD diagnoses were multiply imputed, and AUD diagnoses were obtained using DSM-5 criteria. We conducted cross-tabulations and logistic regression to estimate the associations between AUDs and PDs. Results and discussion Our study did not find significant associations of PDs with heavy drinking patterns or mild AUD. Cluster B PD respondents tended to show the highest conditional prevalence estimates of most alcohol use patterns and AUD, including its severity subtypes. When alcohol outcomes were regressed on all PD Clusters simultaneously, with adjustment for sex and age, only cluster B was significantly associated with past-year alcohol use (OR 3.0), regular drinking (OR 3.2), and AUDs (OR 8.5), especially moderate and severe cases of alcohol use disorders (OR 9.7 and 16.6, respectively). These associations between Cluster B PDs and these alcohol outcomes were shown to be independent of other PD Clusters and individuals´ sex and age. Conclusion The main finding of our study is that AUDs are highly comorbid with PDs. The presence of Cluster B PDs significantly increases the odds of alcohol consumption and disorders and of more severe forms of AUDs. Considering the local context of poor treatment provision, more specific prevention and intervention strategies should be directed to this population.
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Abstract
PURPOSE OF REVIEW Borderline personality disorder (BPD) is prevalent, debilitating and clinically challenging. The evolving field of intervention and outcomes in BPD research is considered with a focus on recent research. RECENT FINDINGS A pattern of clinical and functional improvement is to be expected in patients experiencing BPD. Specialized psychotherapies are shown to be beneficial, but generalist, low-intensity interventions in nonspecialized centres are also showing efficacy. Long-term naturalistic studies show that remission of the disorder is common and promising outcomes are not only possible, but likely. Training in vocational functioning, improving personal competence and promoting resilience needs to be further developed. SUMMARY BPD diagnosis does not need to overwhelm clinicians, nor does it require therapeutic pessimism. Targeted interventions, including meaningful psychoeducation, are helpful in promoting optimism and enhancing recovery-oriented treatments.
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Castillo-Carniglia A, Keyes KM, Hasin DS, Cerdá M. Psychiatric comorbidities in alcohol use disorder. Lancet Psychiatry 2019; 6:1068-1080. [PMID: 31630984 PMCID: PMC7006178 DOI: 10.1016/s2215-0366(19)30222-6] [Citation(s) in RCA: 221] [Impact Index Per Article: 36.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2019] [Revised: 05/13/2019] [Accepted: 05/30/2019] [Indexed: 01/10/2023]
Abstract
Alcohol use disorder is a major contributor to the morbidity and mortality burden worldwide. It often coexists with other psychiatric disorders; however, the nature of this comorbidity is still a matter of debate. In this Series paper, we examine the main psychiatric disorders associated with alcohol use disorder, including the prevalence of co-occurring disorders, the temporal nature of the relationship, and mechanisms that might explain comorbidity across the lifespan. Overall, this disorder co-occurs with a wide range of other psychiatric disorders, especially those disorders involving substance use and violent or aggressive behaviour. The causal pathways between alcohol use disorder and other psychiatric disorders are heterogeneous. Hypotheses explaining these relationships include reciprocal direct causal associations, shared genetic and environmental causes, and shared psychopathological characteristics of broader diagnostic entities (eg, externalising disorders). Efforts to untangle the associations between alcohol use disorder and other disorders across the lifespan remain a crucial avenue of research.
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Affiliation(s)
- Alvaro Castillo-Carniglia
- Society and Health Research Center, Facultad de Humanidades, Universidad Mayor, Santiago, Chile; Department of Population Health, New York University School of Medicine, New York, NY, USA.
| | - Katherine M Keyes
- Department of Epidemiology, College of Physicians and Surgeons, Mailman School of Public Health, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Deborah S Hasin
- Department of Psychiatry, College of Physicians and Surgeons, Mailman School of Public Health, Columbia University and New York State Psychiatric Institute, New York, NY, USA
| | - Magdalena Cerdá
- Department of Population Health, New York University School of Medicine, New York, NY, USA
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