Dual diagnosis substance misuse and noncompliance

The term 'dual diagnosis' has been applied to patients with severe mental illness who also abuse alcohol and/or drugs. Data from the Epidemiologic Catchment Area survey(82> showed that community patients with schizophrenia were nearly five times more likely than controls to have a substance misuse disorder. For inpatients with schizophrenia the likelihood of a dual diagnosis is substantially greater, although the combination of substance misuse and personality disorder has an even greater association with violence. A significant association between patients with a dual diagnosis and violent behaviour is now well established. In the MacArthur Violence Risk Assessment Study(66) (see above) the !-year prevalence figures for violence after discharge from hospital were: major mental disorder alone, !8 per cent; 'dual diagnosis', 3! per cent; substance misuse plus any other mental disorder, 43 per cent. 'Other mental disorder' included a personality or an adjustment disorder and several cases of 'suicidality'. In a community cohort Scott et al.(83) found that patients with a dual diagnosis were six times more likely to describe recent hostile behaviour than those with a psychosis alone. Surprisingly, one-fifth of the 'psychosis only' group had convictions for a drug- or alcohol-related offence.

Provision of care for patients with dual diagnosis in the community is a major challenge for psychiatry; in particular the assessment and management of risk may require a reappraisal of conventional approaches (see ChapteLll.4.3 and Johns(84)). There is evidence that compliance with treatment is particularly poor in those with dual diagnosis/85 and that the combination of substance misuse and non-compliance with medication in the mentally ill is associated with a high risk of violence.(86)

Break Free From Passive Aggression

Break Free From Passive Aggression

This guide is meant to be of use for anyone who is keen on developing a better understanding of PAB, to help/support concerned people to discover various methods for helping others, also, to serve passive aggressive people as a tool for self-help.

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