comorbid.disorders

comorbid.disorders - Examples Of Dual Diagnosis ' MENTAL...

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Unformatted text preview: Examples Of Dual Diagnosis ' MENTAL DISORDERS ' ADDICTION DISORDERS 0 Schizophrenia 0 Alcohol Abuse/Dependmce 0 Bi-polar O Cocaine/Amphetamine Co-Morbid Disorders - - w Mental Illness and Substance Abuse ' m" D'Fm‘im ' MM“ e Borderline Personality e Polysubsunce combinations a Post Traumatic Stress I Prescription drugs Co-Morbid Disorders 0 When two disorders or illnesses occur SimUltaneOUSIY in the same person, Lllellme Preealence ol Drug Disorders Among are Persons With Mood and Amuer Dlsordels 0 Surveys show that drug abuse and other menial Illnesses are oflen comormd. Lifetime Prevalence ur’ Jsr S I Six out of ten people with a subslance use disuder also seller from another form of mental illness. o E e o E I: a e Dara show that persons diagnosed with mood or anxiety disorders are about . cwice as likely no sufier also from a drug use disorder (abuse or dependence) compared with respondents in general. 0 But me high prevalence of these oomorbidilies does not mean lhal one wndmon caused the other, even if one appeared first. Why do they co-occur? 0 There are at least three scenarios that we should consider: 0 drug abuse can cause a mental illness 0 mental illness can lead to dmg abuse 0 drug abuse and mental disorders are both caused by other common risk factors 0 In reality, all three scenarios can contribute, in varying degrees, to the establishment of specific oomorbid mental disorders and addiction. What Kind of Mental or Emotional Problems are Seen in People with Dual Diagnosis? 0 The following psychiatric problems are common to occur in dual diagnosis - i.e.. in tandem with alcohol or drug dependency. 0 Depressive disorders. such as depression and bipolar disorder. 0 Anxiety disorders. including generalized anxiety disorder. panic disorder. obsessive-compulsive disorder. and phobias. 0 Other psychiatric disorders. such as schilophrenia and personality disorders. The lollowing table based on a National Institute of Mental Health study. lisls seven maior psychiatric disorders and shows how much can one increases an indiwdual's nsk for substance abuse. 0 Psychiatric Disorder 0 Increased Illsk Substance Abuse 0 Antisocial personality discrder 0 l5.5% 0 Manic episode I I45 0 Schizophrenia o l0.l 0 Panic disorder 0 4.] I Hajordepressrve episode I 4.| ' Obsessive-compulsive disorder 0 3.4 - Phobias - 2.4 Why Do DrugAbuse and Mental Disorders Commonly Co-occur? Overlapping genetic vulnerabilities. Mounting evidence suggests diat common geneuc factors may predispose individuals to both mental disorders and addiction or to havmg a greater risk oi the second disorder once the first appears. A particularly active area of comorbidicy research involves the search for genes that might predispose individuals to develop both addicuon and other mental illnesses. or to have a greater risk of a second disorder occurring after the first appears. l( is estimated that 40-60 percent ol an individual's vulnerability to addiction is attributable to genetics: most at this vulnerability arises lrom complex interactions among multiple genes and from genetic interactions with environmental influences. Drug abuse and mental illness are developmental discrdersT'hey often beg" in adolescence or even childhood. periods when the brain is undergoing dramauc developmental changes. Early exposure to drugs of abuse can change the brain in ways that increase the risk tor mental illness (figure). just as early symptoms of a mental disorder may increase vulnerability to driq abuse. Why Do DrugAbuse and Mental Disorders Commonly Co—occur? O Overlapping genetic vulnerabilities. a In some instances: gene product may influence how a person responds no a drug (eg.vvhether the drug experience is pleasurable or not) or how long a drug remains in the body 0 But genes can also act indirectly by altering how an individual responds to stress or by increasing the likelihood of risk-taking and novelty-seeking behaviors. which could influence the development of drug use disorders and other mental illnesses. 0 Several regions oi the human genome have been Imlaed to increased risk of both drug use disorders and mental illness. includiru associations With greater vulnerability to adolescent drug dependence and conduct disorders. Why Do Drug Abuse and Mental Disorders Commonly Co-occur? 0 Involvement of similar brain regions. I Some areas of the brain are aflected by both drug abuse and mental disorders ' For example. brain circuits linked to reward processing as well as those implicated in the stress response are affected by abused substances and also show abnormalioes in specific mental discrders. ° Overlap of brain areas involved in both drug use disorders and other mental illnesses suggests that brain changes stemmmg from one may afiect the other. 0 For example.er abuse tint precedes the first symptoms of a mental illness may produce changes in brain structure and function that kindle an underlying propensity to develop that mental illness. O lithe mental disorder develops first. associated changes in brain activity may increase the vulnerability to abusing substances by enhancing their posiove effects. reducing awareness of their negative elfects. or alleviating the unpleasant effects associated With the mental disorder or die mediation used to treat it. Why Do DrugAbuse and Mental Disorders Commonly Co—occur? 0 Overlapping environmental triggers 0 Stress, trauma (e.g.. physical or sexual abuse). and early exposure to drugs are common factors that can lead to addiction and to mental illness, particularly in those with underlying genetic vulnerabilities. Why Do Drug Abuse and Mental Disorders Commonly Co-occur? 0 Drug abuse and mental illness are developmental disorders. ' They olten bqin in adolescence or even childhood. periods when the brain is undergoing dramatic developmental changes. 0 Early exposure to drugs of abuse can change the brain in ways that increase the risk for mental illness (figure). just as urly symptoms of a mental disorder may increase vulnerabiliq to drug abuse. The brain continues to develop into adulthood and undergoes dnmatic changes during adolescence. One of the brain areas still maturing during adolescence is the prefrontal cortex— the part of the brain that involves judgment. planning. enables us to assess situations and keep our emotions and desires under control. The fact that this critical part of an adolescent's brain is still a work in progress puts them at increased risk for poor decisions (such as trying drugs or continuing abuse). ’lhus, introducing drugs while the brain is still developing may have profound and long-lasting consequences. AGES Early Occurrences It is also true that having a mental disorder in childhood or adolescence can increase the risk 0! later drug abuse problems. as frequently occurs with conduct disorder and untreated attention-deficit hyperactivity disorder (ADHD). This presents a challenge when treaerig children with ADHD. since efieccve treatment olten involves prescribing m’mulant medications with abuse potential. This issue has generated strong intemt from the research community. and althoiqh the results are not yet conclusive. most studies suggest that ADHD medications do not increase the risk 0' drug abuse among children with ADHD 4* Early Occurrence Increases Later Risk I Strong evidence has emerged shwing early drug use to be a risk (actor for later substance abuse problems: additional findings suggut that it may also be a risk factor for the later occurrence 0! other mental illnesses. I However. this link is not necessanly a smple one and may hinge upon genetic vulnerability, psychosocial experiences. and/or general enin'ronmental influences. ' A INS study highliglts this complexity. with the finding that frequent marijuana use during adolescence can increase the risk of psychosis in adulthood. but only in individuals who carry a particular gene variant How can comorbidity be diagnosed and treated? The high rate of comorbidity between drug use disorders and other mental illnesses argues for a comprehensive approach to intervention that identifies and evaluates each disorder concurrently. providing treatment as needed. The needed approach calls for broad assessment tools that are less likely to result in a missed diagnosis. Accordingly. patients entering treatment for psychiatric illnesses should also be screened for substance use disorders and vice versa. Accurate diagnosis is complicated. however. by the similarities between dmg-related symptoms such as withdrawal and those of potentially comorbid mental disorders. Careful diagnosis and monitoring will help ensure that symptoms related to drug abuse (9.9.. intoxication. withdrawal) are not mistaken for a discrete mental disorder. How can comorbidity be diagnosed and treated? 0 Thus. when people who abuse drugs enter treatment. it may be necessary to observe them after a period of abstinence in order to distinguish between the effects of substance intoxication or withdrawal and the symptoms of comorbid mental disorders. 0 This practice would allow for a more accurate diagnosis and more targeted treatment. 0 Patients with co-occurring disorders often exhibit more severe symptoms than those caused by either disorder alone, underscoring the need for integrated treatment Barriers to Treatment Although research supports the need for com rehensive treatment to address comorbidity. rovision 0 such treatment can be problematic for a number 0 reasons: In the United States. different treatment systems address drug use disorders and other mental illnesses separately. Physicians are most often the front line of treatment for mental disorders. whereas dru abuse treatment is provided in assorted venues by a mix of he th care professionals with different backgrounds. Thus. neither system may have sufficiently broad expertise to address the full range of problems presented by patients. For example. when suffering from substance abuse and mental illness comorbidities. women more often seek help from mental health practitioners. whereas men tend to seek help through substance abuse treatment channels Treatment 0 Fundamental principle emerging from scientific research is the need to treat comorbid conditions concurrently-which can be a difficult proposition 0 Patients who have both a drug use disorder and another mental illness often exhibit symptoms that are more persistent. severe. and resistant to treatment compared with patients who have either disorder alone. 0 Nevertheless. steady progress is being made through research on new and existing treatment options for comorbidity and through health services research on implementation of appropriate screening and treatment within a variety of settings. including criminal justice systems. Treatment/Medications 0 Effective medications exist for treating opioid. alcohol. and nicotine addiction and for alleviating the symptoms of many other mental disorders. yet most have not been well studied in comorbid populations. 0 Some medications may benefit multiple problems. For example. evidence suggests that bupropion (trade names:Wel|butrin. Zyban). approved for treating depression and nicotine dependence. might also help reduce craving and use of the drug methamphetamine. 0 Clearly. more research is needed to fully understand and assess the actions of combined or dually effective medications. Behavioral Therapies Behavioral treatment (alone or in combination with medications) is the cornerstone to successful outcomes for many individuals with drug use disorders or other mental illnesses. While behavior therapies continue to be evaluated for use in comorbid populations. several strategies have shown promise for treating specific comorbid conditions. Dialectical BehaviorTherapy (DBT). Cognitive BehaviorTherapy (CBT) are two therapies used for treatment Most clinicians and researchers agree that broad spectrum diagnosis and concurrent therapy will lead to more positive outcomes for patients with comorbid conditions. Preliminary findings support this notion. but research is needed to identify the most effective therapies (especially studies focused on adolescents). Examples Of Evidence Based Practices 0 Integrated Treatment for Co-Occurring Disorders 0 Supported Employment 0 Assertive Community Treatment 0 Family Psychoeducation 0 Illness Management and Recovery Barriers to Treatment 0 The stigma attached to substance abuse and mental disorders often hinders early diagnosis and proper treatment. 0 Greater understanding resulting from recent scientific findings that substance abuse and mental illness disrupt some of the same brain functions will reduce the social stigma that hinders trtment seeking. quality. and access by patients with either or both conditions. What is Integrated Treatment? 0 Integrated Treatment is a research-proven model of treatment for people with serious mental illnesses and co-occurring substance use disorders 0 Consumers receive combined treatment for mental illnesses and substance use disorders from the same practitioner or treatment team.They receive one consistent message about treatment and recovery Summary 0 Integrated Treatment for Co-Occurring Disorders is effective in the recovery process for consumers with co-occurring disorders 0 The goal of this evidence-based practice is to support consumers in their recovery process 0 In Integrated Treatment programs. the same practitioners. working in one setting. provide mental health and substance abuse interventions in a coordinated fashion 0 Consumers receive one consistent message about treatment and recovery Self Medication 0 Although self-medicating is often considered to be an adult behavior. young people are also at risk. 0 A 2008 report from theWhite House Office of National Dmg Control Policy (ONDCP) revealed an alarming link between teen drug use and depression. 0 The study described a common scenario of teens treating feelings of depression with man'iuana and other drugs, only to prolong their suffering and develop more significant mental health problems in the future. 0 According to the report. depressed teens are twice as likely as non-depressed teens to use illegal drugs. and many become addicted Self Medication The potential dangers of self-meditating are plentiful. and chief among them is the threat of addiction. A 2007 report in the American journal of Psychiatry identified a clear correspondence between social anxiety and alcohol dependence. The report explained that people suffering from anxiety are vulnerable to a snowballing reliance on alcohol because as alcohol wears off. the resulting withdrawals can cause greater anxiety.which in turn increases the likelihood of further drinking. Alcohol can also exacerbate feelings of depression as it wears off. tempting users to drink more. Self Medication Edward J. Khamzian and David F. Duncan are usually credited with being the originators of the self-medication hypothesis but while theirs are the most fully developed versions there are earlier precedents for the idea. Khanuians version of the Self-Medication Hypothesis holds that addiction occurs in a context of self-regulation vulnerabilities —- primarily difficulties in regulating affects. self-esteem. relationships. and self-care. Potential addicts suffer severely from their feelings, either being overwhelmed with painful emotions or seeming not to feel any emotions at all. Drugs of abuse help such individuals to relieve painful emotions or to experience emotions that are confusing or threatening. Eating Disorders and Substance Abuse 0 Individuals with eatin disorders (ED) are up to 5 times more likely to abuse alcoho or illicit drugs 0 Individuals who abuse alcohol or illicit drugs are | | times more likely to have an ED 0 It is estimated that 8 million Americans have an eating disorder. seven million are women and one million are men Eating Disorders and Substance Abuse 0 Up to 50% of people with ED abuse alcohol or drugs compared to 9% of general population 0 Up to 35% of people who abuse alcohol and drugs have ED compared to 3% of general population 0 Between |2%-|8% of anorexics abuse or are dependent on alcohol and drugs 0 People with ED abuse caffeine. tobacco. alcohol. cocaine .heroin. and over the counter medications such as laxatives . diuretics. and diet pills ...
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comorbid.disorders - Examples Of Dual Diagnosis ' MENTAL...

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