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Winter 2010-11, Vol 14 No 2

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Research Update


By Hema Zbogar



Conduct disorder linked to ADHD and adult substance use disorders

Research from the New York University School of Medicine indicates that adolescent attention-deficit/hyperactivity disorder (ADHD) increases the likelihood of substance use disorders in adulthood, with the relationship being mediated by conduct disorder. Researchers followed 485 individuals for almost 25 years, with two initial assessments at ages 14 and 16 and three outcome assessments between age 27 and 37. At the first two assessments, 12 per cent of adolescents were diagnosed with ADHD and an additional 12 per cent with conduct disorder. The three adult assessments determined that 11 per cent of participants had substance use disorders (SUDs). Participants who had adolescent ADHD were almost twice as likely as those who did not have ADHD to develop SUDs as adults, but this result was not statistically significant when conduct disorder was controlled for. Those who had adolescent conduct disorder were 3.5 times more likely than those without conduct disorder to develop adult SUDs, and this result remained significant when adolescent ADHD was controlled for. Given that adolescents with ADHD were almost 6.5 times more likely than those without to have a conduct disorder, the findings point to conduct disorder mediating the relationship between adolescent ADHD and adult SUDs.

Archives of Pediatrics and Adolescent Medicine, October 2010, v. 164(10): 930–934. David W. Brook et al., Department of Psychiatry, New York University School of Medicine, New York, New York.



Alcohol problems increase risk of early death

Researchers at the University of Munich have found more evidence that people with alcohol problems have an increased risk of early death. The researchers recruited 1,465 individuals in rural Bavaria over age 15 and tracked them for 20 years. Participants were initially assessed for alcohol problems using the Munich Alcoholism Test. Almost two per cent of participants were classified as having severe alcohol problems, while four per cent were deemed to have moderate alcohol problems. By the end of the study, 448 participants had died, including 11 of the 24 participants with severe alcohol problems, 21 of the 59 with moderate problems and 416 of the 1,382 with no alcohol problems. Participants with severe alcohol problems turned out to be 2.4 times more likely than those with no alcohol problems to die over the course of the study. Those with moderate problems were 1.5 times more likely to die, although this result was not statistically significant. The authors conclude that discussions of mortality risk for people with alcohol problems should consider the degree of the severity of alcohol problems, rather than focusing exclusively on severe alcoholism or severe alcohol consumption. They recommend further research to determine whether comparable results can be found in urban settings.

European Archives of Psychiatry and Clinical Neuroscience, September 13, 2010 online, doi:10.1007/s00406-010-0141-y. Manfred M. Fichter et al., Department of Psychiatry, University of Munich, Germany.



Cultural differences found in hallucinations that accompany schizophrenia

The hallucinations experienced by people with schizophrenia vary considerably from culture to culture, according to research from the Medical University of Vienna. The study assessed the one-year prevalence of hallucinations in 1,080 individuals with schizophrenia from Austria, Poland, Lithuania, Georgia, Pakistan, Ghana and Nigeria. Auditory hallucinations were the most prevalent type in all countries, with the highest rates in Ghana and Nigeria (91% and 85%) and the lowest rate in Austria (67%). Visual hallucinations were most frequent in Ghana and Nigeria (54% and 51%) and least frequent in Pakistan (4%). Rates for the European countries ranged between 45 per cent for Poland and 10 per cent for Georgia (classified as European in this study). Cenesthetic hallucinations (relating to the overall sense a person has of their body, resulting from the functioning of their organs) were most frequent in Ghana, followed by the European countries. Hallucinations relating to the senses of smell and taste were most common in European countries. There were no significant country differences for tactile hallucinations. The authors hypothesize that the wide variation in rates of visual hallucinations results from “cultural differences in perceptual and attentional processing” between Westerners and East Asians and that the high rates in West Africa may have to do with a non-Western orientation toward the perceptual (concrete) rather than the conceptual (abstract) aspect of the environment.

Comprehensive Psychiatry, September 6, 2010 online, doi:10.1016/j.comppsych.2010.06.008. Susanne M. Bauer et al., Department of Psychiatry and Psychotherapy, Medical University of Vienna, Austria.



Depressed medical students more likely to self-stigmatize

Medical students are known to have higher rates of depression, suicidal thoughts and suicide than the general population; yet they are less likely to receive treatment despite presumably having better access to it. New research from the University of Michigan points to a possible explanation for this paradox, indicating that depressed medical students are more likely than their non-depressed peers to agree with statements stigmatizing depression. Researchers surveyed 769 medical students enrolled in the university’s medical school. Participants were assessed for depression and were asked whether they agreed or disagreed with 27 statements about stigma and depression. The rate of moderate to severe depression among female participants was 18 per cent, compared with nine per cent among males. Suicidal thoughts were more frequently reported by third- and fourth-year students than by those in their first and second years (8% versus 1%). Students with moderate to severe depression were more likely than those with no to minimal depression to agree that, if they were depressed, other students and faculty would consider them unable to handle their responsibilities (83% versus 55%). They were also more likely to believe that fellow medical students would respect their opinions less (56% versus 24%). Male students were more likely than females to believe that depressed students represented a danger to their patients (36% versus 20%). Students with high depression scores were less inclined than those with low scores to say they would seek treatment for depression (47% versus 87%). In fact, between 70 and 80 per cent of them reported that they had never been diagnosed or treated for depression. According to the authors, these findings point to the need for new approaches “to reduce the stigma of depression and to enhance its prevention, detection, and treatment.”

Journal of the American Medical Association, September 15, 2010, v. 304 (11): 1181–1190. Thomas L. Schwenk et al., Department of Family Medicine, University of Michigan, Ann Arbor, Michigan.



Mobile outreach helps sex workers access addiction treatment

A peer-led mobile outreach program increases the likelihood that sex workers who use drugs will enter addiction treatment, according to research from the University of British Columbia in Vancouver. Researchers interviewed 242 female sex workers at the beginning of the study and bi-annually over 18 months, resulting in a total of 479 reports. Over the course of the study, 42 per cent of the reports indicated that the respondent had used Vancouver’s Mobile Access Project van (the “MAP van”), which operates overnight and is staffed by a driver, a support worker and a peer support worker. Women who used the MAP van were more likely to be at high risk: they were more likely to have had 10 or more clients in the previous week and to solicit clients in isolated settings such as alleys, side streets or industrial areas. A total of 45 reports indicated use of inpatient addiction treatment services (detoxification or residential drug treatment), while 161 reports indicated use of outpatient services (methadone or substance use counselling). Women who used the MAP van were more than four times as likely to access inpatient addiction treatment as women who did not use the MAP van. They were also six times more likely to use a substance use counsellor. The authors conclude that mobile outreach programs play a critical role in reaching sex workers “where and when they work,” thus facilitating access to addiction treatment.

Drug and Alcohol Dependence, 2010, doi:10.1016/j.drugalcdep.2010.07.007. Kathleen N. Deering et al., School of Population and Public Health, University of British Columbia, Vancouver, British Columbia.



Emphasizing neurobiology may not reduce stigma

The emphasis placed on the neurobiological basis of mental illness over the last two decades by advocates, policy makers and health care professionals may be doing little to reduce stigma, according to researchers at Indiana University. The researchers interviewed almost 2,000 members of the public in 1996 and 2006. A neurobiological cause for schizophrenia was endorsed by 86 per cent of participants in 2006, up from 76 per cent in 1996. The comparable figures for depression were 54 per cent in 1996 and 67 per cent in 2006. Endorsement rates for a neurobiological cause of alcohol dependence rose from 38 per cent in 1996 to 47 per cent in 2006. However, the belief that alcohol dependence was due to bad character also increased, from 49 per cent in 1996 to 65 per cent in 2006. The number of participants who endorsed medical treatment increased for all three conditions; however, it was only for schizophrenia that a majority endorsed hospitalization, increasing from 53 per cent in 1996 to 66 per cent in 2006. Despite these mostly positive trends, there were no significant decreases in stigma. In fact, there were sizeable increases in the number of participants who indicated that they would be reluctant to have a person with schizophrenia as a neighbour or have a person with alcohol dependence marry into their family. There was a general increase in all stigmatizing attitudes related to schizophrenia. The authors suggest that efforts to reduce stigma may have to shift their focus to an emphasis on the abilities, competences and community integration of people with mental illness in order to be more successful.

American Journal of Psychiatry, September 15, 2010 online, doi: 10.1176/appi.ajp.2010.09121743. Bernice A. Pescosolido et al., Schuessler Institute for Social Research, Indiana University, Bloomington, Indiana.



Supervised injection facilities help drug users quit

Supervised injection facilities appear to promote increased use of addiction treatment, increasing the likelihood that individuals will stop injection drug use, according to research from St. Paul’s Hospital in Vancouver, British Columbia. The study followed 902 people who visited a supervised injection facility in Vancouver between December 2003 and June 2006. After two years of enrolment in the study, 57 per cent of participants had entered injection treatment, and 23 per cent had stopped injection drug use for at least six months. Those who were regular facility users and those who had regular contact with addiction counsellors at the facility were more likely to have entered addiction treatment. Study participants who were engaged in sex work or who were aboriginal were less likely to enter treatment. The authors note that the provision of a safe space for injection drug use is believed to draw a hidden population of injection drug users into health care settings, and that this may lead users to stop injection drug use. Commenting on the finding that aboriginal participants were less likely to enter treatment, the authors conclude that there is a “need for innovative and culturally appropriate addiction treatment services developed with full consultation with Aboriginal people who use drugs.”

Drug and Alcohol Dependence, August 30, 2010 online, doi:10.1016/j.drugalcdep.2010.07.023. Kora DeBeck et al., B.C. Centre for Excellence in HIV/AIDS, St. Paul’s Hospital, Vancouver, British Columbia.