Shamil Wanigaratne

Cognitive impairment in dual diagnosis inpatients with schizophrenia and alcohol use disorder

Cognitive impairment has been found independently among individuals with schizophrenia and individuals with alcohol use disorders. Less is known about the nature and severity of cognitive impairment in patients with a dual diagnosis, though the co-occurrence of these disorders may further exacerbate cognitive impairment. The study investigates the possible additive effect of alcohol use disorder and schizophrenia on cognitive impairment among patients diagnosed with schizophrenia. Participants were inpatients with schizophrenia (n=30), inpatients with a dual diagnosis of schizophrenia and alcohol use disorder (n=30), and matched controls (n=30): all completed a comprehensive neuropsychological battery. Both patient groups were significantly impaired, relative to controls, across the battery. Dual diagnosis patients were significantly more impaired than schizophrenia patients on delayed verbal memory, and executive functioning, primarily set-shifting, working memory, and planning, and had higher psychiatric morbidity scores. The findings provide support for an additive effect of the two disorders on cognitive impairment. These cognitive deficits may affect capacity to engage in treatment, increase risk of relapse, and adversely affect treatment outcomes. An understanding of the cognitive profile of people with dual diagnosis may help to tailor treatment delivery to meet their specific needs, enhance cognitive strengths, accommodate deficits and improve treatment outcomes.

Changes in neuropsychological functioning during alcohol detoxification.

This study investigates changes in neuropsychological functioning during early abstinence from alcohol. 30 alcohol-dependent inpatients were tested at intake (day 4 of admission) and post detoxification (day 26), using a test-retest design. The neuropsychological battery included measures of pre-morbid IQ, full-scale IQ, verbal and non-verbal measures of memory and executive function. IQ was within the normal range at intake and comparable with age-adjusted normative values and there were some impairments in memory and executive function. There were significant increases in performance scores post detoxification in working memory, verbal fluency and verbal inhibition but not in non-verbal executive function tasks (mental flexibility and planning ability). Despite increased scores on tests of verbal and memory skills after 3 weeks of abstinence, complex executive abilities showed little change. These may have a negative impact on engagement and response to treatment and compromise clinical outcomes, heightening the risk of relapse.

Screening for cognitive functioning in psychiatric outpatients with schizophrenia, alcohol dependence, and dual diagnosis.

Cognitive impairment is common to both schizophrenia and alcoholism. Despite increasing recognition that people with both disorders represent a problematic client group, little is known about the possible additive effect of a dual diagnosis upon impaired cognitive function. This study investigates impairment of cognitive functioning in patients with schizophrenia, alcohol dependence, or a dual diagnosis of schizophrenia and alcohol use disorder. It was hypothesised that patients with dual diagnosis would show greater cognitive impairment than those with a single diagnosis. The Mini-Mental State Examination (MMSE) and standardised measures of psychiatric health and substance use were administered to 120 community psychiatric patients with a diagnosis of schizophrenia, alcohol dependence and both conditions (dual diagnosis). Higher rates of cognitive impairment were found among dual diagnosis patients compared to the schizophrenia or alcohol patients. This was shown in age-adjusted measures of global functioning, and on the tests of language, reading and writing, and visuospatial construction. Despite its common usage, global MMSE scores were insensitive to the cognitive impairments typically found in these clinical groups. Where the MMSE is used as a screening tool, it is recommended that scores are adjusted for the effects of age.

Ethnicity and Drug Use: exploring the nature of particular relationships among diverse populations in the United Kingdom

This paper explores the substance use and misuse issues in the main visible minority ethnic communities in the UK. Trends in choice of substance, culturally specific attitudes, age and gender are explored amongst the African, African-Caribbean, Asian and Cypriot communities. It presents an outline of the patchy epidemiological data that is currently available. The paper also explores the service utilisation by minority ethnic groups and looks at the major barriers to service uptake. Increasing access to services by practical interventions to overcome barriers and prevention strategies are discussed. The difficulties of undertaking research in this field, and the translation of small local non-controlled studies to national strategies are highlighted whilst suggesting avenues for future research.

Sleep related beliefs and their association with alcohol relapse following residential alcohol detoxification treatment

BACKGROUND Alcohol dependence is known to impact upon sleep, and poor sleep has been shown to affect relapse rates following treatment for alcohol dependence. AIMS The aim of this study was to investigate the association between sleep problems and relapse in dependent drinkers in an inpatient setting. This was done by studying sleep related cognitions in individuals undergoing medically assisted alcohol withdrawal. METHOD Sleep and sleep-related cognitions data were collected for 71 individuals undergoing detoxification treatment. Sleep was measured using sleep diaries and actigraph motion monitors. Participants completed sleep-related cognition questionnaires and were subject to telephone follow-up interviews. The results were then used to predict relapse rates 4 weeks after discharge. RESULTS Longer sleep onset latency recorded on the unit predicted relapse at 4 weeks. Higher dysfunctional beliefs about sleep were found to be associated with lower relapse rates. CONCLUSIONS This study suggests that some dysfunctional beliefs about sleep may support recovery following discharge from treatment. The study further supports the need for tailored cognitive-behavioural treatments for sleep difficulties in this population to reduce relapse rates.

A Model of Substance Abuse Risk: Adapting to the Sri Lankan Context

This study translated and validated the Substance Use Risk Profile Scale (SURPS) among 13 to 18 year old Sri Lankan adolescents attending school. A standard systematic translation procedure was followed to translate the original SURPS into Sinhala language. A Delphi process was conducted to determine judgmental validity of Sinhala SURPS. Confirmatory factor analysis was performed to test the translated version against the original theoretical model of the SURPS. Test-retest and internal consistency were used to ensure reliability. A few terms in one of the items posed some difficulty in translating into Sinhala. Adequate judgmental validity was determined except for one item, which was modified to suit the Sri Lankan setting. The four subscales introversion/ hopelessness, impulsivity, sensation seeking and anxiety sensitivity showed satisfactory test-retest reliability estimates of .74, .68, .76, and .88, respectively. The Sinhala SURPS is applicable in Sri Lankan context. Several implications based on the results are discussed.

Patterns of alcohol consumption and problems among the Irish in London: A preliminary comparison of pub drinkers in London and Dublin.

Alcohol-related morbidity and mortality rates among the Irish in England and Wales are higher than both other ethnic minorities and the general population. Higher consumption per episode of drinking is responsible for higher overall mean consumption levels among the Irish. Patterns of consumption and problems among the Irish were investigated in two samples recruited in pubs in London and Dublin. Mean weekly alcohol consumption was found to be higher – by approximately 50% – in the London sample with more high-risk drinking a result of more frequent drinking patterns. Hazardous drinking was strongly normative among young Irish people in both London and Dublin. The distinct Irish style of drinking – greater quantities per episode – and the English pattern of more frequent drinking combine to produce elevated risk among the Irish in London. Irish drinking patterns in general, and the alcohol-related needs of the young Irish in Britain in particular, require further study to better understand the nature of risk and to prevent harm.

Autobiographical Memory in Detoxified Dependent Drinkers

In experimental studies, many clinical populations, e.g. depression and trauma, show a relative difficulty to produce specific autobiographical memories when compared to non-clinical participants (e.g. Williams et al ., 2007). ‘Specific’ memories are defined as a single event lasting <1 day. Clinically, this reduced autobiographical memory specificity is associated with poorer psychological functioning, problem solving limitations, greater hopelessness (Henderson et al ., 2002) and poorer outcome. Such aspects have potential relevance in relation to alcohol problems, specifically cognitively based theories of and interventions for alcohol problems. We are not aware of published research examining autobiographical memory function within this population. In our study, 26, in treatment, detoxified dependent drinkers were recruited along with 29 non-dependent drinkers recruited from community sources. The median time since last consuming an alcoholic drink for the dependent drinkers was 16 days, range 1–365 days. The mean Severity of Alcohol Dependence Questionnaire …

Transforming a residential substance dependence program: experience from the National Rehabilitation Centre, United Arab Emirates

This article describes the experience of transforming a residential substance dependence treatment program from an extended non-structured program to a structured, differentiated short-term residential treatment which allows for treatment personalization. Carried at the National Rehabilitation Centre, Abu Dhabi, United Arab Emirates, and commissioned by its management, the transformation aimed to address extended length of stay, long waiting lists, service expansion requirement, and diversity in demand for treatment. Transforming the residential program would optimize efficiency as it is the most common and resourceful phase of substance dependence treatment regionally, hence the significance of this effort. The transformation process extended from April 2009 to April 20l3 over two phases: (a) program development and (b) implementation. Gaps in human resource capacity, and the absence of monitoring and evaluation systems were identified as major challenges in transformation. Six recommendations were gener...

Substance Misuse in the UAE and the National Rehabilitation Center

The life and lifestyle of people who are identified as Emiratis has changed rapidly since the unification of the seven Trucial States and subsequent birth of the nation in 1971. Since then, the UAE has undergone a rapid change in every sphere of life, which is perhaps unprecedented in history. For the indigenous Emirati, the transition from poverty to affluence in such a brief period has been an extraordinary one (Al Nahyan, 2014) and requires significant psychological adjustment (Thomas, 2013). The impact it has had on culture and identity is a worthy field of study in its own right. This rapid development has required a massive influx of a foreign and multinational workforce, which has significantly impacted Emirati culture, traditions, and social and family structures in addition to Westernization and globalization. There are perhaps no parallels in history to this transformation. This nonimmigrant influx of many cultures simultaneously and its impact on indigenous people is quite possibly a unique phenomenon.