Addiction Disorders & Psychiatric Comorbidity - al'Absi

Question 1

What does drug abuse trigger or exacerbate?

Answer 1

Mental disorders

Question 2

What does the dose response relationship mean in terms of substance use and mental illness?

Answer 2

• Relationship between magnitude of substance use problems and the severity of mental illness
  
  • higher substance use with more severe mental health problem

Question 3

What does the dose response relationship mean in terms of substance use and suicide?

Answer 3

higher substance abuse correlates with higher rates of suicide ideations

Question 4

Why do the vast majority of patients with addiction disorders not receive treatment?

Answer 4

• Issue of access?
• Issue of perception?
• Stigma?
• Socioeconomic conditions?

Question 5

What are some etiologic connections between substance use disorders and psychiatric conditions?

Answer 5

• Substance induced mental illness
• Self-medication
• Gene/Environmental risk factors
• Neurochemical imbalance

Question 6

Why do people with psychiatric illness try to self-medicate with substance use?

Answer 6

• Rationale: Mechanism of action for many drugs of abuse are similar to that of drugs used a psychotherapeutic agents
• Effect: Alterations in the brain as a result of chronic use of some of these drugs of abuse results in users that are particularly susceptible to mental illness.

Question 7

What type of risk factor is always present in addiction disorders? What type of risk factor is not necessarily always there but contributes to the chances of developing an addiction disorder?

Answer 7

Must have environmental factors, but not necessarily have genetic factors → having both increases risk greatly

Question 8

What neurochemical problems contribute to addicition disorder etiologies?

Answer 8

• Imbalance of neurotransmitters, increases risk for substance use
• DA → Schizophrenia - 80% of Schizophrenics use substances to increase the amount of DA in the system and activate more DA receptors
• 5-HT → Depression

Question 9

What drugs are associated with schizophrenia, paranoia, anhedonia, and compulsive disorder?

Answer 9

Cocaine & Meth

Question 10

What drug(s) are associated with anxiety, panic attacks, mania and sleep disorder?

Answer 10

Stimulants

Question 11

What drugs are associated with delusions and hallucinations?

Answer 11

LSD, Ecstasy, Psychedelics

Question 12

What drugs are associated with depression and mood disturbance?

Answer 12

Alcohol, sedatives, sleep aids, narcotics

Question 13

What drugs are associated with antisocial behavior?

Answer 13

PCP & Ketamine

Question 14

Why is there diagnostic confusion between substance use disorders and mental illness?

Answer 14

• Withdrawal symptoms resemble symptoms of many psychiatric disorders
  
  • Acute intoxication - mood symptoms
  • Withdrawal - anxiety and mood symptoms
  • Chronic use - delirium, cognitive changes

Question 15

T/F The relationship between substance use disorders and psychiatric illness is unidirectional.

Answer 15

FALSE

• Relationship is not unidirectional!!!
• Substance use disorders (SUDs) increase risk for the development of psychiatric disorders
  
  • adolescent use particularly problematic
• Some psychiatric disorders increase risk for development of SUDs
• Certain environmental conditions predispose to both SUD and psychiatric disorders.

Question 16

What is important to assess when evaluating individuals with addictive disorders/mental illness?

Answer 16

• Every individual with a psychiatric disorder should be screened for substance use
• Every individual with a substance use disorder should be screened for psychiatric disorder

Question 17

When do you diagnose psychiatric illness if substance use disorder is present?

Answer 17

• Diagnose if:
  
  • Symptoms clearly began before the onset of substance use disorder
  • Symptoms persist during sustained periods of abstinence
  • Shorter period of abstinence may be necessary to accurately diagnose some disorders

Question 18

When should you treat psychiatric illness if substance use disorder is present?

Answer 18

• When possible, delay treatment by 1-4 weeks to allow for the identification of transient substance-induced symptoms
• Earlier treatment if:
  
  • Severe symptoms
  • Symptoms precede substance use/prior episodes
  • Family history positive

Question 19

What are important treatment recommendations when treating psychiatric illness in the presence of a substance use disorder?

Answer 19

• Try non drug options first and use cognitive behavioral therapy
  
  • Enhance self-efficacy
  • Decrease helplessness/depression
  • Enhance coping strategies

Question 20

What type of general medication should you use to treat psychiatric illness in the presence of substance use disorder?

Answer 20

Use medication with least abuse potential and least toxicity should relapse occur.

Question 21

What pharmacological therapies can be used to treat bipolar disorder in the presence of substance use disorder?

Answer 21

lithium, valproate, carbamazepine

Question 22

What pharmacological therapies can be used to treat schizophrenia in the presence of substance use disorder?

Answer 22

• Use atypical antipsychotics
• Also can use naltrexone to decrease alcohol cravings

Question 23

What medication helped people with early onset severe alcoholism?

Answer 23

Sertraline