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Handwriting Analysis Indicates Spontaneous Dyskinesias in Neuroleptic Naïve Adolescents at High Risk for Psychosis

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Rural and urban differences in patients with a dual diagnosis.

K T Mueser¹, S M Essock, R E Drake

¹New Hampshire-Dartmouth Psychiatric Research Center, Concord, NH 03301, USA. Kim.T.Mueser@Dartmouth.edu

Schizophrenia Research

|March 30, 2001

Summary

Patients with severe mental illness and substance use disorders in urban areas face greater challenges, including higher rates of cocaine use and homelessness, necessitating enhanced support services compared to rural counterparts.

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Area of Science:

Psychiatry
Public Health
Addiction Medicine

Background:

Severe mental illness (schizophrenia-spectrum or bipolar disorder) often co-occurs with substance-use disorders, creating complex treatment needs.
Geographic location (rural vs. urban) may influence the presentation and challenges faced by individuals with dual diagnoses.

Purpose of the Study:

To compare demographic characteristics, psychiatric and substance use profiles, and quality of life between patients with dual diagnoses residing in rural (New Hampshire) versus urban (Connecticut) settings.

Main Methods:

A comparative study evaluated two cohorts of patients with dual diagnoses (N=225 rural, N=166 urban) using identical recruitment criteria.
Data collected included demographics, housing, legal issues, psychiatric diagnoses, substance use patterns, symptom severity, and quality of life.

Main Results:

Urban patients (Connecticut) exhibited higher rates of cocaine-use disorder, criminal justice involvement, homelessness, and minority status.
The urban group also had more schizophrenia diagnoses, greater symptom severity, and lower socioeconomic indicators (marriage, education, work).
Rural patients (New Hampshire) had higher rates of alcohol-use disorder.

Conclusions:

Urban patients with dual diagnoses may require more intensive ancillary services due to higher substance abuse severity and psychiatric illness.
Recommended services include residential programs, Assertive Community Treatment, and jail diversion programs for successful treatment outcomes.