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Risk Factors Associated With Psychiatric Comorbidity in a Sample of Male Egyptian Patients With Substance Use Disorder

Khalil, Afaf H. MD*; Omar, Abdel N.M. MD*; Ali, Ramy R. MD*; Mahmoud, Dalia A.M. MD*; Naoum, Dina O. MD; Khumisi, Abdallah A. MBBch; El Missiry, Ahmed A. MD*

Addictive Disorders & Their Treatment: September 2019 - Volume 18 - Issue 3 - p 157–168
doi: 10.1097/ADT.0000000000000158
Original Articles

Background: The co-occurrence of psychiatric and substance use disorder increases the duration of illness, hospitalization rates, and causes more functional impairment and legal problems, which may increase the burden of illness. Hence, identifying the risk factors of such comorbidity may help in mitigating such problems.

Objective: This study examined the risk factors associated with comorbid Axis I and Axis II disorders in a sample of male Egyptian patients with substance abuse.

Patients and Methods: A total of 158 male inpatients diagnosed with substance use disorder according to diagnostic and statistical manua-IV diagnostic criteria answered the Structured Clinical Interview for Axis I and Axis II disorders (SCID-I and SCID-II). They were also evaluated by the Addiction Severity Index scale and the Global Assessment of Functioning.

Results: An overall 60% were diagnosed with another Axis I or Axis II disorder. An overall 26% of them had psychosis, and 21% had borderline personality disorder. Unemployment, history of child abuse, high cannabis, opioid and tramadol abuse, frequent overdosing, longer hospitalization, aggressive behavior, family dysfunction, and occupational and legal problems were significantly more in patients with comorbidity. Moreover, 62% of them had severe problems on the Addiction Severity Index scale. The predictive risk factors for comorbidity were familial problems, aggressive symptoms, cluster B personality traits, past history of psychiatric disorders, longer time of hospitalization, and lower Global Assessment of Functioning scores.

Conclusions: Identifying the risk factors for psychiatric comorbidity in patients with substance dependence highlights the importance of developing a dual diagnosis service to meet the needs of this population.

*Faculty of Medicine, Institute of Psychiatry, Ain Shams University

Department of Psychiatry, Al Mashfa Hospital, Cairo, Egypt

The authors declare no conflict of interest.

Reprints: Dalia A.M. Mahmoud, MD, Institute of Psychiatry, Ain Shams university, Cairo 11566, Egypt (e-mail:

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