dua diagnosis

Question 1

what is dual diagnosis

Answer 1

AKA co-morbidity/co-occurence

more than one diagnosis

• 2+ health problems
• medical, mental health, AOD, interlectual impairment, etc.

Question 2

what are the two distinctions categories of dual diagnoses

Answer 2

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

Question 3

most common dual diagnosis case?

Answer 3

drug issue and mental health

presence of a MH disorder = likely to have substance abuse disorder
» and vice versa

Question 4

why is dual diagnosis a useful term in a health setting

Answer 4

useful when there is a relationship between them and one issue is complicating the other

Question 5

incidences of DD in A&D settings

for females

Answer 5

48% of females with alcohol use disorder also have anxiety, affective or drug use disorder

Question 6

incidences of DD in A&D settings

for males

Answer 6

34% of males with alcohol use disorder had another mental disorder
- compared to 9% of males that don’t have alc use disorder

Question 7

incidences of DD in A&D settings

overall alcohol dependence = ___

Answer 7

alcohol dependent =
more likely to have affective disorder (4.5x) and
more likely to have anxiety disorder (4.4x)

Question 8

incidences of DD in A&D settings

overall cannabis dependent = __

Answer 8

more likely to have anxiety disorder (4.3x)

Question 9

incidences of DD in A&D settings

tobacco users

Answer 9

2. 2x more likely to have effective dissorder

2. 4x mroe likely to have anxiety disorder

Question 10

incidneces of DD in mental health

Answer 10

17% with affective disorder also have alcohol use disorder

16% with an anxiety disorder also had alcohol use disorder

Question 11

common incidences of dual diagnosis

in alcohol and drug settings

Answer 11

mostly anxiety, depression and personality disorders

some psychosis/schizophrenia

Question 12

ocmmon incidences of dual diagnosis

in mental health settings

Answer 12

mostly alcohol and tobacco

some cannabis/amphetamines/heroin

Question 13

how could drugs cause mental health problems

Depression

Answer 13

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

Question 14

how could drugs cause mental health problems?

anxiety

Answer 14

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

Question 15

how could drugs cause mental health problems ?

Psychosis

Answer 15

• 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

Question 16

how can mental health cause A&D problems?

Answer 16

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

Question 17

why is dual diagnosis of concern

issues for the client

Answer 17

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

Question 18

what is the wider problem associated with having a dual diagnosis related to mental health and AOD

Answer 18

mental health leading to stigmatisation and having less opportunities in life

Question 19

issues for treatment services

Answer 19

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?

Question 20

diagnostic issues

Schizophrenia

Answer 20

positive symptoms

• hallucinations
• delusional thinking
• disorganised speech

negative symptoms

• flattened affect
• lack of motivation
• poverty of speech

Question 21

diagnostic issues

depression

Answer 21

• low/irritable mood
• loss of interest inthings
• appetite issue/weight variations
• sleep problems
• lack of energy
• reduced activity
• guilt / worthlessness
• poor concentration
• suicidal ideation

Question 22

issues for treatment services

assessment

Answer 22

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

Question 23

issues for treatment services

treatment

Answer 23

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

Question 24

describe the relationship between MH and SUD

Answer 24

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

Question 25

treatment methods

Answer 25

sequential - A&D <> MH

parrallel - A&D at the same time as MH

third specialist service
DD service encompasing A&D + MH

collaborative - together

intergrated - one within the other

Question 26

national and state programs

last 20 years seen more focus on response to DD, particularly in VIC

what are some guildelines and support services avaliable now that are specific to DD

Answer 26

headspace, dual diagnosis specialist positions

variations between states

Question 27

eveidence based treatemtns are limited but increasing

treatments are more effective when

Answer 27

intergrated

focused on maintaining motivation and promoting treatment engagemen t

assertive case management

extends over several months

based on no-wrong-door approach

Question 28

what are some evidence based treatments for DD

Answer 28

soem support for CBT e.g. depressions and Alcohol abuse

group treatment - e.g. substace abuse and bipolar

Question 29

what is the dilemma in planning a treatment cause for DD patients

Answer 29

its preferable for substance use to be ceased to assist metnal health treatment but it is often not possible

the question of which came first should not delay treatment of either disorder