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Precision Psychiatry and Dual Disorders

Nestor Szerman & Lola Peris. J Dual Diagn, 2019 Jan 14 :1-10 (Epub ahead of print). doi: 10.1080/15504263.2018.1512727.

 

Abstract :

Objective: Addiction co-occurs with distinct pathological personality traits, other psychiatric

disorders or symptoms and cognitive impairment, which are known as dual disorders or cooccurring disorders. This symptomatic high concurrency suggests that both conditions are

in some ways causally linked. Research is ongoing to identify distinctive neurobehavioral

mechanisms and endophenotypes that predispose individuals to compulsive drug use and other mental disorders. Research is also providing new revelations about the diverse effects

of substances on individuals, including differences according to sex. Today we know that the same substance may give rise to different behavioral, affective, cognitive, and sensory

effects across different individuals.

Methods: This state-of the art review tends to address the concept of precision psychiatry and dual disorders. The PubMed database was searched for the last 15 years to identify those articles that reported neurobiological perspectives on dual disorders, addiction and other mental disorders, precision medicine, and precision psychiatry.

Results: There has been considerable progress made in recent years in relation to the study of addiction and dual disorders. The concept of dual disorders attempts to capture not only the persistence of substance use and substance seeking but also the evident vulnerability of specific subpopulations to switch from controlled to compulsive drug use. Precision medicine is focused on identifying this individual vulnerability to illness as much as the individual response to treatment. Psychiatry is fully committed to this goal. Regarding addiction, essential precision medicine advances will be possible if concerted efforts are made in the discovery of biological variations and environmental factors that contribute to individual vulnerability to addictive disorders and dual disorders, together with the identification of moderators of treatment response.

Conclusions: Here we survey the discoveries, future research directions, and translational relevance of the concept of precision psychiatry for dual disorders. The review may offer new perspectives on this issue and highlight a new way to see and to think about dual disorders.

The implementation and first insights of the French-speaking Swiss programme for monitoring self-harm

Ostertag Louise, Golay Philippe, Dorogi Yves, Brovelli Sebastien, Bertran Marta, Cromec Ioan, Van Der Vaeren Bénédicte, Khan Riaz, Costanza Alessandra, Wyss Karine, Edan Anne, Assandri Francesca, Barbe Rémy, Lorillard Solenn, Saillant Stéphane, Michaud Laurent. Swiss Med Wkly, Feb. 2019. doi:10.4414/smw.2019.20016 (open access)

 

Abstract :

Aims of the study: Self-harm is a major risk factor for suicide but remains poorly documented. No data on self-harm in French-speaking Switzerland exist. To address this deficiency, the Swiss Federal Office of Public Health commissioned a specific self-harm monitoring programme. We present and discuss its implementation and first findings.

Methods: Every patient aged 18–65 years presenting for self-harm to the emergency departments of the Lausanne and Neuchâtel general hospitals were included in the monitoring programme over a 10-month period (December 2016 to September 2017). Clinicians collected anonymous sociodemographic and clinical data.

Results: The sample included 490 patients (54.9% female and 45.1% male) for 554 episodes of self-harm, showing a higher proportion of patients aged 18–34 (49.2%) than older age groups (35–49, 33.7% and 50–65, 17.1%). Patients were mostly single (56.1%) and in problematic socioeconomic situations (65.7%). Self-poisoning was the most commonly used method (58.2%) and was preferred by women (71% of females and 42.5% of males, Fisher’s exact test, p <0.001) and the majority of patients (53.3%) had experienced at least one previous episode of self-harm. The self-harm rate was 220 per 100,000 inhabitants in Lausanne and 140 in Neuchâtel. Suicidal intent was clear for 50.6% of the overall sample, unclear for 25.1% and absent for 24.3%. It differed significantly between sites (?2(2) = 9.068, p = 0.011) as Lausanne reported more incidents of unclear intent (27.7% versus 17.4% in Neuchâtel) and Neuchâtel more incidents with absence of intent (33.1% versus 21.3% in Lausanne). In Lausanne, patients more frequently resorted to methods such as jumping from a height (11.4%) and hanging (9%) than in Neuchâtel (1.6% and 4.9%, Fisher’s exact test, p = 0.006).

Conclusions: Our results are globally consistent with previous research on self-harm. We found significant intersite differences in methods, suicidal intent and self-harm rates. Our findings highlight the importance of implementing local self-harm monitoring to identify specific at-risk groups and develop targeted preventive intervention.

 

 

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Projets en cours

Gender differences in sleep disturbances perception in dual disorders patients

A cognitive training program for ADHD (collaboration avec l’Université de Fribourg)

Clinical efficacy of a structured group psychoeducation program for patients with schizophrenia

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