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ABSTRACTS / 27TH NORDIC PSYCHIATRIC CONGRESS I
diseases like depression, anxiety, obsessive-compulsive disorders,
and personality disorders and offered them treatment like CBT-
groups or medication that is specially focused on their particular
problems. We have put great emphasis on family treatment and
individual counselling.
In this way we have extended our treatment in order to treat
simultaneously the alcohol or drug addiction along with the other
psychiatric problems that can usually be found in these patient
groups.
s - !X / 2 Thursday 14/8,11:00-12:30
psychiatric comorbidity. Clinical aspects
Krislinn Tómasson, MD, Dr. Med., Dept. of Research & Occupational Health, Admini-
stration for Occupational Health & Safety, Bfldshöfða 16,110 Reykjavík, Iceland
kristinn@ver.is
Introduction: Psychiatric comorbidiy among alcoholics and other
substance abusers is an important phenomenon that needs to be
acknowledged by those taking care of them.
Methods: The present paper, reviews different definitions of co-
morbidity, gives a review of several studies on the prevalence of
psychiatric comorbidity, both among the general population of
substance abusers, and those who are treatment seeking
Results: Definition of comorbidity greatly affects the prevalence.
However, using a definition without exclusion criteria the preva-
lence in the community varies between 20% and 60% depending
°n method of diagnosis, while among treatment seeking population
the prevalence varies between 50% and 95% depending on method
use for diagnosing and population surveyed. Even this wide defini-
t>on has prognostic implication in terms of course of the substance
use disorder, social consequences of substance use and mental
health in general
Conclusion: For proper treatment of substance use disorders a
thorough assessment is needed, without using or applying exclusion
cnteria while diagnosing psychiatric comorbidity.
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Psychosocial treatment, especially for patients with
comorbidity
Agnetaöjeha,®S * * * * * 11, Associate Professor, Dept. of Clin. Neuroscience, Div. of Psychiatry,
85 Lund, Sweden
a8nela-ojehagen@psykiatr. lu.se
Backyround: In order to determine the effectiveness of psycho-
soctal treatment for alcohol dependence, a systematic review of all
fandomized controlled trials (RCT) addressing this issue was
Performed by the SBU. Among questions addressed were: Are
SOme treatnient methods better than others? Does matching
Patients to treatment improve outcome? Is special treatment
uceded for substance abusers with mental illness?
ethods: With the search terms “alcoholism” and „randomized
controlled trials" the literature was searched, and the Iatest update
was performed April 2002. A total of 164 published RCTs were
ound reporting on outcomes of psychosocial treatment.
Results: Specific methods, i.e. theory based, well described and often
manual based (motivational enhancement, cognitive behaviour the-
rapy, interactional, well structured psychodynamic, 12 step pro-
gramme) were better than general support. When comparing diffe-
rent specific treatment, no significant differences were found. There is
little support for matching treatment to patient characteristics. Fifteen
studies concerned subjects with comorbid psychiatric disorders, and
there were no differences between the specific methods used. The
psychosocial treatment for the substance use disorder should be
coordinated with the treatment for the psychiatric disorder.
Conclusions: Specific methods targeting the substance abuse
should be coordinated with treatment for the psychiatric disorder.
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Psychopharmacological treatment, especially for patients
with comorbidity
Mats Berglund, Professor, MD, Department of Clinical Alcohol Research, Malmö
University Hospital, S-205 02 Malmö, Sweden
mats. berglund@alk.mas. lu.se
Background: Evidence-based treatment for alcohol dependence
with medication has improved considerably during the last decade.
Methods: Systematic review of literature as a part of the Swedish
SBU-report.
Results: In total, 104 published and 16 unpublished randomized
controlled trials assessed the effects of medication on alcohol depen-
dence. The agents acamprosate and naltrexone, have well-documen-
ted effects. Acamprosate significantly increases the rate of complete
recovery while naltrexone significantly reduces alcohol abuse when
the drug is combined with effective psychosocial interventions such
as cognitive behavioral therapy. Antabus (disulfiram) is also
documented as an effective method to reduce alcohol intake, but
only when used under supervision. Drugs (antidepressants/buspi-
rone) are effective in treating depression or anxiety in alcoholics.
However, they have no confirmed effects on alcohol dependence.
Conclusion: Effective pharmacological treatment methods are
available both for alcohol dependence and concomitant psychiatric
comorbidity.
S - IX / 5 Thursday 14/8, 11:00-12:30
Educational assets. Addiction medicine
Marianne Mánsson, Senior Physician, Addiction Centre, Malmö University Hospital, S-
205 02 Malmö, Sweden
marianne.mansson@alk.mas.lu.se
Background: In 1992 a new clinical curriculum was introduced in
the Medical School at Malmoe General Hospital, University of
Lund. A 2-week problem based course in addiction medicine was
created and integrated with the internal medicine/surgery courses
during the fourth year. Three modules of the course were defined
according to three different major goal sections; theoretical lear-
ning, attitude analysis, practical skills, and knowledge in specific
clinical areas.
Mctliods: Theoretical learning: A specific textbook has been
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