title: Outcome of patients with dual diagnosis in secondary psychiatric care.
abstract: BACKGROUND
  Dual diagnosis (DD) is a common co-morbidity of mental illness and substance use disorder (SUD) and patients with DD are prone to complications. Better knowledge on the outcome, mortality and management of patients with DD in usual secondary psychiatric care would help to inform improved treatment strategies in the future.
  
  
  OBJECTIVE
  To explore the functional outcome and mortality of patients with DD receiving psychiatric treatment. To assess the recognition of substance use disorders (SUDs) in terms of diagnosis, and the associations of clinically diagnosed SUDs with treatment-related variables.
  
  
  METHODS
  The sample of 330 patients was collected by screening all currently treated patients with the Alcohol Use Disorders Identification Test (AUDIT) and a question about other substances used. The inclusion criteria were AUDIT >7 and/or reported use of other substances during the preceding 12 months. The Global Assessment of Functioning scale was used to assess functional outcomes during a 2-year follow-up. Information concerning treatment and patient characteristics was collected retrospectively.
  
  
  RESULTS
  Level of functioning remained stable among all study patients during follow-up. The mortality rate was not increased. Effective medication use was associated with improved functional outcomes. SUDs were underdiagnosed. A clinically diagnosed SUD seemed to have an impact on the regularity of appointments and the doses of prescribed medications.
  
  
  CONCLUSIONS
  Given our results suggesting a stable level of functioning, patients with DD appear to be well managed within secondary psychiatric care. Attention should be paid to more precise diagnostics of SUDs and to effective use of medication.
authors.affiliation: a Department of Psychiatry , Seinäjoki Hospital District , Seinäjoki , Finland ;|b University of Tampere, Medical School, 33014 University of Tampere , Finland.
authors.forename: Kaisa E
authors.initials: KE
authors.lastname: Luoto
authors.affiliation: a Department of Psychiatry , Seinäjoki Hospital District , Seinäjoki , Finland ;|b University of Tampere, Medical School, 33014 University of Tampere , Finland.
authors.forename: Antti
authors.initials: A
authors.lastname: Koivukangas
authors.affiliation: a Department of Psychiatry , Seinäjoki Hospital District , Seinäjoki , Finland ;
authors.forename: Antero
authors.initials: A
authors.lastname: Lassila
authors.affiliation: a Department of Psychiatry , Seinäjoki Hospital District , Seinäjoki , Finland ;|b University of Tampere, Medical School, 33014 University of Tampere , Finland.
authors.forename: Olli
authors.initials: O
authors.lastname: Kampman
mesh_terms: D000328:Adult; D015897:Comorbidity; D017831:Diagnosis, Dual (Psychiatry) / Q000379:methods / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D008875:Middle Aged; D011613:Psychotherapy / Q000379:methods / Q000639:trends; D012189:Retrospective Studies; D063127:Secondary Health Care / Q000379:methods / Q000639:trends*; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Dual diagnosis; functional outcome; mortality; secondary psychiatric care; treatment variables