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K T Brady

Publications and source records attributed to K T Brady.

At least 37 records · Page 2Linked to original sources
PubMed2000

Comorbidity of psychiatric disorders and posttraumatic stress disorder.

Posttraumatic stress disorder (PTSD) commonly co-occurs with other psychiatric disorders. Data from epidemiologic surveys indicate that the vast majority of individuals with PTSD meet criteria for at least one other psychiatric disorder, and a substantial percentage have 3 or more other psychiatric diagnoses. A number of different hypothetical constructs have been posited to explain this high comorbidity; for example, the self-medication hypothesis has often been applied to understand the relationship between PTSD and substance use disorders. There is a substantial amount of symptom overlap between PTSD and a number of other psychiatric diagnoses, particularly major depressive disorder. It has been suggested that high rates of comorbidity may be simply an epiphenomenon of the diagnostic criteria used. In any case, this high degree of symptom overlap can contribute to diagnostic confusion and, in particular, to the underdiagnosis of PTSD when trauma histories are not specifically obtained. The most common comorbid diagnoses are depressive disorders, substance use disorders, and other anxiety disorders. The comorbidity of PTSD and depressive disorders is of particular interest. Across a number of studies, these are the disorders most likely to co-occur with PTSD. It is also clear that depressive disorder can be a common and independent sequela of exposure to trauma and having a previous depressive disorder is a risk factor for the development of PTSD once exposure to a trauma occurs. The comorbidity of PTSD with substance use disorders is complex because while a substance use disorder may often develop as an attempt to self-medicate the painful symptoms of PTSD, withdrawal states exaggerate these symptoms. Appropriate treatment of PTSD in substance abusers is a controversial issue because of the belief that addressing issues related to the trauma in early recovery can precipitate relapse. In conclusion, comorbidity in PTSD is the rule rather than the exception. This area warrants much further study since comorbid conditions may provide a rationale for the subtyping of individuals with PTSD to optimize treatment outcomes.

Anxiety Disorders↗
PubMed2000

Difficulties in diagnosis and management of bipolar disorder: three case presentations.

Bipolar disorder is associated with significant problems in patient management, including misdiagnosis, noncompliance, and comorbid substance use disorders. This article describes strategies for the management of difficult cases, with particular emphasis on the choice of therapeutic agents, such as mood stabilizers and atypical antipsychotics, for optimal control of symptoms and psychosocial interventions for reinforcement of therapeutic interventions. Special attention is given to the relationship between bipolar disorder and substance use disorders.

Adult↗
PubMed1999

Gender differences in substance use disorders.

Despite the fact that the rate of substance abuse and dependence is higher among men than it is among women, the prevalence rates, especially the more recent ones, indicate that a diagnosis of substance abuse is not gender specific. From the emerging literature on gender differences over the past 25 years, male and female substance abusers are clearly not the same. Women typically begin using substances later than do men, are strongly influenced by spouses or boyfriends to use, report different reasons for maintaining the use of the substances, and enter treatment earlier in the course of their illnesses than do men. Importantly, women also have a significantly higher prevalence of comorbid psychiatric disorders, such as depression and anxiety, than do men, and these disorders typically predate the onset of substance-abuse problems. For women, substances such as alcohol may be used to self-medicate mood disturbances, whereas for men, this may not be true. Although these comorbid disorders might complicate treatment for women, women are, in fact, responsive to treatment and do as well as men in follow-up. Gender differences and similarities have significant treatment implications. This is especially true for the telescoping phenomenon, in which the window for intervention between progressive landmarks is shorter for women than for men. This is also true for the gender differences in physical and sexual abuse, as well as other psychiatric comorbidity that is evident in female substance abusers seeking treatment. The barriers to treatment for women are being addressed in many treatment settings to encourage more women to enter treatment, and family and couples therapy are standard therapeutic interventions. Negative consequences associated with substance abuse are different for men and women, and gender-sensitive rating instruments must be used to measure not only the severity of the problem but also to evaluate treatment efficacy. To determine whether gender differences observed over the past 25 years become less demarcated in comparisons of younger cohorts of substance abusers in the future will be interesting. Changing societal roles and attitudes toward women, the increase in women entering the workplace, in general, and into previously male-dominated sports and professions, in particular, may influence not only opportunities to drink but also drinking culture. Some gender differences likely will remain, but other gender differences will probably also emerge. The comparison of male and female substance abusers promises to be a fruitful one for researchers. The translation if the research findings to the treatment community to improve treatment outcome for both sexes will be an equally exciting challenge for the field.

Alcohol Drinking↗
PubMed1999

Substance abuse and bipolar comorbidity.

Bipolar disorder and substance abuse commonly co-occur. In fact, as many as 50% of individuals with bipolar disorder have been found to have a lifetime history of substance abuse or dependence. This article discusses the very important comorbidity of bipolar disorder as it is complicated by substance abuse, focusing on the prevalence, course, diagnostic considerations and treatment.

Anti-Anxiety Agents↗
PubMed1999

Substance abuse and emergency psychiatry.

Given the high rates of comorbidity, patients commonly present with multiple diagnoses to PESs or crisis services. Clinicians must be well versed in the evaluation, differential diagnosis, and treatment of patients with substance-abuse disorders or other Axis I, II, or III conditions if they are to provide state-of-the-art treatment of patients in need of emergency care.

Adult↗
PubMed1999

HIV-risk behaviors in adolescent substance abusers.

Thirty adolescents aged 12-18 years from each group (substance use disorders, psychiatric disorders, and controls) were assessed to explore HIV-risk behaviors and knowledge about HIV/AIDS. Semi-structured instruments for psychiatric and substance use disorders were also administered. There were no significant differences between groups in knowledge of HIV/AIDS. However, chi-square analysis of risk behaviors revealed significant differences between the substance use disorders group and the controls. The knowledge-behavior gap was greater for the substance users than all other groups, in that while they knew an equal amount about HIV/AIDS, they actually engaged in more risky sexual behaviors than the other two groups. It may be that the impulsivity associated with substance use disorders accounts for this difference. It is recommended that HIV/AIDS prevention education and impulse control strategies are included in the treatment of adolescents with substance use disorders.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Intimate violence and post-traumatic stress disorder among individuals with cocaine dependence.

Intimate physical assault and post-traumatic stress disorder (PTSD) were assessed in a sample of 91 adults seeking treatment for cocaine dependence. Physical assault included self-report of aggravated assault with a weapon, aggravated assault without a weapon, and simple assault. PTSD was assessed with a structured interview. Overall, 85.7% of the participants reported having been physically assaulted at least once during their lifetime. Slightly less than half of these individuals (46.2%) reported physical assault by an intimate partner. Close to half also met criteria for PTSD at some point in their lives. Women were more likely than men to be physically assaulted by an intimate partner and to report PTSD. Men who experienced physical assault by an intimate were more likely to report PTSD than men assaulted by others. Male victims of intimate violence had higher scores on certain subscales measuring addiction severity than male victims assaulted by others. Findings suggest careful assessment of intimate violence is essential given its high prevalence among cocaine-dependent women and men and its association with PTSD.

Adult↗
PubMed1999

Attention-deficit/hyperactivity disorder and substance use: symptom pattern and drug choice.

While there has been much recent interest in the relationship between attention-deficit/hyperactivity disorder (ADHD) and substance use disorders (SUDs), little has been reported about ADHD diagnostic subtypes, persistence of symptoms from childhood into adulthood, and substance of choice in individuals with substance use disorders (SUD+) and comorbid ADHD. To examine the prevalence and subtypes of ADHD in a group of SUD+ individuals, 136 inpatients with an SUD diagnosis (cocaine vs. alcohol vs. cocaine/alcohol) were administered a structured interview for ADHD. Of the SUD+ individuals, 32% met criteria for ADHD, and 35% of those with a childhood diagnosis of ADHD continued to have clinically significant symptoms into adulthood. There were no significant differences in the percentage of ADHD between the SUD+ groups divided by drug choice. Of ADHD subtypes, subjects with combined and inattentive types were significantly more likely to have symptoms continue into adulthood (p < or = .05) than the hyperactive/impulsive subtype. Patients with cocaine use were more likely to have ADHD in childhood only when compared to the alcohol or cocaine-alcohol groups. The findings of this study indicate that ADHD is prevalent in treatment-seeking substance users without difference in prevalence or subtype by drug choice.

Adult↗
PubMed1999

A review of bipolar disorder among adults.

OBJECTIVE: This paper reviews the epidemiology, etiology, assessment, and management of bipolar disorder. Special attention is paid to factors that complicate treatment, including noncompliance, comorbid disorders, mixed mania, and rapid cycling. Advances in biopsychosocial treatments are briefly reviewed, including new health service models for providing care. METHODS: A MEDLINE search was done for the period from January 1988 through October 1997 using the key terms of bipolar disorder, diagnosis, and treatment. Papers selected for further review included those published in English in peer-reviewed journals. Preference was given to articles reporting randomized, controlled trials. RESULTS: Bipolar disorder is a major public health problem. The etiology of the disorder appears multifactorial. Diagnosis often occurs years after onset of the disorder. Comorbid conditions are common. Management includes a lifetime course of medication and attention to psychosocial issues for patients and their families. Standardized treatment guidelines for the management of acute mania have been developed. New potential treatments are being investigated. CONCLUSIONS: Assessment of bipolar disorder must include careful attention to comorbid disorders and predictors of compliance. Randomized trials are needed to further evaluate the efficacy of medication, psychosocial interventions, and other health service interventions, particularly as they relate to the management of acute bipolar depression, bipolar disorder co-occurring with other disorders, and maintenance prophylactic treatment.

Adult↗
PubMed1999

The role of stress in alcohol use, alcoholism treatment, and relapse.

Addiction to alcohol or other drugs (AODs) is a complex problem determined by multiple factors, including psychological and physiological components. Stress is considered a major contributor to the initiation and continuation of AOD use as well as to relapse. Many studies that have demonstrated an association between AOD use and stress have been unable to establish a causal relationship between the two. However, stress and the body's response to it most likely play a role in the vulnerability to initial AOD use, initiation of AOD abuse treatment, and relapse in recovering AOD users. This relationship probably is mediated, at least in part, by common neurochemical systems, such as the serotonin, dopamine, and opiate peptide systems, as well as the hypothalamic-pituitary-adrenal (HPA) axis. Further exploration of these connections should lead to important pharmacological developments in the prevention and treatment of AOD abuse. Studies indicate that treatment techniques which foster coping skills, problem-solving skills, and social support play a pivotal role in successful treatment. In the future, individualized treatment approaches that emphasize stress management strategies in those patients in whom a clear connection between stress and relapse exists will become particularly important.

Alcoholism↗
PubMed1998

Screening for PTSD in a substance abuse sample: psychometric properties of a modified version of the PTSD Symptom Scale Self-Report. Posttraumatic stress disorder.

The high rate of posttraumatic stress disorder (PTSD) among substance use disorder (SUD) patients has been documented in research protocols, but there is evidence that it is markedly under-diagnosed in clinical settings. To address the need for a brief self-report measure to identify SUD patients who may benefit from further assessment and/or treatment for PTSD, the psychometric properties of a modified version of the PTSD Symptom Scale Self-Report (PSS-SR) were examined in a treatment-seeking SUD sample (N = 118). The modified version of the PSS-SR, which measures both frequency and severity of PTSD symptoms, demonstrated good internal consistency reliability and was correlated with other self-report measures of trauma-related symptomatology. Comparisons between a structured PTSD diagnostic interview and the modified PSS-SR indicated that 89% of the PTSD positive patients were correctly classified by the modified PSS-SR. The clinical relevance of these findings was discussed.

Adolescent↗
PubMed1998

Diagnosis of personality disorders in cocaine-dependent individuals.

The authors explored the relationship between personality disorder (PD) and cocaine use. Diagnostic interviews for PD were performed at baseline and 12 weeks (study termination) in 47 cocaine-dependent individuals entering a pharmacologic treatment trial; 68% met criteria for a PD at baseline, 51% at study termination. In comparing baseline and termination PD, 22 individuals had no change in the number of PDs, 6 had more, and 17 had fewer. The group with an increase in the number of PD diagnoses had more positive urine drug screens than either of the other groups and more cocaine use by self-report. Personality disorders appear to be common in cocaine-dependent individuals but may be affected by cocaine use and withdrawal.

Adult↗
PubMed1998

Substance use disorders in an adolescent inpatient psychiatric population.

This study examined the comorbidity of substance use disorders and other psychiatric disorders in adolescent populations. The study population was comprised of 100 consecutive admissions, ages 13 to 17, to an acute care adolescent psychiatric inpatient unit for substance use disorders. Patients were assessed using the Personal Experience Screening Questionnaire (PESQ) and the substance-use disorder portion of the Structured Clinical Interview for DSM III-R (SCID-R). Thirty-three (33%) patients were identified as having a substance abuse or dependence diagnosis. There was no significant difference in the age between substance users and nonsubstance users. There were significantly more whites in the substance-using group. Sixty percent of all adolescents interviewed had histories of sexual or physical trauma, with trauma being significantly more common in the substance-using group. There were no significant differences in the number or type of other Axis I or Axis II diagnoses between the two groups. While substance users and nonsubstance users had no significant difference in the number of past psychiatric hospitalizations, nonsubstance users had significantly more past medical hospitalizations. These results indicate that high rates of comorbid substance abuse and psychiatric disorders exist in adolescents, and more in-depth study of comorbidity among adolescents is warranted.

Adolescent↗
PubMed1998

Posttraumatic stress disorder and cocaine dependence. Order of onset.

To investigate differences between patients whose posttraumatic stress disorder (PTSD) preceded their cocaine dependence and vice versa, 33 patients with comorbid PTSD and cocaine dependence were divided into two groups: one in which the traum and PTSD occurred before onset of cocaine dependence (primary PTSD) and one in which the PTSD occurred after cocaine dependence was established (primary cocaine). In the primary-PTSD group, the trauma was generally childhood abuse. In the primary-cocaine group, the trauma was generally associated with the procurement and use of cocaine. In the primary PTSD group, there were significantly more women, more other Axis I diagnoses, more Cluster B and C Axis II diagnoses, and more benzodiazepine and opiate use. In the primary-cocaine group, there was a trend toward more cocaine use in the previous month. Significant clinical differences between these two groups may warrant different types of treatment or differing treatment emphasis.

Adult↗
PubMed1998

The relationship between substance use disorders, impulse control disorders, and pathological aggression.

The authors examine the relationship between substance use disorders, impulse control disorders (ICDs), and pathological aggression. Phenomenologic evidence, neurobiologic evidence, and comorbidity data, as well as evidence from the pharmacotherapy of aggression and impulse control and substance use disorders, suggest links between substance use, impulsivity, and pathologic aggression. There also is evidence suggesting that dysfunction in common neurotransmitter systems, particularly the serotonin and GABAergic systems, may be involved in both disorders. Serotonergic agents have been explored in the treatment of ICDs, pathological aggression, and substance use disorders. Mood-stabilizing anticonvulsant have GABAergic activity, have received preliminary exploration in the treatment of ICDs and aggression in a number of psychiatric disorders. There is also evidence that these agents may be useful in subgroups of individuals with substance use disorders.

Aggression↗
PubMed1997

Posttraumatic stress disorder and substance abuse: use of research in a clinical setting.

The goal of the present investigation was to evaluate whether the process of assessing posttraumatic stress disorder (PTSD) in substance abuse/dependence inpatients (N = 95) as part of a research protocol influenced the diagnostic assessment conducted by clinical staff. The prevalence of current crime-related PTSD (CR-PTSD) observed with a research interview was 40% (n = 38), whereas the rate of current CR-PTSD documented in (the same) patients' discharge summaries was 15% (n = 14). An even lower CR-PTSD prevalence rate of 8% (n = 5) was obtained from a new sample of patient discharge summaries (N = 59) collected after the cessation of the research project. On chart intake reports, clinical staff documented a history of sexual and/or physical assault in approximately one-half of these patients, but PTSD was not evaluated. PTSD appears to be under-diagnosed by clinical staff in patients with substance use disorders.

Adolescent↗