Kannabista käyttävillä mieliala- ja psykoosisairauspotilailla on enemmän psykososiaalisia ongelmia kuin niillä, jotka eivät käytä kannabista

Kannabista käyttävillä mieliala- ja psykoosisairauspotilailla on enemmän psykososiaalisia ongelmia kuin niillä, jotka eivät käytä kannabista

Compton, Michael T et al,

Axis IV psychosocial problems among patients with psychotic or mood disorders with a cannabis use disorder comorbidity.

The American Journal on Addictions. Vol.20(6), Nov-Dec 2011, pp. 563-567.

Among 1,610 patients with psychotic or mood disorders in routine psychiatric practice, odds ratios (crude and adjusted for age, education, gender, and race) quantified associations between the presence of comorbid cannabis abuse/dependence and seven psychosocial problems.

Results revealed a higher prevalence of five of seven Axis IV psychosocial problems among patients who had a psychotic or mood disorder and a comorbid cannabis use disorder.

The results underscore the need for careful screening and treatment of comorbid cannabis abuse/dependence among patients with psychotic or mood disorders given the prominent associated psychosocial impairments in this population.


Axis IV: Psychosocial and Environmental Problems

Axis IV is for reporting psychosocial and environmental problems that may affect the diagnosis, treatment, and prognosis of mental disorders (Axis I and II). A psycho¬social or environmental problem may be a negative life event, an environmental dif¬ficulty or deficiency, a familial or other interpersonal stress, an inadequacy of social support or personal resources, or other problem relating to the context in which a per¬son's difficulties have developed. So-called positive stressors, such as job promotion, should be listed only if they constitute or lead to a problem, as when a person has dif¬ficulty adapting to the new situation. In addition to playing a role in the initiation or exacerbation of a mental disorder, psychosocial problems may also develop as a consequence of a person's psychopathology or may constitute problems that should be considered in the overall management plan.

When an individual has multiple psychosocial or environmental problems, the cli¬nician may note as many as are judged to be relevant. In general, the clinician should note only those psychosocial and environmental problems that have been present during the year preceding the current evaluation. However, the clinician may choose to note psychosocial and environmental problems occurring prior to the previous year if these clearly contribute to the mental disorder or have become a focus of treat¬ment-for example, previous combat experiences leading to Posttraumatic Stress Disorder.

In practice, most psychosocial and environmental problems will be indicated on Axis IV. However, when a psychosocial or environmental problem is the primary fo¬cus of clinical attention, it should also be recorded on Axis I, with a code derived from the section "Other Conditions That May Be a Focus of Clinical Attention" (see p. 731- DSM-IV-TR). For convenience, the problems are grouped together in the following categories:
•    Problems with primary support group - e.g., death of a family member; health problems in family; disruption of family by separation, divorce, or estrangement; removal from the home; remarriage of parent; sexual or physical abuse; parental overprotection; neglect of child; inadequate discipline; discord with siblings; birth of a sibling
•    Problems related to the social environment- e.g., death or loss of friend; inade-quate social support; living alone; difficulty with acculturation; discrimination; ad-justment to life-cycle transition (such as retirement)
•    Educational problems - e.g., illiteracy; academic problems; discord with teachers or classmates; inadequate school environment
•    Occupational problems - e.g., unemployment; threat of job loss; stressful work schedule; difficult work conditions; job dissatisfaction; job change; discord with boss or co-workers
•    Housing problems - e.g., homelessness; inadequate housing; unsafe neighborhood; discord with neighbors or landlord
•    Economic problems - e.g., extreme poverty; inadequate finances; insufficient wel¬fare support
•    Problems with access to health care services - e.g., inadequate health care ser-vices; transportation to health care facilities unavailable; inadequate health insur¬ance
•    Problems related to interaction with the legal system/crime - e.g., arrest; incar-ceration; litigation; victim of crime
•    Other psychosocial and environmental problems - e.g., exposure to disasters, war, other hostilities; discord with nonfamily caregivers such as counselor, social worker, or physician; unavailability of social service agencies.
When using the Multiaxial Evaluation Report Form (see p. 36), the clinician should identify the relevant categories of psychosocial and environmental problems and in¬dicate the specific factors involved. If a recording form with a checklist of problem categories is not used, the clinician may simply list the specific problems on Axis IV