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Severe Mental Illness and Substance Misuse (Dual Diagnosis): Community Health and Social Care Services

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Severe Mental Illness and Substance Misuse (Dual Diagnosis): Community Health and Social Care Services Severe mental illness and substance misuse (dual diagnosis): community health and social care services Draft Review 1: The epidemiology, and current configuration of health and social care community services, for people in the UK with a severe mental illness who also misuse substances A systematic review Dr. Odette Megnin-Viggars, Ms Marie Brown, Ms Elena Marcus, Ms Sarah Stockton and Prof. Steve Pilling National Collaborating Centre for Mental Health Draft version v4.0, December 2015 Prepared for the Public Health and Social Care Centre at the National Institute for Health and Care Excellence (NICE) Severe mental illness and substance misuse (dual diagnosis) – community health and social services – Review 1 ACKNOWLEDGEMENTS The authors are also grateful for the helpful comments and support received from the project team (Lakshmi Murthy, Chris Carmona, Paul Levay, Caroline Mulvihill) at NICE. Page 2 of 301 Severe mental illness and substance misuse (dual diagnosis) – community health and social services – Draft Review 1 Table of Contents Acknowledgements ...................................................................................................................... 2 Glossary and abbreviations ....................................................................................................... 5 Executive summary ...................................................................................................................... 8 Introduction ................................................................................................................................. 27 1.1 Context in which the review is set ................................................................................ 27 1.2 Aims and objectives of the review................................................................................ 29 1.3 Review questions and protocol .................................................................................... 29 1.4 Identification of possible equality and equity issues................................................... 31 Methodology ................................................................................................................................ 32 1.5 Literature search and abstract appraisal ..................................................................... 32 1.6 Retrieval of data and full paper appraisal.................................................................... 34 1.7 Quality assessment and applicability appraising ........................................................ 34 1.8 Methods of data extraction, synthesis and presentation............................................ 35 Review question 1.1: What are the health and social care needs of people in the UK with a severe mental illness who also misuse substances? ...................................... 38 1.9 Studies considered for review question 1.1 ................................................................ 38 1.10 Summary of the evidence for review question 1.1 ..................................................... 38 1.11 Discussion ...................................................................................................................... 87 Review question 1.2: What is the current configuration of health and social care community services and the care pathway through which people in the UK with coexisting severe mental illness and substance misuse are recognised, treated, managed and followed-up? ............................................................................................... 88 1.12 Studies considered for review question 1.2 ................................................................ 88 1.13 Expert advisory group ................................................................................................... 88 1.14 Summary of the evidence for review question 1.2 ..................................................... 89 1.15 Discussion .................................................................................................................... 100 References ................................................................................................................................. 101 Appendices ................................................................................................................................ 103 Appendix 1. Sample search strategy............................................................................ 103 Appendix 2. Example completed quality appraisal checklist for RQ 1.1 ................... 113 Appendix 3. Example completed quality appraisal checklist for RQ 1.2 ................... 114 Appendix 4. PRISMA diagram – RQ 1.1 ...................................................................... 116 Appendix 5. PRISMA diagram – RQ 1.2 ...................................................................... 117 Appendix 6. Bibliography of included studies for RQ 1.1 ........................................... 118 Appendix 7. Bibliography of excluded studies for RQ 1.1 .......................................... 122 Page 3 of 301 Severe mental illness and substance misuse (dual diagnosis) – community health and social services – Draft Review 1 Appendix 8. Bibliography of included studies for RQ 1.2 ........................................... 169 Appendix 9. Bibliography of excluded studies for RQ 1.2 .......................................... 170 Appendix 10. Forest plots for meta-analyses ................................................................ 173 Appendix 11. Evidence tables: RQ1.1 epidemiology ................................................... 177 Appendix 12. Evidence tables: RQ1.2 current practice ............................................... 267 Page 4 of 301 Severe mental illness and substance misuse (dual diagnosis) – community health and social services – Draft Review 1 GLOSSARY AND ABBREVIATIONS AESOP study: Aetiology and Ethnicity of Schizophrenia and Other Psychoses (AESOP) epidemiological study (conducted 1997-1999) APMS 2001: Adult Psychiatric Morbidity Survey (Psychiatric Morbidity among Adults [16-74 years] Living in Private Households in England, Wales, and Scotland [Singleton et al. 2001]) APMS 2007: Adult Psychiatric Morbidity Survey (APMS) conducted in England in 2007. The APMS was designed to be representative of the population living in private households in England AUDIT: Alcohol Use Disorders Identification Test ( Babor et al. 2001). WHO measure of alcohol-use disorders. The AUDIT has ten items constructed across three domains: consumption (items 1 to 3); dependence (items 4 to 6); and problems (items 7 to 10). The AUDIT has a maximum score of 40 with the following categories being defined: 1 to 7, low-risk drinking; 8 to 15, hazardous drinking; 16 to 19, harmful drinking; and 20 or more, possible alcohol dependence. AUS: Alcohol Use Scale (Drake et al., 1990). The AUS is a 5-point scale based on DSM-III-R criteria for severity of disorder: 1 = abstinence, 2 = use without impairment, 3 = abuse, 4 = dependence and 5 = severe dependence. CMHT: Community Mental Health Team COMO study: Comorbidity Dual Diagnosis Study (COMO) RCT COSMIC study: Comorbidity of Substance Misuse and Mental Illness Collaborative (COSMIC) study CPA: Care Programme Approach DIP-DM: Diagnostic Interview for Psychosis-Diagnostic Module DSM-IV: Diagnostic and Statistical Manual of Mental Disorders, 4th Edition DUS: Drug Use Scale (Drake et al., 1990). The DUS is a 5-point scale based on DSM-III-R criteria for severity of disorder: 1 = abstinence, 2 = use without impairment, 3 = abuse, 4 = dependence and 5 = severe dependence. EPSILON study: European Psychiatric Services: Inputs Linked to Outcome Domains and Needs (EPSILON) study GPRD: General Practice Research Database Page 5 of 301 Severe mental illness and substance misuse (dual diagnosis) – community health and social services – Draft Review 1 ICD-9/10: International Statistical Classification of Diseases and Related Health Problems (ICD)- 9th/10th revision IGC: Item Group Checklist Mann-Whitney U test: Nonparametric test that makes no assumptions about the probability distributions of the variables being assessed and tests the null hypothesis that two samples come from the same population against the alternative hypothesis that the two samples come from different populations. NIFEPS: Northern Ireland First Episode Psychosis Study OPCRIT: Operational Checklist for Psychiatric Disorders ONS: Office of National Statistics PANSS: Positive and Negative Syndrome Scale. The PANSS is a scale that measures the severity of symptoms in people with psychosis. It includes 3 subscales: 1 for positive symptoms, 1 for negative symptoms and 1 for general psychopathology. Scores range from 30 to 210, with higher scores indicating greater severity of symptoms. PPHS: Personal and Psychiatric History Schedule PSQ: Psychosis Screening Questionnaire (Bebbington & Nayani, 1994, 1995) SADQ(-C): Severity of Alcohol Dependence Questionnaire (-Community version) (Stockwell et al. 1979). It is a 20-item questionnaire with a maximum score of 60. Five elements of the alcohol dependence syndrome examined are: Physical withdrawal (items 1 to 4); Affective withdrawal (items 5 to 8); Withdrawal relief drinking items (9 to 12); Alcohol consumption items (13 to 16); Rapidity of reinstatement items (17 to 20). SADQ scores of at least 31 indicate severe alcohol dependence SANS: Scale for the Assessment of Negative Symptoms is a rating scale to measure negative symptoms of psychosis. It is split into 5 domains,
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