title: A retrospective analysis focusing on a group of patients with dual diagnosis treated by both mental health and substance use services.
abstract: OBJECTIVE
  To highlight which demographic, familial, premorbid, clinical, therapeutic, rehabilitative, and assistance factors were related to dual diagnosis, which, in psychiatry, means the co-occurrence of both mental disorder and substance use in the same patient.
  
  
  METHODS
  Our sample (N=145) was chosen from all outpatients with a dual diagnosis treated from January 1, 2012 to July 31, 2012 by both the Mental Health Service and the Substance Use Service of Modena and Castelfranco Emilia, Italy. Patients who dropped out during the study period were excluded. Demographic data and variables related to familial and premorbid history, clinical course, rehabilitative programs, social support and nursing care, and outcome complications were collected. The patients' clinical and functioning conditions during the study period were evaluated.
  
  
  RESULTS
  Our patients were mostly men suffering from a cluster B personality disorder. Substance use was significantly more likely to precede psychiatric disease (P<0.001), and 60% of the sample presented a positive familial history for psychiatric or addiction disease or premorbid traumatic factors. The onset age of substance use was related to the period of psychiatric treatment follow-up (P<0.001) and the time spent in rehabilitative facilities (P<0.05), which, in turn, was correlated with personality disorder diagnosis (P<0.05). Complications, which presented in 67% of patients, were related to the high number of psychiatric hospitalizations (P<0.05) and professionals involved in each patient's treatment (P<0.05). Males more frequently presented familial, health, and social complications, whereas females more frequently presented self-threatening behavior (P<0.005).
  
  
  CONCLUSIONS
  It was concluded that the course of dual diagnosis may be chronic, severe, and disabling, requiring many long-term therapeutic and rehabilitative programs to manage various disabilities.
authors.affiliation: Mental Health Department, Azienda USL di Modena, Modena, Italy.
authors.forename: Rosaria
authors.initials: R
authors.lastname: Di Lorenzo
authors.affiliation: School of Nursing, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Agnese
authors.initials: A
authors.lastname: Galliani
authors.affiliation: Department of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Alessia
authors.initials: A
authors.lastname: Guicciardi
authors.affiliation: Department of Psychiatry, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Landi
authors.affiliation: School of Nursing, University of Modena and Reggio Emilia, Modena, Italy.
authors.forename: Paola
authors.initials: P
authors.lastname: Ferri
keywords: dual diagnosis patients; mental disorder and substance use co-occurrence; mental health and substance use services