dua diagnosis Flashcards
what is dual diagnosis
AKA co-morbidity/co-occurence
more than one diagnosis
- 2+ health problems
- medical, mental health, AOD, interlectual impairment, etc.
what are the two distinctions categories of dual diagnoses
heterotypic/homotypic
- metal health and physical health vs. 2 mental health disorders
concurrent/successive
- alcohol dependence and depression at the same time vs. panic disorder in teen years and cannabis use in 20s
most common dual diagnosis case?
drug issue and mental health
presence of a MH disorder = likely to have substance abuse disorder
» and vice versa
why is dual diagnosis a useful term in a health setting
useful when there is a relationship between them and one issue is complicating the other
incidences of DD in A&D settings
for females
48% of females with alcohol use disorder also have anxiety, affective or drug use disorder
incidences of DD in A&D settings
for males
34% of males with alcohol use disorder had another mental disorder
- compared to 9% of males that don’t have alc use disorder
incidences of DD in A&D settings
overall alcohol dependence = ___
alcohol dependent =
more likely to have affective disorder (4.5x) and
more likely to have anxiety disorder (4.4x)
incidences of DD in A&D settings
overall cannabis dependent = __
more likely to have anxiety disorder (4.3x)
incidences of DD in A&D settings
tobacco users
- 2x more likely to have effective dissorder
2. 4x mroe likely to have anxiety disorder
incidneces of DD in mental health
17% with affective disorder also have alcohol use disorder
16% with an anxiety disorder also had alcohol use disorder
common incidences of dual diagnosis
in alcohol and drug settings
mostly anxiety, depression and personality disorders
some psychosis/schizophrenia
ocmmon incidences of dual diagnosis
in mental health settings
mostly alcohol and tobacco
some cannabis/amphetamines/heroin
how could drugs cause mental health problems
Depression
depressants - general depressant effects
- alcohol, cannabis, opiates
stimulants -
- existing depression may get worse when coming down
- common in the months following cessation
- use/abuse may worsen the sleep/wake cycle
how could drugs cause mental health problems?
anxiety
depressants - agitation, anxiety and irritability are common features of withdrawal
- alcohol - alc related problems can create new problems
- cannabis - paranoia is common symptom of intoxication
stimulants
- chronic use - anxiety states and panic
- high doses- obsessive cognitions and compulsive behaviours
how could drugs cause mental health problems ?
Psychosis
- reinforcing effect of drugs related to dopamine (dopamine hypothesis)
- cannabis
stimulants - may directly cause psychotic episodes
- amphetamine psychosis - breif psychotic reaction that may last weeks
alcohol
- negative symptoms worse and effects and affects treatment
- non-compliance with medication
- higher relapes rates
how can mental health cause A&D problems?
social lubrication - depressant drugs used as a form of self-medication for anxiety symptoms
pick me up - stimulant drugs use as self-medication of depression
drowning your sorrows - pain releiving drugs to manage chronic emotional pain and trauma
cannabis to manage issues with low appetite
stimulants used to suppress appetite
why is dual diagnosis of concern
issues for the client
greater severity of disorders
- more hallucinations, depressive symptoms and suicidal ideations
- relapse risk increased
- re-hospitalisation
- effects on medication
loss of support networks/extra challenges
- unstable accomodaiton
- family, relationship issues/stress
- harder to receive and access services
- double stimatisaiton
- lack of educaiton
- forensic mental health/legal issues
poor self care
- inceased risk taking behaviour
- less compliant with medicaiton
- sleep
- diet
- exercise
what is the wider problem associated with having a dual diagnosis related to mental health and AOD
mental health leading to stigmatisation and having less opportunities in life
issues for treatment services
complex presentaitons
- more than one drug use/mental health issue
- psycho-social issues
diagnoses are often unclear
- lack of screening
- misdiagnosis
lack of dual expertise or awareness of issue
added work vs more effective work perceptions
lack of flexibility in service provisions - appointment based models
confronts clinicians own issues?
diagnostic issues
Schizophrenia
positive symptoms
- hallucinations
- delusional thinking
- disorganised speech
negative symptoms
- flattened affect
- lack of motivation
- poverty of speech
diagnostic issues
depression
- low/irritable mood
- loss of interest inthings
- appetite issue/weight variations
- sleep problems
- lack of energy
- reduced activity
- guilt / worthlessness
- poor concentration
- suicidal ideation
issues for treatment services
assessment
how to improve assessment?
- accurate history is crucial
- family history of MH problems?
- order of disease onset
- better screening
- cease drug use before assessing?
- 3 mth of abstinence is considered adequate
- get lots of experience in both services
issues for treatment services
treatment
engagement an follow up processes
conflicts in philosophies/perspectives fo different services
(i.e attitudes, harm minimisation vs. 0 tolerance, reluctance to work with DD)
may not benefit from standard interventions - poorer treatment response and outcomes
describe the relationship between MH and SUD
use of substances cause or exacerbates underlying mental health problems
mental health disorders lead to substance use and abuse (i.e. self medication)
MH and SUD develop together and reinforce eachother (bidirectional model - benzos and depression )
both MH and SUD develop somewhat independently f eachother (common factors - trauma /adversity )
regardless of relationship they usually become inter connected over time and result in worsening clinical picture
