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BMC Psychiatry

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Open Access 01-12-2021 | Schizophrenia | Research article

Scope, quality and inclusivity of international clinical guidelines on mental health and substance abuse in relation to dual diagnosis, social and community outcomes: a systematic review

Authors: Ray Alsuhaibani, Douglas Cary Smith, Richard Lowrie, Sumayah Aljhani, Vibhu Paudyal

Published in: BMC Psychiatry | Issue 1/2021

Abstract

Objective

It is estimated that up to 75% of patients with severe mental illness (SMI) also have substance use disorder (SUD). The aim of this systematic review was to explore the scope, quality and inclusivity of international clinical guidelines on mental health and/or substance abuse in relation to diagnosis and treatment of co-existing disorders and considerations for wider social and contextual factors in treatment recommendations.

Method

A protocol (PROSPERO CRD42020187094) driven systematic review was conducted. A systematic search was undertaken using six databases including MEDLINE, Cochrane Library, EMBASE, PsychInfo from 2010 till June 2020; and webpages of guideline bodies and professional societies. Guideline quality was assessed based on ‘Appraisal of Guidelines for Research & Evaluation II’ (AGREE II) tool. Data was extracted using a pre-piloted structured data extraction form and synthesized narratively. Reporting was based on PRISMA guideline.

Result

A total of 12,644 records were identified. Of these, 21 guidelines were included in this review. Three of the included guidelines were related to coexisting disorders, 11 related to SMI, and 7 guidelines were related to SUD. Seven (out of 18) single disorder guidelines did not adequately recommend the importance of diagnosis or treatment of concurrent disorders despite their high co-prevalence. The majority of the guidelines (n = 15) lacked recommendations for medicines optimisation in accordance with concurrent disorders (SMI or SUD) such as in the context of drug interactions. Social cause and consequence of dual diagnosis such as homelessness and safeguarding and associated referral pathways were sparsely mentioned.

Conclusion

Despite very high co-prevalence, clinical guidelines for SUD or SMI tend to have limited considerations for coexisting disorders in diagnosis, treatment and management. There is a need to improve the scope, quality and inclusivity of guidelines to offer person-centred and integrated care.

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Carrà G, Bartoli F, Brambilla G, Crocamo C, Clerici M. Comorbid addiction and major mental illness in Europe: a narrative review. Subst Abus. 2015;36(1):75–81. https://doi.org/10.1080/08897077.2014.960551.CrossRefPubMed

Fantuzzi C, Mezzina R. Dual diagnosis: a systematic review of the organization of community health services. Int J Soc Psychiatry. 2020;66(3):300–10. https://doi.org/10.1177/0020764019899975.CrossRefPubMed

McCreadie RG. Use of drugs, alcohol and tobacco by people with schizophrenia: case–control study. Br J Psychiatry. 2002;181(4):321–5. https://doi.org/10.1192/bjp.181.4.321.CrossRefPubMed

Temmingh HS, Williams T, Siegfried N, Stein DJ. Risperidone versus other antipsychotics for people with severe mental illness and co-occurring substance misuse. Cochrane Database Syst Rev. 2018;1.

Elliott I. Poverty and mental health: a review to inform the Joseph Rowntree Foundation’s Anti-Poverty Strategy. Available from: http://www.patient.co.uk/doctor/Poverty-and-Mental-Health.htm. Accessed 07 Feb 2021.

Wade D, Harrigan S, Edwards J, Burgess PM, Whelan G, McGorry PD. Substance misuse in first-episode psychosis: 15-month prospective follow-up study. Br J Psychiatry. 2006;189(3):229–34. https://doi.org/10.1192/bjp.bp.105.017236.CrossRefPubMed

National Institute on Drug Abuse. Comorbidity: substance use disorders and other mental illnesses drugfacts. Available from: https://www.drugabuse.gov/drug-topics/publications/drug-facts. Accessed 07 Feb 2021.

Antai-Otong D, Theis K, Patrick DD. Dual diagnosis: coexisting substance use disorders and psychiatric disorders. Nurs Clin. 2016;51(2):237–47. https://doi.org/10.1016/j.cnur.2016.01.007.CrossRef

Brunette MF, Mueser KT, Drake RE. A review of research on residential programs for people with severe mental illness and co-occurring substance use disorders. Drug Alcohol Rev. 2004;23(4):471–81. https://doi.org/10.1080/09595230412331324590.CrossRefPubMed

10.

Lambert-Harris C, Saunders EC, McGovern MP, Xie H. Organizational capacity to address co-occurring substance use and psychiatric disorders: assessing variation by level of care. J Addict Med. 2013;7(1):25–32. https://doi.org/10.1097/ADM.0b013e318276e7a4.CrossRefPubMed

11.

Hjorthøj C, Østergaard MLD, Benros ME, Toftdahl NG, Erlangsen A, Andersen JT, et al. Association between alcohol and substance use disorders and all-cause and cause-specific mortality in schizophrenia, bipolar disorder, and unipolar depression: a nationwide, prospective, register-based study. Lancet Psychiatry. 2015;2(9):801–8. https://doi.org/10.1016/S2215-0366(15)00207-2.CrossRefPubMed

12.

Lynskey MT, Kimber J, Strang J. Drug-related mortality in psychiatric patients. Lancet Psychiatry. 2015;2(9):767–9. https://doi.org/10.1016/S2215-0366(15)00372-7.CrossRefPubMed

13.

Fridell M, Bäckström M, Hesse M, Krantz P, Perrin S, Nyhlén A. Prediction of psychiatric comorbidity on premature death in a cohort of patients with substance use disorders: a 42-year follow-up. BMC Psychiatry. 2019;19(1):150. https://doi.org/10.1186/s12888-019-2098-3.CrossRefPubMedPubMedCentral

14.

Fekadu W, Mihiretu A, Craig TKJ, Fekadu A. Multidimensional impact of severe mental illness on family members: systematic review. BMJ Open. 2019;9(12).

15.

Lukasiewicz M, Blecha L, Falissard B, Neveu X, Benyamina A, Reynaud M, et al. Dual diagnosis: prevalence, risk factors, and relationship with suicide risk in a nationwide sample of French prisoners. Alcohol Clin Exp Res. 2009;33(1):160–8. https://doi.org/10.1111/j.1530-0277.2008.00819.x.CrossRefPubMed

16.

Polcin DL. Co-occurring substance abuse and mental health problems among homeless persons: suggestions for research and practice. J Soc Distress Homeless. 2016;25(1):1–10. https://doi.org/10.1179/1573658X15Y.0000000004.CrossRefPubMed

17.

Schütz C, Choi F, Jae Song M, Wesarg C, Li K, Krausz M. Living with dual diagnosis and homelessness: marginalized within a marginalized group. J Dual Diagn. 2019;15(2):88–94. https://doi.org/10.1080/15504263.2019.1579948.CrossRefPubMed

18.

Buckley PF. Prevalence and consequences of the dual diagnosis of substance abuse and severe mental illness. J Clin Psychiatry. 2006;67:5.CrossRefPubMed

19.

McLeod KE, Butler A, Young JT, Southalan L, Borschmann R, Sturup-Toft S, et al. Global prison health care governance and health equity: a critical lack of evidence. Am J Public Health. 2020;110(3):303–8. https://doi.org/10.2105/AJPH.2019.305465.CrossRefPubMedPubMedCentral

20.

Kelly TM, Daley DC. Integrated treatment of substance use and psychiatric disorders. Soc Work Public Health. 2013;28(3–4):388–406. https://doi.org/10.1080/19371918.2013.774673.CrossRefPubMedPubMedCentral

21.

Gunner E, Chandan SK, Yahyouche A, Paudyal V, Marwick S, Saunders K, et al. Provision and accessibility of primary healthcare services for people who are homeless: a qualitative study of patient perspectives in the UK. Br J Gen Pract. 2019;69(685):E526–36. https://doi.org/10.3399/bjgp19X704633.CrossRefPubMedPubMedCentral

22.

Paudyal V, Maclure K, Forbes-McKay K, McKenzie M, McLeod J, Smith ASD. If I die, I die, I don’t care about my health’: perspectives on self-care of people experiencing homelessness. Health Soc Care Community. 2020;28(1):160–72. https://doi.org/10.1111/hsc.12850.CrossRefPubMed

23.

Paudyal V, MacLure K, Buchanan C, Wilson L, Macleod J, Stewart D. ‘When you are homeless, you are not thinking about your medication, but your food, shelter or heat for the night’: behavioural determinants of homeless patients’ adherence to prescribed medicines. Public Health. 2017;148:1–8. https://doi.org/10.1016/j.puhe.2017.03.002.CrossRefPubMed

24.

Pinderup P. Challenges in working with patients with dual diagnosis. Adv Dual Diagn. 2018;11(2):60–75. https://doi.org/10.1108/ADD-11-2017-0021.CrossRef

25.

Sorsa M, Greacen T, Lehto J, Åstedt-Kurki P. A qualitative study of barriers to care for people with co-occurring disorders. Arch Psychiatr Nurs. 2017;31(4):399–406. https://doi.org/10.1016/j.apnu.2017.04.013.CrossRefPubMed

26.

Ducharme LJ, Knudsen HK, Roman PM. Availability of integrated care for co-occurring substance abuse and psychiatric conditions. Community Ment Health J. 2006;42(4):363–75. https://doi.org/10.1007/s10597-005-9030-7.CrossRefPubMed

27.

Murthy P, Chand P. Treatment of dual diagnosis disorders. Curr Opin Psychiatry. 2012;25(3):194–200. https://doi.org/10.1097/YCO.0b013e328351a3e0.CrossRefPubMed

28.

Stewart SH, Conrod PJVO-19. State-of-the-art in cognitive-behavioral interventions for substance use disorders: introduction to the special issue. J Cogn Psychother. 2005;19(3):195.

29.

McGovern MP, Lambert-Harris C, Gotham HJ, Claus RE, Xie H. Dual diagnosis capability in mental health and addiction treatment services: an assessment of programs across multiple state systems. Adm Policy Ment Health Ment Health Serv Res. 2014;41(2):205–14. https://doi.org/10.1007/s10488-012-0449-1.CrossRef

30.

Perron BE, Bunger A, Bender K, Vaughn MG, Howard MO. Treatment guidelines for substance use disorders and serious mental illnesses: do they address co-occurring disorders? Subst Use Misuse. 2010;45(7–8):1262–78. https://doi.org/10.3109/10826080903442836.CrossRefPubMedPubMedCentral

31.

De Brún C. Finding the evidence: a key step in the information production process. Inf Stand Guid. 2013.

32.

Moher D, Liberati A, Tetzlaff J, Altman DG, The PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. PLoS Med. 2009;6(7):e1000097. https://doi.org/10.1371/journal.pmed1000097.CrossRefPubMedPubMedCentral

33.

American Pyschiatric Association. Diagnostic and statistical manual of mental disorders (DSM-5®): American Psychiatric Association; 2013. https://www.psychiatry.org/psychiatrists/practice/dsm. Accessed 07 Feb 2021

34.

Mclellan AT. Substance misuse and substance use disorders: why do they matter in healthcare? Trans Am Clin Climatol Assoc. 2017;128:112.PubMedPubMedCentral

35.

Brouwers MC, Kho ME, Browman GP, Burgers JS, Cluzeau F, Feder G, et al. AGREE II: Advancing guideline development, reporting and evaluation in health care. CMAG. 2010;182(18).

36.

Brouwers MC, Kerkvliet K, Spithoff K, Consortium ANS. The AGREE reporting checklist: a tool to improve reporting of clinical practice guidelines. BMG. 2016;352:i1152.

37.

National Institute for Health and Care Excellence (NICE). Psychosis with coexisting substance misuse: assessment and management in adults and young people. Available from: https://www.ncbi.nlm.nih.gov/books/NBK109783/pdf/Bookshelf_NBK109783.pdf. Accessed 07 Feb 2021.

38.

NICE. Coexisting existing severe mental illness and substance misuse : community health and social care services. Available from: https://www.nice.org.uk/guidance/ng58. Accessed 07 Feb 2021.

39.

Marel C, Mills KL, Kingston R, Gournay K, Deady M, Kay-Lambkin F, et al. Co-occurring alcohol and other drug and mental health conditions in alcohol and other drug treatment settings. Illustrations; 2016.

40.

Lingford-Hughes AR, Welch S, Peters L, Nutt DJ. BAP updated guidelines: evidence-based guidelines for the pharmacological management of substance abuse, harmful use, addiction and comorbidity: Recommendations from BAP. J Psychopharmacol. 2012;26(7):899–952. https://doi.org/10.1177/0269881112444324.CrossRefPubMed

41.

Soyka M, Kranzler HR, Hesselbrock V, Kasper S, Mutschler J, Möller HJ. Guidelines for biological treatment of substance use and related disorders, part 1: alcoholism, first revision. World J Biol Psychiatry. 2017;18(2):86–119. https://doi.org/10.1080/15622975.2016.1246752.CrossRefPubMed

42.

Gov.uk. Drug misuse and dependence: UK guidelines on clinical management. 2021. Available from: https://www.gov.uk/government/publications/drug-misuse-and-dependence-uk-guidelines-on-clinical-management. Accessed 07 Feb 2021.

43.

Preuss UW, Gouzoulis-Mayfrank E, Havemann-Reinecke U, Schäfer I, Beutel M, Hoch E, et al. Psychiatric comorbidity in alcohol use disorders: results from the German S3 guidelines. Eur Arch Psychiatry Clin Neurosci. 2018;268(3):219–29. https://doi.org/10.1007/s00406-017-0801-2. Accessed 07 Feb 2021.

44.

NICE. Alcohol-use disorders: diagnosis, assessment and management of harmful drinking (high-risk drinking) and alcohol dependence. Available https://www.nice.org.uk/guidance/cg115. Accessed 07 Feb 2021.

45.

Reus VI, Laura Fochtmann CJ, Oscar Bukstein M, Evan Eyler MA, Donald Hilty MM, Horvitz-Lennon M, et al. The american psychiatric association practice guideline for the pharmacological treatment of patients with alcohol use disorder guideline writing group systematic review group steering committee on practice guidelines APA assembly liaisons. 2018. Available from: https://psychiatryonline.org/doi/pdf/10.1176/appi.books.9781615371969. Accessed 07 Feb 2021.

46.

Comer S, Cunningham C, Fishman MJ, Gordon FA, Kampman FK, Langleben D, et al. National practice guideline for the use of medications in the treatment of addiction involving opioid use. Am Soc Addicit Med. 2015;66.

47.

Scottish Intercollegiate Guideline Network. SIGN 131 • Management of schizophrenia key to evidence statement and grades of recommendations Available from: http://sign.ac.uk/pdf/sign131.pdf.

48.

NICE. Psychosis and schizophrenia in adults: treatment and management. https://www.nice.org.uk/guidance/cg178. Accessed 07 February 2021.

49.

Hasan A, Falkai P, Wobrock T, Lieberman J, Glenthoj B, Gattaz WF, et al. World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for biological treatment of schizophrenia part 3: update 2015 management of special circumstances: depression, Suicidality, substance use disorders and pregnancy and lactation. World J Biol Psychiatry. 2015;16(3):142–70. https://doi.org/10.3109/15622975.2015.1009163.CrossRefPubMed

50.

Castle DJ, Galletly CA, Dark F, Humberstone V, Morgan VA, Killackey E, et al. The 2016 royal australian and New Zealand college of psychiatrists guidelines for the management of schizophrenia and related disorders. Med J Aust. 2017;206(11):501–5. https://doi.org/10.5694/mja16.01159.

51.

Barnes TRE, Drake R, Paton C, Cooper SJ, Deakin B, Ferrier IN, et al. Evidence-based guidelines for the pharmacological treatment of schizophrenia: updated recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2020;34(1):3–78. https://doi.org/10.1177/0269881119889296.

52.

Keepers GA, Anzia JM, Benjamin S, Lyness JM, Mojtabai R, Servis M, et al. The American Psychiatric Association practice guideline for the treatment of patients with schizophrenia Guideline .https://www.psychiatry.org/psychiatrists/practice/clinical-practice-guidelines. Accessed 07 Feb 2021.

53.

Department of Veterans Affairs, Department of Defense. VA/DoD clinical practice guidline for management of bipolar disorder in adults; 2009. p. 1–176. Available from: http://www.healthquality.va.gov/guidelines/MH/bd/bd_305_full.pdf Accessed 07 Feb 2021

54.

Mok YM, Chan HN, Chee KS, Chua T-E, Lim BL, Marziyana AR, et al. MOH clinical practice guidelines: bipolar disorder. Ministry of Health. Available from: https://pubmed.ncbi.nlm.nih.gov/22159936/. Accessed 07 Feb 2021.

55.

NICE. Bipolar disorder: assessment and management. https://www.nice.org.uk/guidance/cg185/resources/bipolar-disorder-assessment-and-management-pdf-35109814379461 . Accessed 07 Feb 2021.

56.

Goodwin GM, Haddad PM, Ferrier IN, Aronson JK, Barnes TRH, Cipriani A, et al. Evidence-based guidelines for treating bipolar disorder: revised third edition recommendations from the British Association for Psychopharmacology. J Psychopharmacol. 2016;30(6):495–553. https://doi.org/10.1177/0269881116636545.

57.

Yatham LN, Kennedy SH, Parikh SV, Schaffer A, Bond DJ, Frey BN, et al. Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder. Bipolar Disord. 2018;20(2):97–170. https://doi.org/10.1111/bdi.12609.

58.

Keating D, McWilliams S, Schneider I, Hynes C, Cousins G, Strawbridge J, et al. Pharmacological guidelines for schizophrenia: a systematic review and comparison of recommendations for the first episode. BMJ Open. 2017;7(1):e013881. https://doi.org/10.1136/bmjopen-2016-013881.CrossRefPubMedPubMedCentral

59.

Johnston A, Hsieh S-C, Carrier M, Kelly SE, Bai Z, Skidmore B, et al. A systematic review of clinical practice guidelines on the use of low molecular weight heparin and fondaparinux for the treatment and prevention of venous thromboembolism: implications for research and policy decision-making. PLoS One. 2018;13(11):e0207410. https://doi.org/10.1371/journal.pone.0207410.

60.

Zhang P, Lu Q, Li H, Wang W, Li G, Si L, et al. The quality of guidelines for diabetic foot ulcers: a critical appraisal using the AGREE II instrument. PLoS One. 2019;14(9):e0217555. https://doi.org/10.1371/journal.pone.0217555.CrossRefPubMedPubMedCentral

61.

Ziedonis DM, Smelson D, Rosenthal RN, Batki SL, Green AI, Henry RJ, et al. Improving the care of individuals with schizophrenia and substance use disorders: consensus recommendations. J Psychiatr Pract. 2005;11(5):315–39. https://doi.org/10.1097/00131746-200509000-00005.CrossRefPubMedPubMedCentral

62.

Morrens M, Dewilde B, Sabbe B, Dom G, De Cuyper R, Moggi F. Treatment outcomes of an integrated residential programme for patients with schizophrenia and substance use disorder. Eur Addict Res. 2011;17(3):154–63. https://doi.org/10.1159/000324480.CrossRefPubMed

63.

Bowen M, Marshall T, Yahyouche A, Paudyal V, Marwick S, Saunders K, et al. Multimorbidity and emergency department visits by a homeless population: a database study in specialist general practice. Br J Gen Pract. 2019;69(685):E515–25. https://doi.org/10.3399/bjgp19X704609.CrossRefPubMedPubMedCentral

64.

Moxley VBA, Hoj TH, Novilla MLB. Predicting homelessness among individuals diagnosed with substance use disorders using local treatment records. Addict Behav. 2020;102:106160. https://doi.org/10.1016/j.addbeh.2019.106160.CrossRefPubMed

65.

Padgett DK, Stanhope V, Henwood BF, Stefancic A. Substance use outcomes among homeless clients with serious mental illness: comparing housing first with treatment first programs. Community Ment Health J. 2011;47(2):227–32. https://doi.org/10.1007/s10597-009-9283-7.CrossRefPubMed

66.

Field G. Continuity of offender treatment for substance use disorders from institution to community: treatment improvement protocol (TIP) series 30. Washington, DC: Department of Health and Human Services; 1998.

67.

Peters RH, Bartoi MG, Sherman PB. Screening and assessment of co-occurring disorders in the justice system. https://www.ce-credit.com/articles/100958/Screening_Assessment_Mono.pdf. Accessed 18 Mar 2021.

68.

Paudyal V, Gibson Smith K, MacLure K, Forbes-McKay K, Radley A, Stewart D. Perceived roles and barriers in caring for the people who are homeless: a survey of UK community pharmacists. Int J Clin Pharm. 2019;41(1):215–27. https://doi.org/10.1007/s11096-019-00789-4.

69.

Jagpal P, Saunders K, Plahe G, Russell S, Barnes N, Lowrie R, et al. Research priorities in healthcare of persons experiencing homelessness: outcomes of a national multi-disciplinary stakeholder discussion in the United Kingdom. Int J Equity Health. 2020;19(1):1–7 https://doi.org/10.1186/s12939-020-01206-3.

70.

Jagpal P, Barnes N, Lowrie R, Banerjee A, Paudyal V. Clinical pharmacy intervention for persons experiencing homelessness: evaluation of patient perspectives in service design and development. Pharmacy. 2019;7(4):153. https://doi.org/10.3390/pharmacy7040153.CrossRefPubMedCentral

71.

Alenezi A, Yahyouche A, Paudyal V. Interventions to optimize prescribed medicines and reduce their misuse in chronic non-malignant pain: a systematic review. Eur J Clin Pharmacol. 2021;77(4):467–90.CrossRefPubMed

72.

Ali RA, Jalal Z, Paudyal V. Barriers to monitoring and management of cardiovascular and metabolic health of patients prescribed antipsychotic drugs: a systematic review. BMC Psychiatry. 2020;20(1) https://doi.org/10.1186/s12888-020-02990-6.

Title: Scope, quality and inclusivity of international clinical guidelines on mental health and substance abuse in relation to dual diagnosis, social and community outcomes: a systematic review
Authors: Ray Alsuhaibani
Douglas Cary Smith
Richard Lowrie
Sumayah Aljhani
Vibhu Paudyal
Publication date: 01-12-2021
Publisher: BioMed Central
Keywords: Schizophrenia
Substance Abuse
Substance Abuse
Published in: BMC Psychiatry / Issue 1/2021
Electronic ISSN: 1471-244X
DOI: https://doi.org/10.1186/s12888-021-03188-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Scope, quality and inclusivity of international clinical guidelines on mental health and substance abuse in relation to dual diagnosis, social and community outcomes: a systematic review

Abstract

Objective

Method

Result

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objective

Method

Result

Conclusion

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