![]() MEDLINE and PsycINFO computerized searches of the English language literature were conducted for the period 1990-2002. The authors review and evaluate the literature and guidelines on care for individuals with a co-occurring affective or anxiety disorder and substance use disorder. Thus, schizophrenic patients may have a predilection for addictive behavior as a primary disease symptom in parallel to, and in many, cases independent from, their other symptoms. Altered integration of these signals would produce neural and motivational changes similar to long-term substance abuse but without the necessity of prior drug exposure. ![]() In this model, disturbances in drug reward are mediated, in part, by dysregulated neural integration of dopamine and glutamate signaling in the nucleus accumbens resulting form frontal cortical and hippocampal dysfunction. We hypothesize that abnormalities in the hippocampal formation and frontal cortex facilitate the positive reinforcing effects of drug reward and reduce inhibitory control over drug-seeking behavior. However, recent advances suggest that increased vulnerability to addictive behavior may reflect the impact of the neuropathology of schizophrenia on the neural circuitry mediating drug reward and reinforcement. It is commonly held that substance use comorbidity in schizophrenia represents self-medication, an attempt by patients to alleviate adverse positive and negative symptoms, cognitive impairment, or medication side effects. Given the impact of MA psychosis and other drug-induced symptoms on hospitals and mental health services, the description and characterization of comorbid psychiatric symptoms associated with MA use is of paramount importance. Male subjects reported a higher percentage of MA-induced delusions compared to female abusers. Of all participants, 26.5% had anxiety disorders and 3.7% had a substance-induced anxiety disorder, all of which were induced by MA. A substantial number of lifetime mood disorders were identified that were not substance-induced (32.3%), whereas 14.8% had mood disorders induced by substances, and 10.6% had mood disorders induced by amphetamines. Across the sample, 28.6% had primary psychotic disorders, 23.8% of which were substance-induced 13.2% had MA-induced delusional disorders and 11.1% had MA-induced hallucinations. Structured clinical interviews (SCIDs) were administered to 189 MA-dependent subjects and lifetime prevalence of DSM-IV diagnoses was assessed. The secondary aim was to assess whether the prevalence of psychiatric comorbidities varied by gender. The primary aim of the present study was to assess the prevalence of psychiatric comorbidity in a large sample of methamphetamine (MA)-dependent subjects using a validated structured clinical interview, without limitation to sexual orientation or participation in a treatment program. This result emphasizes the importance of accurate diagnosis of clients with opiate-related disorders and accordant treatment planning, which also takes into account the cocaine-related disorder. ![]() Despite of that, cocaine-related disorder is highly prevalent in this setting due to the fact, that it is mostly a comorbid disorder within patients with opiate-related disorders. Conclusions: Clients of outpatient treatment settings seem not to seek help primarily because of their cocaine-related disorders. (6) Cocaine clients terminated treatment as intended less often than alcohol clients but more often than opiate clients. ![]() (5) 50% of cocaine clients sought treatment for the first time. (4) Comorbid disorders were more often found in cocaine clients. (3) Cocaine clients had similar sociodemographic characteristics as opiate clients but differed from alcohol clients. (2) Cocaine clients were younger than alcohol clients and almost similar aged as opiate clients. Results: Comparisons of characteristics of clients treated for cocaine-, opiate- or alcohol-related disorders revealed that (1) 20% of male and 10% of female clients were treated for cocaine disorders. Method: Aggregated data from 454 outpatient treatment facilities, which deliver data for the German Statistics on substance related outpatient treatment were analysed. Aim: Description of cocaine clients in outpatient treatment regarding sociodemographics, comorbidity, consumption patterns and treatment characteristics. ![]()
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