الفهرس 
IntroductionOnly 14 pages are availabe for public view
 |  | from | 177 |  |  |
| | | from | 177 | | |
Abstract
Dual diagnosis is one of the major problems confronting the mental health field.
Individuals with psychiatric disorders are at increased risk for having a comorbid
substance abuse disorder, and vice versa.
The present study was concerned with the prevalence of comorbid psychiatric
disorders among substance abuser subjects, and studying the relationship between the type
of substance and the comorbid psychiatric disorder occurred and searching for specific
risk factors that can cause this comorbidity.
The studied group was 120 Egyptian subjects. Their age range between 18-50 years
old and both sexes were included. They were fulfilling the criteria for substance abuse
according to DSM-IV-TR criteria. They were selected from both inpatients of the
Addiction Centre and from psychiatric outpatient clinic of Neuro-Psychiatry Department
in Menoufia University Hospitals. The study was a cross sectional study that was
conducted in the context of time frame of 18 months (starting on the 1st of July, 2011 till
the end of December of 2012)
After taking oral consent from each subject under the study, the participants were
evaluated through using semi structured interview sheet that gather general data as well as
the drug habits of the patients (type of drug, route of administration, dose…etc.), Fahmy
and El-Sherbini’s Social Classification Scale that evaluate the social class, Structured
Clinical Interview for DSM-IV (SCID I) to diagnose psychiatric disorders, Structured
Clinical Interview for DSM-IV axis II disorders (SCID II) to assess the DSM IV
personality disorders, Addiction severity Index scale to provide a multidimensional
assessment for the problems presented by patients with substance abuse disorder and a
urine screening for substances of abuse.
SUMMARY
138
The main findings of the present study were as follow:
• Descriptive data:
The mean age of onset of substance abuse was 25 years. The prevalence of
substance abuse was as follow: opiods abuse (especially tramadol tablets) were the most
prevalent substance of abuse both currently and lifetime. Followed by polydrugs abuse
then sedatives abuse, cannabis abuse, and alcohol abuse both currently and lifetime. The
least frequent substance of abuse was inhalant abuse.
The severity of substance abuse according to Addiction Severity Index Scale was as
follow: Psychological dimension was the most considerable problem in studied subjects
followed by drug use dimension, family & social dimension and legal dimension. While
employment& support and medical status were the least considerable problem in various
dimensions of the ASI scale.
Regarding the prevalence of psychiatric disorders among studied group according
to Structured Clinical Interview for DSM-IV (SCID I& SCID II); 63 % had comorbid
psychiatric disorder. The prevalence of mood disorders was as follow; 20% had substance
induced mood disorders, 10% had major depressive disorders and 3-5 % had bipolar
disorders. The prevalence of anxiety disorders was as follow; 17% had substance induced
anxiety disorder, 7% had generalized anxiety disorder (GAD) and 7% had lifetime O.C.D.
the prevalence of psychotic disorders was as follow; 7-12% had substance Induced
psychotic disorder and 3% had schizophrenia. The prevalence of personality disorders, 63
% had comorbid personality disorders (35 % had antisocial PD, 17% had borderline PD, 3
% had passive aggressive PD, 2 % had dependant PD, and 3 % had depressive PD).
• The relation between type of abused substance and the comorbid psychiatric disorders
The study showed highly significant relationship between alcohol abuse and
substance induced anxiety disorders, generalized anxiety disorder, obsessive compulsive
disorder and antisocial PD.
There were significant relationship between cannabis abuse and major depressive
disorder, dysthymia, substance induced psychotic disorders, schizophrenia, and substance
induced anxiety disorders, somatization disorder and dependent PD.
Also, significant relationships were found between opioid abuse and major
depressive disorders, bipolar II disorders and both borderline PD and antisocial PD.
There were significant relationships between sedatives abuse and substance induced
anxiety disorder, obsessive compulsive disorder, generalized anxiety disorder, panic
disorders and borderline PD. Also, a significant relationship was found between
polysubstance abuse and substance induced anxiety disorder.
• Comparison between subjects having comorbid Axis-I and subjects without
comorbid Axis-I
Substance abuse subjects with comorbid Axis-I disorders have significant young age
(<25 years old) , family history of alchol abuse , higher affection of family & social
dimensions of addiction severity Index scale and most of them are single compared to
subjects without comorbid Axis-I disorders.
• Comparison between subjects having comorbid Axis-II and subjects without
comorbid Axis-II
In the present study, the most prevalent personality disorders were Borderline PD
and Antisocial PD.
Illiteracy and higher affection in legal dimension in addiction severity index scale
were significantly higher among subjects with comorbid borderline PD than those without
comorbid personality disorders.
Substance abuse subjects with comorbid antisocial P.D. disorder have significant
young age (<25 years old), low social class, higher prevalence of outpatient treatment
programs, higher affection in family & social dimensions of addiction severity Index scale
and most of them are single and illiterate compared to subjects without comorbid
personality disorders.
• Risk factors for different substance abuse.
On studying risk factors for different substance abuse in studied subjects, mood
disorders especially major depressive disorders were the strongest predictor of alcohol
abuse, followed by Anxiety disorders.
Also, dependent personality disorder was the strongest predictor of cannabis abuse
followed by schizophrenia. Also, mood disorders especially major depressive disorders were the strongest predictor of opioid abuse followed by borderline personality disorders.
Also, substance induced anxiety disorder was the strongest predictor of sedative abuse
followed by borderline personality disorder.
• Risk factors for comorbid psychiatric disorders (axisI& axisII)
On studying risk factors for comorbid psychiatric disorders in studied subjects ,
younger age(less than twenty five years old) was the strongest predictor of comorbid axis I
disorders followed by higher severity of family & social dimensions in ASI scale then
single subjects (marital status).
Also, male sex and younger age (less than twenty five years old) were independent
risk factor for comorbid antisocial personality disorders followed by low social class.
Also, higher severity of legal and psychiatric dimension in addiction severity index scale
was independent risk factor for comorbid borderline personality disorders followed by
illiteracy .