الفهرس 
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Abstract
Summary
ubstance use disorder is one of the most complicated problems that face not only medical professionals but the whole community. Problems of substance abuse produce dramatic costs for all societies in the term of low productivity, medical complications, family and social troubles as well as crimes.
The comorbidity of substance use rate increased by about 10% each year among psychiatric patients, and co-morbid cases are becoming younger. Large-scale epidemiological surveys have also shown that drug use disorders – drug abuse or drug dependence – are prevalent and characterized by substantial comorbidity with mental disorders.
Epidemiologic studies of various types converge to suggest that the association between psychiatric and drug disorders is etiologically meaningful. However, convincing etiological models do not, as yet, seem to have been put forward. The rapid development of technical advances in the neurosciences has led to a better understanding of the molecular biology, neurotransmitter systems, and neural circuitry involved in mental illness and substance use disorders. Better understanding of the connection between substance use disorders and psychiatric disorders could have a profound effect on prevention and treatment.
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There are potentially four explanations of the underlying causal processes that lead to the comorbidity of substance use disorders and psychiatric disorders. First, it may be suggested that these comorbidities arise from common or correlated factors that predispose the individual to both substance use disorders and psychiatric disorders. These factors may include both genetic and environmental factors shared by psychiatric and substance use disorders.
Second, it may be proposed that the associations arise as a result of self-medication processes which predispose those with psychiatric disorders to use substances in order to mitigate psychiatric symptoms. Third, it may be suggested that the associations arise because of social and/or biological processes that result in the use of substances increasing risks of psychiatric disorders. Finally, it may be suggested that the associations arise from a reciprocal feedback loop involving simultaneous causation between substance use disorders and psychiatric disorders.
The study took place within a period of 6 months started at the 1st March 2013 and terminated at the 31st August 2013. The present study was conducted aiming to estimate the rate of substance use occurrence among psychiatric inpatient, and to compare the groups of patients with a dual diagnosis to the group of mental patients without substance use regarding to demographics and different clinical correlates affecting them, all included patients
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divided into two groups: group I include 140 patients without substance use and group II include 93 patients with substance use. All data gathered were recorded, tabulated and transferred on Statistical Package for Social Sciences (SPSS).
The rate of substance use among our psychiatric inpatients was 39.9 %. Our results revealed that the mean age of the sample was 32.4±9.5 years, 171(73.4%) were males and 62(26.6%) were female, 132(73.4%) from Cairo and 101(43.3%) from other towns, 122(52.4%) were single, 86(36.9%) married and 25(10.7%) divorced. No widow reported in the sample, 94(40.3%) have a secondary education and 24 (10.3%) was illiterate and 104 (44.6%) were low social standard and 26(11.2%) were high standard, 94(40.3%) were a secondary educated, 44(18.9%) university educated and 36(15.5%) primary educated, 35(15%) preparatory educated and 24(10.3%) were illiterate.
The study results show no statistical significance between the two groups regarding residence, educational level and social standard, while there was a highly statistical significance (p= 0.001) regarding age where group II have younger age than group I. Also a highly statistical significance (p=< 0.001) detected regarding sex where females in group II were 1(1.1%) while in group I were 61(43.6%).
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Our results revealed a statistical significance regarding marital status between the two groups (p= 0.016) where single patients in group II were more than that of group II. The age of start psychiatric illness is significantly younger statistically in group II than group I (p= 0.016).
Involuntary admission and aggression as a cause of admission are significantly higher statistically in group II than in group I(p= 0.001). History of smoking and family history of substance use are significantly higher statistically in group II than group I (p= 0.001). Duration since last admission is significantly shorter statistically in group II than group I (p= 0.007).
The positive patients account for 93(39.9%) of the sample (n=233). 45(48.4 %) of the positive patients used cannabis plus tramadol, 28(30.1%) used cannabis only, 16(17.2%) used cannabis plus benzodiazepines and 4(4.3%) were used cannabis plus opiates (opium or heroin). There is a highly statistical significant association between schizophrenia (p=<0.001) and bipolar disorder (p=<0.008) regarding cannabis plus tramadol use. There is a statistical significant association between involuntary admission (p=<0.001) and aggression as a cause of admission (p=0.028) and schizophrenia.
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Tools used:
A- A urine screen for substances of use:
Urine screening for common substances of use (opiates, cannabis, benzodiazepines, barbiturates, and amphetamines) was performed on admission of patient to determine substance use.
B- Designed psychiatric questionnaire:
It was designed to assess the following:
1-Demographic data:
a) Age
b) Gender
c) Marital status
d) Residence
e) Educational level
2- Data related to admissions and psychiatric illness:
a) Number of previous admissions
b) Type of current admission (voluntary or involuntary)
c) Duration since last admission (in months)
d) Contribution of aggression to admission
e) Number of previous episodes
f) Age at the start of psychiatric illness
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3- Data related to substance use:
a) Age at the start of substance use.
b) First substance used.
c) Duration of substance use in months.
d) Substances used in previous 12 month.
e) The primary substance used in the previous 30 days.
f) Family history of substance use.
g) Smoking.
C- Fahmy and El Sherbini socio-economic scale (1988):
Aim: Assessment of the socio-economic status.
D- The Mini-International Neuropsychiatry Interview (MINI) plus:
Aim: to reach to an accurate and short psychiatric diagnosis.
E- Addiction severity Index (ASI 5th Ed.):
Aim: to assess the substance use among psychiatric patients