Acute alcohol consumption and mechanism of injury

Objective: The purpose of this study was to determine whether injury mechanism among injured patients is differentially distributed as a function of acute alcohol consumption (quantity, type, and drinking setting). Method: A cross-sectional study was conducted between October 2000 and October 2001 in the Gold Coast Hospital Emergency Department, Queensland, Australia. Data were collected quarterly over a 12-month period. Every injured patient who presented to the emergency department during the study period for treatment of an injury sustained less than 24 hours prior to presentation was approached for interview. The final sample comprised 593 injured patients (males = 377). Three measures of alcohol consumption in the 6 hours prior to injury were obtained from self-report: quantity, beverage type, and drinking setting. The main outcome measure was mechanism of injury which was categorized into six groups: road traffic crash (RTC), being hit by or against something, fall, cut/piercing, overdose/poisoning, and miscellaneous. Injury intent was also measured (intentional vs unintentional). Results: After controlling for relevant confounding variables, neither quantity nor type of alcohol was significantly associated with injury mechanism. However, drinking setting (i.e., licensed premise) was significantly associated with increased odds of sustaining an intentional versus unintentional injury (odds ratio [OR] = 2.79, 95% confidence interval [CI] = 1.4-5.6); injury through being hit by/against something versus other injury types (OR = 2.59, 95% CI = 1.4-4.9); and reduced odds of sustaining an injury through RTC versus non-RTC (OR = 0.02, 95% CI = 0.004-0.9), compared with not drinking alcohol prior to injury. Conclusions: No previous analytical studies have examined the relationship between injury mechanism and acute alcohol consumption (quantity, type, and setting) across all types of injury and all injury severities while controlling for potentially important confounders (demographic and situational confounders, risk-taking behavior, substance use, and usual drinking patterns). These data suggest that among injured patients, mechanism of injury is not differentially distributed as a function of quantity or type of acute alcohol consumption but may be differentially distributed as a function of drinking setting (i.e., RTC, intentional injury, being hit). Therefore, prevention strategies that focus primarily on the quantity and type of alcohol consumed should be directed generically across injury mechanisms and not limited to particular cause of injury campaigns.

Number and type of substances in alcohol and drug-related completed suicides in an Australian sample

Background: The association between substance use and suicide is well-established, but evidence is scant regarding the relationship between the number, type, and level of substances and other risk factors in completed suicide across the lifespan. Aims: To examine the relationship between social/demographic characteristics and the number, type, and level of drugs present in an unrestricted age sample of completed suicides in Australia. Method: An analysis was undertaken of 893 substance-related suicides using data from the Government Statistician's Office for the years 1989-1992. Results: The number and type of substances present in suicide victims was related to the individual's gender, age, marital status, employment status, and method of suicide. Blood alcohol level was significantly different between the methods of suicide, but was unrelated to demographic characteristics of the individual. The level of antidepressants and minor tranquilizers in the individuals was also unrelated to demographic characteristics. Conclusion: Examination of the type and number of substances present in completed suicides is an important component in creating profiles of potential suicide victims.

Cannabis use and psychotic disorders: an update

This paper evaluates three hypotheses about the relationship between cannabis use and psychosis in the light of recent evidence from prospective epidemiological studies. These are that: ( 1) cannabis use causes a psychotic disorder that would not have occurred in the absence of cannabis use; ( 2) that cannabis use may precipitate schizophrenia or exacerbate its symptoms; and ( 3) that cannabis use may exacerbate the symptoms of psychosis. There is limited support for the first hypothesis. As a consequence of recent prospective studies, there is now stronger support for the second hypothesis. Four recent prospective studies in three countries have found relationships between the frequency with which cannabis had been used and the risk of receiving a diagnosis of schizophrenia or of reporting psychotic symptoms. These relationships are stronger in people with a history of psychotic symptoms and they have persisted after adjustment for potentially confounding variables. The absence of any change in the incidence of schizophrenia during the three decades in which cannabis use in Australia has increased makes it unlikely that cannabis use can produce psychoses that would not have occurred in its absence. It seems more likely that cannabis use can precipitate schizophrenia in vulnerable individuals. There is also reasonable evidence for the third hypothesis that cannabis use exacerbates psychosis.

Increased health care utilization and increased antiretroviral use in HIV-infected individuals with mental health disorders

Objectives The aims of the study were to describe the prevalence and associations of mental health disorder (MHD) among a cohort of HIV-infected patients attending the Victorian HIV/AIDS Service between 1984 and 2000, and to examine whether antiretroviral therapy use or mortality was influenced by MHD (defined as a record of service provision by psychiatric services on the Victorian Psychiatric Case Register). It was hypothesized that HIV-positive individuals with MHD would have poorer treatment outcomes, reduced responses to highly active antiretroviral therapy (HAART) and increased mortality compared with those without MHD. Methods This is a retrospective cohort of 2981 individuals (73% of the Victorian population diagnosed with HIV infection) captured on an HIV database which was electronically matched with the public Victorian Psychiatric Case Register (VPCR) (accounting for 95% of public system psychiatry service provision). The prevalence, dates and recorded specifics of mental health disorders at the time of the electronic match on 1 June 2000 are described. The association with recorded MHD, gender, age, AIDS illness, HIV exposure category, duration and type of antiviral therapy, treatment era (prior to 1986, post-1987 and pre-HAART, and post-HAART) on hospitalization and mortality at 1 September 2001 was assessed. Results Five hundred and twenty-five individuals (17.6% of the Victorian HIV-positive population) were recorded with MHD, most frequently coded as attributable to substance dependence/abuse or affective disorder. MHD was diagnosed prior to HIV in 33% and, of those diagnosed after HIV, 93.8% were recorded more than 1 year after the HIV diagnosis. Schizophrenia was recorded in 6% of the population with MHD. Hospitalizations for both psychiatric and nonpsychiatric illness were more frequent in those with MHD (relative risk 5.4; 95% confidence interval 3.7, 8.2). The total number of antiretrovirals used (median 6.4 agents vs 5.5 agents) was greater in those with MHD. When adjusted for antiretroviral treatment era, HIV exposure category, CD4 cell count and antiretroviral therapy, survival was not affected by MHD. Conclusions MHD is frequent in this population with HIV infection and is associated with increased healthcare utilization but not with reduced survival.

Drug use patterns and mental health of regular amphetamine users during a reported 'heroin drought'

Aims The present study extends the findings of a pilot study conducted among regular amphetamine users in Newcastle, NSW, in 1998. It compares key features between current participants in a state capital city (Brisbane) and a regional city (Newcastle) and between the 1998 and current Newcastle sample. Design Cross-sectional survey. Setting Brisbane and Newcastle, Australia. Participants The survey was conducted among 214 regular amphetamine users within the context of a randomized controlled trial of brief interventions for amphetamine use. Measurements Demographic characteristics, past and present alcohol and other drug use and mental health, treatment, amphetamine-related harms and severity of dependence. Findings The main findings were as follows: (i) the rate of mental health problems was high among regular amphetamine users and these problems commonly emerged after commencement of regular amphetamine use; (ii) there were regional differences in drug use with greater accessibility to a wider range of drugs in a state capital city and greater levels of injecting risk-taking behaviour outside the capital city environment; and (iii) there was a significant increase in level of amphetamine use and percentage of alcohol users, a trend for a higher level of amphetamine dependence and a significant reduction in the percentage of people using heroin and benzodiazepines among the 2002 Newcastle cohort compared to the 1998 cohort. Conclusions Further longitudinal research is needed to elucidate transitions from one drug type to another and from recreational to injecting and regular use and the relationship between drug use and mental health in prospective studies among users. Implications Intervention research should evaluate the effectiveness of interventions aimed at: preventing transition to injecting and regular use of amphetamines; toward reducing levels of depression among amphetamine users and interventions among people with severe psychopathology and personality disorders; and toward reducing the prevalence of tobacco dependence among amphetamine users.

The use of electropalatography in the assessment and treatment of acquired motor speech disorders in adults: Current knowledge and future directions

Electropalatography (EPG) has been employed to measure speech articulation since the mid-1970s. This technique has predominately been used in experimental phonetic research and in the diagnosis and treatment of articulation disorders in children. However, there is a growing body of research employing EPG to diagnose and treat articulatory impairment associated with acquired motor speech disorder (MSD) in adults. The purpose of this paper was to (1) review the findings of studies pertaining to the assessment and treatment of MSDs in adults using EPG, (2) highlight current methodologies employed, and (3) discuss the potential limitations of EPG in the assessment and treatment of MSDs and examine directions for future applied research and treatment studies.