Dual Diagnosis

Question 1

What are the two types of dual diagnosis distinctions?

Answer 1

• heterotypic/homotypic: mental health and physical disorder vs 2 mental health disorders
• concurrent/successive: alcohol and depression at the same time vs panic disorder in teens and cannabis use in 20s

Question 2

Almost half of the female population who have an alcohol use disorder also have?

Answer 2

an anxiety disorder

Question 3

If you are alcohol dependent you are more likely to also have what disorders?

Answer 3

• affective disorder

- anxiety disorder

Question 4

If you are cannabis dependent you are more likely to also have what disorder?

Answer 4

anxiety disorder

Question 5

If you are a tobacco user you are more likely to also have what disorders?

Answer 5

• affective disorder

- anxiety disorder

Question 6

If you have one disorder you have an increased risk of what?

Answer 6

developing other types of disorders

Question 7

What other disorders are related to meth dependence?

Answer 7

• major depression

- anxiety disorder

Question 8

How can alcohol cause depression?

Answer 8

• it is a depressant so it causes a depressant effect
• interferes with medication
• long term effect on relationships, employment, health etc

Question 9

How can cannabis cause depression?

Answer 9

• depressant
• long term use may cause depression-like symptoms
• hypothesised amotivational syndrome

Question 10

How can opioids cause depression?

Answer 10

• depressant

- Lifestyle-related factors associated with opioid dependence

Question 11

How can stimulants cause depression?

Answer 11

• Existing depression may get worse when coming down
• Common in the months following cessation
  Use/abuse may worsen the sleep/wake cycle

Question 12

What are some symptoms of an anxiety disorder?

Answer 12

• feeling worried all the time
• getting tired easily
• unable to concentrate
• feeling irritable
• irregular heartbeats or palpitations
• dizziness
• muscle tensions and pains

Question 13

How can depressants cause anxiety?

Answer 13

• Agitation, anxiety, and irritability are common features of withdrawal
• Alcohol = Alcohol-related problems can create new worries
• Cannabis = Paranoia a common symptom of intoxication

Question 14

How can stimulants cause anxiety?

Answer 14

• chronic use - anxiety states and panic

- high doses - obsessive cognitions and compulsive behaviours

Question 15

What causes and what occurs during hangxiety?

Answer 15

• brain activity involving dopamine is lower during a hangover
• heightened stress during a hangover can make it difficult for someone to cope with additional stress
• trouble regulating emotions

Question 16

How can cannabis cause psychosis?

Answer 16

• Hypothesised to precipitate psychotic episodes
• causal link
• Pharmacology and potency (THC vs CBD)
• Cannabis use increases rates of hospitalisation, psychotic relapse and psychotic symptoms

Question 17

How can alcohol cause psychosis?

Answer 17

• Negative symptoms worse and affects treatment
  
  • Non-compliance with medication
  • Higher relapse rates

Question 18

How can stimulants cause psychosis?

Answer 18

• May directly cause psychotic episodes

- Amphetamine psychosis: brief psychotic reaction that may last for several weeks

Question 19

How could mental health cause problems with depressant use?

Answer 19

• Depressant drugs used as a form of “self-medication” of anxiety symptoms
  
  • ‘Social lubricant’

Question 20

How could mental health cause problems with stimulant use?

Answer 20

• Stimulant drugs used as self-medication of depression

* ‘Pick me up’

Question 21

How could mental health cause problems with Pain-relieving drug misuse?

Answer 21

• Pain-relieving drugs to manage chronic emotional pain/trauma
  
  • Opiates and sedatives commonly linked to trauma
  • ‘Drowning your sorrows’

Question 22

Why is dual diagnosis of concern?

Answer 22

• greater severity of disorders: relapse risk increased, more symptoms
• loss of social network: double stigmatization
• poorer self-care: increase in risk behaviour, less compliant with medication

Question 23

What are some issues with treatment services?

Answer 23

• complex presentations
• diagnoses often unclear
• lack of dual expertise or awareness
• added work vs More effective work perceptions
• lack of flexibility in service provision

Question 24

What are the positive symptoms of Schizophrenia?

Answer 24

○ Hallucinations
○ Delusional thinking
○ Disorganised speech

Question 25

What are the negative symptoms of Schizophrenia?

Answer 25

○ Flattened affect
○ Lack of motivation
○ Poverty of speech

Question 26

In treatment services what are some conflicts in philosophies/perspectives of different services?

Answer 26

• Harm minimisation vs Zero tolerance

* Reluctance to work with DD

Question 27

What is the relationship between mental health and substance use disorders?

Answer 27

• substance use causes mental health disorders
• mental health disorders can lead to substance use
• Mental health disorders and substance abuse disorders develop together and reinforce each other

Question 28

What makes dual diagnosis treatment more effective?

Answer 28

• Integrated
• Focused on motivation & treatment engagement
• Assertive case management
• Extends over several months
• Based on “no wrong door” approach