In the U.S., criteria for a substance abuse or dependence diagnosis were met by approximately 22.2 million in 2008, while managed healthcare covered 176.3 million Americans. This study examined how risk for substance abuse disorders interacted with age, gender, and mental health and medical comorbidity status to affect behavioral health treatment utilization and cost. Individual impacts include risks to physical and psychological well-being. The disruptive behaviors of substance use disorders influence families through both social impairment and an inability to maintain role functions, leading to discord within couples and an increased risk of cognitive, emotional, and behavioral problems in offspring. Substance use disorders affect businesses through absenteeism, reduced productivity, and termination and new-hire costs. Local, state, and federal governments all attempt to minimize the impact of substance use disorders on communities, which significantly affects the workload and fiscal solvency of those governments through public welfare and law enforcement programs. Treatment of substance use disorders has been shown to effectively mitigate the immediate impacts on individuals, families, and businesses; yet, the impact on governments has not been explored, though they may be inferred to receive some benefit through the same mechanisms by which they are negatively influenced. The study sample consisted of 13,417 adult members of a managed behavioral healthcare company who went to at least one outpatient mental health session and reported a significant level of psychological distress on a self-report measure administered at that session. Substance use risk, age, gender, comorbidity status, treatment utilization, and treatment cost for a four-month period were examined, based on data from that assessment and claims data. Correlations initially ruled out any significant effect of psychological distress on the other predictor variables, indicated that Facility and Other treatment types were highly interrelated, and set the foundation for later multiple regressions. Factor analysis then determined that Facility and Other treatment types were part of a single factor for both treatment utilization and cost; so, these criterion variables were then combined. Multiple regressions then examined the relationships between multiple predictors on each criterion. Results indicated significant relationships for most analyses which was expected given the large sample size, so Cohen's d was used to discuss the relative strength of the effects. No relatively weak results were found between all of the predictor and criterion variables. Suggested causes for this pattern of outcomes included methodological flaws in operationalization or minimal relationship between the constructs of interest and the assessment questions aimed at evaluating those constructs. Future research is discussed in terms of improving methodological problems of the current study. / Counseling Psychology

Schizophrenia is a disease which presents many challenges. Medically, legally, and socially, afflicted individuals face obstacles that decrease their overall quality of life. Some of these are sequela of the disease and its decrease in social functioning, or symptoms of paranoia and disorganization. However, others are placed on these individuals by society. This has created a lifestyle which is marred by comorbid medical conditions and a resistance to receive treatment. It also creates frequent contact with the legal system, leading to a disorganized home life, and a significant amount of time spent behind bars, and being victimized by others. Finally, many schizophrenic patients are unable to find jobs, and report being without significant supportive relationships in their lives, creating stress both on themselves and their families and caregivers. These difficulties in life can be inseparable from their disease and place schizophrenic patients at a further disadvantage. / Urban Bioethics

Bakgrund: Användandet av substanser är ett ökande problem såväl globalt som i Sverige. Förekomsten av samsjuklighet anses vanligt förekommande då individer lider av både psykisk ohälsa och ett substansbrukssyndrom. Patienter med substansbrukssyndrom är i stort behov av att samverkan mellan olika instanser är välfungerande för att få adekvat hjälp i sin situation. Trots lagstiftning kring samverkan har brister uppmärksammats. Syfte: Syftet var att belysa specialistsjuksköterskans erfarenheter av samverkan mellan psykiatrisk vård och andra aktörer när patienter har substansbrukssyndrom. Metod: En intervjustudie med specialistsjuksköterskor som arbetade inom öppen- och sluten psykiatrisk vård. Studien hade en induktiv ansats och grundade sig i Graneheim och Lundmans kvalitativa innehållsanalys. Resultat: I resultatet framkom det erfarenheter av utmaningar i samverkan som delats in bristfällig kunskap, resursbrister, bristande uppföljning efter LVM kopplat till otillräcklig kommunikation samt utmaningar i samsynen kring patientgruppen. Erfarenheter av att främja god samverkan lyfts även i resultatet genom positiva erfarenheter av samverkan samt vikten av att samverka med närstående. Konklusion: Att belysa specialistsjuksköterskans erfarenheter av samverkan kan leda till att specialistsjuksköterskan når en fördjupning och medvetandegör sin kunskap. Detta kan bidra till en säkrare och mer personcentrerad vård för patientgruppen samt att specialistsjuksköterskan synliggör de främjande komponenterna och utmaningarna i samverkan. / Background: Substance abuse is an increasing problem both globally and in Sweden. The occurrence of co-morbidity is considered common when individuals suffer from both mental illness and substance abuse syndrome. Patients with substance abuse syndrome are in great need of well-functioning cooperation between different agencies in order to receive adequate help with their situation. Despite legislation regarding cooperation, shortcomings have been noticed. Purpose: The purpose was to illustrate the specialist nurse's experiences of collaboration between psychiatric care and other actors when patients have substance abuse syndrome. Method: An interview study with specialist nurses who worked in outpatient and inpatient psychiatric care. The study had an inductive approach and was based on Graneheim and Lundman's qualitative content analysis. Results: The results revealed experiences of challenges in cooperation divided into insufficient knowledge, resource shortages, lack of follow-up after LVM linked to insufficient communication and challenges in consensus around the patient group. Experiences in encouraging good collaboration is also highlighted in the results through positive experiences of collaboration and the importance of collaborating with close relatives. Conclusion: Highlighting the specialist nurse's experiences of collaboration can lead to the specialist nurse reaching greater depth in and raising awareness of their knowledge. This can contribute to a safer and more person-centered care for the patient group and that the specialist nurse makes visible the promoting components and the challenges in the collaboration.

Bakgrund: Psykisk ohälsa och substansbruk utgör båda separat globala hälsoproblem. Samsjuklighet i form av psykisk ohälsa och substansbruk är vanligt förekommande och komplexiteten av denna sjukdomsbild utgör utmaningar för hälso- och sjukvården.  Syfte: Studiens syfte var att beskriva upplevelser av möten med omvårdnadspersonal bland personer med samsjuklighet i form av psykisk ohälsa och substansbruk.  Metod: En allmän litteraturstudie genomfördes, i enlighet med Nio-Stegsmodellen av Polit och Beck. Denna översikt inkluderade och metodiskt analyserade nio originalartiklar, med användning av innehållsanalysmetodiken som beskrivits av Graneheim och Lundman.  Resultat: Tre huvudkategorier framträdde: Personen bakom substansbruket, Vårdrelations betydelse och Utmaningar kopplade till samsjuklighet, tillsammans med sex underliggande subkategorier.  Slutsats: Personer med samsjuklighet i form av psykisk ohälsa och substansbruk utgör en komplex patientgrupp. Studiens resultat tyder på att vårdsystemets utformning och upplevd bristande kunskap hos omvårdnadspersonalen utgör hinder för dessa patienter att erhålla adekvat vård. Det krävs en ökad kunskap och förståelse hos omvårdnadspersonal för de unika utmaningar som dessa personer står inför för att bättre kunna möta deras behov. Ytterligare forskning på detta område behövs därmed för att förbättra vården av denna patientgrupp. / Background: Mental health and substance use both separately constitute global health challenges. Comorbidity of mental health issues and substance use is common, and the complexity of this clinical picture poses challenges for healthcare.  Aim: The study's aim was to describe experiences of encounters with nursing staff among individuals with comorbidity of mental illness and substance use.  Method: A general literature review was conducted, adhering to the Nine-Step model by Polit and Beck. This review included and methodically analyzed nine original articles, employing the content analysis methodology outlined by Graneheim and Lundman.  Results: Three main categories were identified: The person behind the substance use, The significance of the care relationship, and Challenges related to comorbidity, along with six associated subcategories.  Conclusions: People with comorbidity in the form of mental disorder and substance use constitute a complex patient group. This study’s results imply that the design of the healthcare system and the perceived lack of knowledge among nursing staff pose barriers for these patients to receive adequate care. There is a need for increased knowledge and understanding among nursing staff regarding the unique challenges faced by these people to better meet their needs. Further research in this area is therefore needed to improve the care of this patient group.

Studien syftar till att få en förståelse för hur socialsekreterare uppmärksammar samsjuklighet hos individer som söker hjälp för beroende. Vidare undersöks hur socialsekreterare upplever mötet med individer som har beroende och som har psykisk ohälsa. Syftet är även att undersöka socialsekreterares upplevelser om vilka faktorer som kan påverka arbetet med samsjuklighet. Studiens empiriska material grundas på kvalitativa, semistrukturerade intervjuer med fem socialsekreterare som har erfarenhet av att arbeta med individer som har samsjuklighet. Tre verksamheter i samma kommun besöktes. Det empiriska materialet grundas också på kunskapsläget inom området. De teoretiska perspektiv som har applicerats är samverkan och stigma. Resultatet visar att socialsekreterare möter i sitt arbete individer som har beroende parallellt med psykisk ohälsa, vilket de identifierar som samsjuklighet. De arbetar med individuella anpassningar utifrån individens situation. Det finns också en viss samverkan mellan socialtjänsten och psykiatrin. Samtidigt pågår det ett samverkansarbete för att utveckla nya arbetssätt som kan användas i samverkan kring individer som har samsjuklighet. Individer som har samsjuklighet är särskilt utsatta och riskerar att hamna mellan verksamheter. De faktorer som kan påverka arbetet med samsjuklighet är individens intelligens, tillgång till bostad, arbete, socialt nätverk och psykiatrikontakt. Socialsekreterares upplevelser kring mötet med individer som har samsjuklighet upplevs som komplext och svårhanterligt. Detta till följd av samsjuklighetens innebörd, avsaknad kunskap samt att samverkansarbetet har problematiserats och att nya arbetssätt utvecklas. / The study aims to gain an understanding of how social workers attend to comorbidities in individuals who search help with their addiction. Furthermore, it is investigated how social workers experience meetings with indviduals who have an addiction and who have mental illness. The aim is also to investigate social workers’ experiences of which factors can affect the work of social harmony. The empirical material of the study is based on qualitative, semi-structured interviews with five social workers who have experiences with individuals comorbidities. Three operations were visited in the same community. The empirical material is also based on the knowledge situation in the field. The theoretical perspectives that have been applied are collaboration and stigma. The results show that social workers that face individuals who have an addiction as well as mental illness, which they identify as a comorbidity. They work with individual adaptations based on the individual’s situation. There is also some interaction between social services and psychiatry. At the same time, there is a collaborative effort to develop new working methods that can be used in collaboration around individuals who have comorbidities. Individuals who have comorbidities are particularly vulnerable and at risk to end up between businesses. The factors that can affect the work with social harmony are the individual’s intelligence, access to housing, work, social network, and psychiatric contact. Social workers experience about meeting with indviduals who have comorbidities are perceived to be complex and difficult. This is because of the meaning of comorbidites, lack of knowledge, and that collaborative work has been problematized and new working methods are being developed.

Bakgrund: Många personer lever med hälsoångest men få vet egentligen vad det innebär för individen själv och individens familj. Hälsoångest som kännetecknas av en stark oro av att ha eller drabbas av sjukdom är relativt nytt även inom sjukvården, varpå personalen behöver få ökad förståelse för personer som lever med hälsoångest. Syfte: Syftet med studien var att belysa erfarenheter hos personer som lever med hälsoångest. Metod: Studien är skriven som en allmän litteraturstudie med induktiv ansats där 12 kvantitativa och två kvalitativa vetenskapliga artiklar inkluderades för att beskriva det aktuella kunskapsläget. Resultatartiklarna analyserades systematiskt och resulterade i fyra kategorier. Resultat: Fyra kategorier framkom ur resultatet: Tidigare trauma, Oro, Informationssökande och Samsjuklighet. I de flesta studierna framkom att livshändelser såväl tidigare som senare i livet påverkade graden av hälsoångest. Oro kring hälsa, psykiatrisk och somatisk samsjuklighet samt informationssökande efter symtom på internet hade stor påverkan på hälsoångest. Konklusion: Hälsoångest är vanligt förekommande bland personer i samhället och utbildning och personcentrerad vård är två sätt att angripa tillståndet på. Vidare saknas kvalitativ forskning inom området vilket hade ökat förståelsen för tillståndet ytterligare. / Background: Many people live with health anxiety, but few know what it means for the individual himself/herself and for their family. Health anxiety, which is characterized by a concern about having or suffering from an illness, is relatively new even in healthcare, and the staff needs to increase understanding of people with health anxiety. Aim: The aim was to shed light on the experiences of people living with health anxiety. Method: The study was written as a general literature study with an inductive approach with 12 quantitative and two qualitative scientific articles to describe the current state of knowledge. The resulting articles were systematically analyzed and resulted in four categories. Results: Four categories emerged from the results: Previous trauma, Worry, Information seeking and Comorbidity. In most of the studies, life events influenced the degree of health anxiety. Concerns about health, psychiatric and somatic comorbidity and searching for information on symptoms on the internet also had a major impact on health anxiety. Conclusion: Health anxiety is common among people in society, and education and person-centered care are two ways to treat the condition. Furthermore, there is a lack of qualitative research, which would have further increased the understanding of the condition.

Untersucht wurde in dieser Studie retrospektiv, ob sich alkoholabhängige Personen mit (n = 42) und ohne (n = 35) komorbide affektive Pathologie hinsichtlich kortikaler und subkortikaler Veränderungen unterscheiden. 3-Tesla MRT-Aufnahmen dieser Patienten, die zwischen 2008 und 2012 eine qualifizierte stationäre Entgiftungsbehandlung erhielten, wurden hierzu herangezogen. Mittels FreeSurfer erfolgten Kortexdickebestimmungen und Segmentierungen neuroanatomischer Strukturen; die statistische Auswertung erfolgte mittels IBM SPSS. Die Ergebnisse zeigen in der Gruppe der nur alkoholabhängigen Personen ein höheres Maß zerebraler Atrophien für das gesamte Gehirn. In keiner Hirnregion wies die Gruppe der Komorbiden geringere kortikale Volumen auf. Kein Gruppenunterschied konnte festgestellt werden für die Abhängigkeitsschweremarker „Dauer der Alkoholabhängigkeit“ und „mittlere tägliche Konsummenge“.

Thesis (Ph. D.)--University of Texas Health Science Center at Houston, School of Public Health, 2008. / "May 2008." Source: Dissertation Abstracts International, Volume: 69-02, Section: B, page: 0912. Adviser: Deanna M. Hoelscher. Includes bibliographical references (leaves 139-149).

Abstract Bullous pemphigoid (BP) is an autoimmune skin disease predominantly found in elderly people, which causes blistering of the skin and severe itching. The incidence of BP reported by previous studies has varied greatly between 0.05 and 42.8 per 1 million persons per year. Higher incidences have been reported in Western Europe and the USA, while countries around the Mediterranean have reported lower rates. However, the epidemiology of BP has not previously been studied in any Scandinavian country. The one-year mortality of BP is highly variable with estimates between 11% and 41% worldwide. As for comorbidities, the previous studies have shown that BP is associated with neurological disorders. The aim of this study was to investigate the incidence and mortality of BP in Finland, to assess the treatments used for BP, and the potential contribution of systemic glucocorticoid treatment to the high mortality rate found in BP patients. A further aim was to obtain more specific information about the neurological diseases associated with BP, and to clarify the less studied association with psychiatric disorders. For these purposes, we collected the records of all immunologically confirmed BP patients diagnosed in the Oulu University Hospital between 1985 and 2012, and, for a sub-study III, data for all patients diagnosed with BP in Finnish hospitals between 1987 and 2013. We found that the incidence of BP in Northern Finland has increased over the past two decades to approximately 27 new BP cases per 1 million persons per year. The one-year mortality of BP patients is 17%, and the standardized mortality ratio (SMR) is 7.6. Common comorbidities found in the sample of BP patients were: cardiovascular diseases (76%), neurodegenerative diseases (41%), skin conditions other than BP (37%) and type 2 diabetes (23%). Many neurodegenerative diseases of the central nervous system were associated with BP, as were many psychiatric disorders. The association was strongest between multiple sclerosis (MS) and BP, with MS patients having almost a 6-fold higher risk of BP than controls. The present study reports for the first time the incidence and mortality of BP in Finland, and provides new information about the association between BP and neurological and psychiatric disorders. / Tiivistelmä Rakkulainen pemfigoidi (josta jatkossa käytetään nimitystä pemfigoidi) on autoimmuunisairaus, joka esiintyy yleensä iäkkäillä, ja aiheuttaa ihon rakkulointia ja hankalaa kutinaa. Aiemmissa tutkimuksissa pemfigoidin ilmaantuvuus on vaihdellut 0,05:sta 42,8:aan tapaukseen miljoonaa ihmistä kohden vuodessa. Ilmaantuvuuden on havaittu olevan korkeampi Länsi-Euroopassa, kun taas Välimeren ympäristössä ilmaantuvuus on matalampi. Pemfigoidia sairastavien kuolleisuus vuoden kuluessa diagnoosista vaihtelee noin 11-41%:n välillä. Aiemmat tutkimukset ovat myös osoittaneet, että pemfigoidi liittyy neurologisiin sairauksiin. Pemfigoidin epidemiologiaa ei ole kuitenkaan tutkittu Suomessa tai muissa Pohjoismaissa. Tämän tutkimuksen tarkoituksena oli selvittää pemfigoidin ilmaantuvuus ja kuolleisuus Suomessa, tutkia sen hoitoon käytettyjä lääkkeitä sekä arvioida systeemisen glukokortikoidihoidon osuutta korkeaan kuolleisuuteen. Lisäksi tavoitteena oli saada yksityiskohtaista tietoa pemfigoidiin liittyvistä neurologisista sairauksista ja selvittää lisää aiemmissa tutkimuksissa ristiriitaiseksi jäänyttä yhteyttä psykiatrisiin sairauksiin. Tätä varten keräsimme tiedot kaikista Oulun yliopistollisessa sairaalassa diagnosoiduista, immunologisesti varmennetuista pemfigoiditapauksista vuosilta 1985-2012. Kolmannessa osatyössä käytimme kansallista aineistoa, joka sisälsi kaikkialla Suomessa diagnosoidut pemfigoidia sairastavat potilaat vuosilta 1987-2013. Pemfigoidin ilmaantuvuus kasvoi seuranta-aikana ollen nykyisin Pohjois-Suomessa noin 27 tapausta miljoonaa ihmistä kohden vuodessa. Kuolleisuus vuoden kuluessa diagnoosista oli 17% ja vakioitu kuolleisuussuhde (standardized mortality ratio) 7,6. Yleisiä oheissairauksia pemfigoidia sairastavilla olivat sydän- ja verisuonisairaudet (76%), neurodegeneratiiviset sairaudet (41%), muut ihosairaudet (37%) sekä tyypin 2 diabetes (23%). Tutkimuksessa todettiin, että monet neurogeneratiiviset sairaudet ja monet psykiatriset sairaudet liittyvät pemfigoidiin. Yhteys oli vahvin pesäkekovettumataudin (MS-tauti) ja pemfigoidin välillä, ja MS-tautia sairastavilla riski sairastua pemfigoidiin oli lähes 6-kertainen verrattuna kontrollipotilaisiin. Tämä tutkimus on ensimmäinen, joka raportoi pemfigoidin ilmaantuvuuden ja kuolleisuuden Suomessa. Tutkimus antaa lisäksi uutta tietoa pemfigoidin yhteydestä neurologisiin ja psykiatrisiin sairauksiin.

The objective of this study was to investigate the utilization of the diagnose-based Charlson Comorbidity Index (CCI) and the medication-based Rx-Risk Comorbidity Index on Swedish administrative data. Data was collected over a ten-year period from the National Patient Register and the National Prescribed Medication Register on 3609 respondents from the national public health survey 2018, aged 16-84 and registered in Stockholm County. The overall aim was to identify comorbid conditions in the study population; and to examine if the identified comorbidities differ between indices, based on subject characteristics such as age and gender. Moreover, the specific aim was to quantify correlation between the indices, as well as within indices over look-back periods of up to ten years. Among the study population, 13 % were identified with at least one comorbid condition through CCI, and 87 % had medications indicative of at least one condition covered by Rx-Risk. Both the original Charlson weights and updated weights by Quan were used to compute the comorbidity scores for CCI. Results showed that when CCI and Quan may have scored low, the Rx-Risk picked up more conditions. The Spearman rank correlation between CCI and Quan scores resulted in relatively high correlation with a coefficient of 0.82 (p-value < 0.05) over look-back periods of 2, 5 and 10 years. Moreover, the correlation between CCI and Rx-Risk was fairly low over all look-back periods with a correlation coefficient of 0.34 (p-value < 0.05) at most. The within-correlation showed that CCI identified much of the comorbidity between the one- and two-year look-back periods, whilst Rx-Risk identified much comorbidity within the one-year look-back period. The overall implications of the presented results are that a utilization of Charlson index and Rx-Risk is likely to capture comorbid conditions in different health care settings, and thus expected correlation is to be of modest level between the two indices. The research question of interest should therefore determine which index is favorable when assessment of comorbidity is desired.