A retrospective analysis focusing on a group of patients with dual diagnosis treated by both mental health and substance use services

Abstract

Rosaria Di Lorenzo,1 Agnese Galliani,2 Alessia Guicciardi,3 Giulia Landi,3 Paola Ferri2 1Mental Health Department, Azienda USL di Modena, Modena, Italy; 2School of Nursing, University of Modena and Reggio Emilia, Modena, Italy; 3Department of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy Objective: To highlight which demographic, familial, premorbid, clinical, therapeutic, ­rehabilitative, and assistance factors were related to dual diagnosis, which, in psychiatry, means the co-occurrence of both mental disorder and substance use in the same patient.Methods: Our sample (N=145) was chosen from all outpatients with a dual diagnosis treated from January 1, 2012 to July 31, 2012 by both the Mental Health Service and the Substance Use Service of Modena and Castelfranco Emilia, Italy. Patients who dropped out during the study period were excluded. Demographic data and variables related to familial and premorbid history, clinical course, rehabilitative programs, social support and nursing care, and outcome complications were collected. The patients’ clinical and functioning conditions during the study period were evaluated.Results: Our patients were mostly men suffering from a cluster B personality disorder. Substance use was significantly more likely to precede psychiatric disease (P<0.001), and 60% of the sample presented a positive familial history for psychiatric or addiction disease or premorbid traumatic factors. The onset age of substance use was related to the period of psychiatric treatment follow-up (P<0.001) and the time spent in rehabilitative facilities (P<0.05), which, in turn, was correlated with personality disorder diagnosis (P<0.05). Complications, which presented in 67% of patients, were related to the high number of psychiatric hospitalizations (P<0.05) and professionals involved in each patient’s treatment (P<0.05). Males more frequently presented familial, health, and social complications, whereas females more frequently presented self-threatening behavior (P<0.005). Conclusion: It was concluded that the course of dual diagnosis may be chronic, severe, and disabling, requiring many long-term therapeutic and rehabilitative programs to manage various disabilities. Keywords: dual diagnosis patients, mental health and substance use services, mental disorder and substance use co-occurrence