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The validity of subtypes based on antisocial personality disorder (APD) or childhood conduct disorder without adult APD (CD only) in patients with schizophrenia (or schizoaffective disorder) and a substance use disorder (abuse or dependence) was examined. APD patients scored lower on personality measures related to socialization and higher on antisocial behavior, psychopathy, and aggression. APD patients also reported higher rates of aggression and legal problems. APD, and to a lesser extent CD only, was associated with more severe psychiatric symptoms, an earlier age of onset of substance abuse, more severe symptoms of substance abuse, and a stronger family history of substance abuse and psychiatric hospitalization. The findings suggest that schizophrenia patients with APD represent a high-risk subgroup vulnerable to more severe substance abuse, psychiatric impairment, aggression, and legal problems.

Despite recent advances in the psychosocial treatment of schizophrenia and other severe mental illnesses, little is known about the specific needs of elderly persons with these disorders. To address this gap in understanding, we examined the functional impairments of a sample of elderly patients with diagnoses of schizophrenia or schizoaffective disorder (N = 55), bipolar disorder (N = 39), or major depression (N = 90) who were living in the community and receiving mental health services. Functioning in four different areas was assessed: social skills, behavior problems, self-care skills, and community living skills. Diagnostic group comparisons indicated that the schizophrenia-schizoaffective disorder group had worse functioning than the other groups across all of the different domains. The clinical and research implications of the findings for the development of psychosocial interventions for elderly persons with schizophrenia are discussed.

Objective: To examine the relationships between childhood conduct disorder (CD), antisocial personality disorder (ASPD) and substance use disorders (substance abuse or substance dependence) in psychiatric patients with severe mental illness. Method: Substance use-related problems on screening instruments, lifetime and recent prevalence of substance use disorders, and family history of substance use disorder were evaluated in four groups of 293 patients with mainly schizophrenia-spectrum and major affective disorders: No ASPD/CD, CD Only, Adult ASPD Only, Full ASPD. Results: Full ASPD was strongly related to all measures of substance use problems and disorders, as well as fathers' history of substance use disorder. The odds ratios for Full ASPD and substance use disorders ranged between 3.96 (lifetime cannabis use disorder) to 11.35 (recent cocaine use disorder). To a lesser extent, patients with CD Only or Adult ASPD Only were also at increased risk for having substance use disorders compared to the No ASPD/CD patients. Conclusions: Childhood CD and adult ASPD represent significant risk factors for substance use disorders in patients with schizophrenia-spectrum and major affective disorders. Considering other research indicating that CD and ASPD have a higher prevalence in patients with severe mental illness, the present findings suggest that CD and ASPD could reflect a common factor that independently increases patients' vulnerability to both psychiatric and substance use disorders. (J. Stud. Alcohol 60: 278-284, 1999), Antisocial personality disorder (ASPD) and substance use disorders (substance abuse or substance dependence) have a very high rate of comorbidity in the general population (Regier et al., 1990). In addition, [...]

Objective: This report describes the prevalence and correlates of co-occurring depressive symptoms and alcohol use in an older Veteran's Affairs primary care clinic population. Methods: Participants include 8,782 older primary care patients (age 65 +) who responded to a self-report, mailed survey. Patients were classified into six mutually exclusive groups based upon screening indicators for problem drinking (quantity/frequency questions) and depressive symptoms (General Health Questionnaire). Groups included: (a) neither problem drinking nor depressive symptoms (n = 6,415, 73.0%); (h) at-risk alcohol use (n = 761; 8.7%); (c) heavy alcohol use (n = 201; 2.3%); (d) depressive symptoms (n = 1,234, 14.1%); (e) depressive symptoms and at-risk alcohol use (n = 120; 1.4%); and (f) depressive symptoms and heavy alcohol use (n = 51; 0.6%). Chi-square and ANOV1A were used to test for equality of demographic and clinical characteristics across groups. Results: 12.9% of patients reported alcohol use consistent with problem drinking (including 10.0% with at-risk alcohol use and 2.9% with heavy alcohol use) and 16.1% screened positive for possible depressive symptoms (including 2.0% with co-occurring at-risk or heavy alcohol use). The combination of heavy alcohol use and depressive symptoms was associated with the highest rates of death and suicidal ideation; living alone; being divorced, separated, or widowed; and regular cigarette smoking. The presence of depressive symptoms (regardless of amount of alcohol use) was associated with worse perceived health, and perceived lack of social support. Finally, individuals with at-risk alcohol use alone were younger and had better perceived health compared to those with non-problem alcohol use or no alcohol use. However, there were no differences between those with at-risk drinking and depressive symptoms and those with depressive symptoms alone. Conclusions: Self-reported heavy alcohol use combined with depressive symptoms identifies a subgroup of older primary care patients at especially high risk with respect to suicidal ideation and poor mental and physical well-being. In contrast, older adults with depressive symptoms and self-reported "at-risk" alcohol use were not differentiated from older persons with depressive symptoms reporting non-problematic or nonuse of alcohol. [ABSTRACT FROM AUTHOR]

This research brief provides information about an initiative, supported by the Robert Wood Johnson Foundation, to provide clinicians with an integrated system for assessing client needs, planning effective treatment, and measuring treatment outcomes for the growing population of older adults with mental disorders. The initiative, called the Outcomes-Based Treatment Planning (OBTP) System, aims to provide clinicians and policy makers with important information about the outcomes and effectiveness of treatment. The study investigated whether clinicians' ability to recognize and treat mental illness in older adults could be improved. Further, it investigated whether the consistent use of tools specifically designed for this population could both inform treatment and give policymakers important data, more specific treatments, and better chart documentation of both initial severity and client progress over time.