Θωμάς Παπαρρηγόπουλος, Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Μινέρβα-Μελπομένη Μαλλιώρη, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Ηλίας Τζαβέλλας, Επίκουρος Καθηγητής, Ιατρική Σχολή, ΕΚΠΑ
Patients suffering from dual diagnosis are proved to be at high risk of relapse, hospital admission, infection from the Human Immunodeficiency Virus (HIV) and Hepatitis C and utilize quite more often the Health Services.
Objective: This study aims to measure prevalence of dual diagnosis in a public Psychiatric Hospital in Athens, Greece and investigate the sociodemographic variables that might affect dual diagnosis and to study the types of substances used, so as to facilitate specialized services. The demographics were collected on gender, age, race, residence, employment status, marital status and education.
Method: In this retrospective study, we studied 320 formally and informally admitted patients in Attica Psychiatric Hospital “Dromokaiteio” in Greece during 2017, who were diagnosed with one of the following psychiatric diagnoses: schizophrenia, schizoaffective disorder, bipolar disorder, other affective disorders (e.g. depression), anxiety disorders and mental disorders due to harmful use/abuse of psychoactive drugs (cocaine, cannabis, benzodiazepines, barbiturates, opiates, amphetamines) according to ICD-10. Chi-Square X2, Mann-Whitney, Student’s Test and logistic regression were used with a view to identifying correlations with specific sociodemographic variables: a) in patients with dual diagnosis compared to patients without dual diagnosis, b) in patients with bipolar disorder and substance-related mental disorder compared to patients with psychosis and substance-related mental disorder and c) in patients with mental disorder and substance-related mental disorder compared to patients without drug use psychopathology.
Results: Dual diagnosis was estimated at 29.7%; at 34.7% in patients presenting with schizophrenia, at 33.9% in patients diagnosed with a psychotic spectrum disorder, at 40% in those with a schizoaffective disorder diagnosis, at 23.7% in patients with bipolar disorder and at 26.6% in those diagnosed with other affective disorders. Patients with a psychotic spectrum disorder were frequent cannabis (48, 3%) and alcohol users (26.7%); likewise, patients with a bipolar disorder diagnosis presented with high cannabis and alcohol patterns of use (cannabis at 55.6 % and alcohol at 22.2%). The patients with a dual diagnosis were more frequently male compared to patients without a dual diagnosis (OR=2.543, 95% CI 1.374-4.708, p<0.003) in multivariate analysis. Those living in Athens compared to those living in the countryside had a higher risk of psychosis and drug induced mental disorder (OR=49.072, p-value<0.047). In univariate analysis, the patients with a dual diagnosis were more frequently male, of lower median age compared to patients with mental disorder without a drug use disorder, an association that did reach statistical significance in the multivariate analysis only for the male sex as a risk factor. Male patients are at higher risk of a dual diagnosis compared to female (OR=3.112, p-value<0.001). Admissions due to alcohol induced mental disorder without comorbid psychiatric disorder were 3.8%, elevated at 12.2% when dual diagnosis with alcohol as the predominant abused drug was taken into consideration. 11.6% of all admissions were conducted only due to substance induced mental disorders without comorbidity of mental disorders. Among patients with a mental disorder due to drug use with or without comorbid mental psychiatric disorder, 20.9% used multiple drugs-licit and illicit; whilst 57.4% used only one drug. 10.3% were positive with Hepatitis C virus antibodies.
Conclusion: These results provide evidence of dual diagnosis in a large Psychiatric Hospital in Athens and appear to be in accordance with worldwide literature. It is considerably vital to investigate any possible drug use especially in young, male patients, who are admitted in General or Psychiatric Hospitals, suffering from a psychiatric mental disorder.
Comorbidity, Dual diagnosis, Psychoactive drugs, Alcohol, Mental psychiatric disorder, Psychotic spectrum disorder