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Addictieve en compulsieve stoornissen > Lecture 4: Comorbidity in addiction > Flashcards

Lecture 4: Comorbidity in addiction Flashcards

1
Q

prevalences of SUD

A

19.1% lifetime prevalence, 5.6% incidence

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2
Q

prevalentie comorbiditeit

A
  • 50% of SUD clients has another mental disorder (dual diagnosis)
  • 25% suffers from comorbid mood/anxiety disorders
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3
Q

welke disorders komen het vaakste samen voor

A
  • mood disorders
  • anxiety disorders
  • adhd
  • personality disorder
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4
Q

welke specifieke disorders komen het meeste voor

A
  • dysthymia
  • GAD
  • agoraphobia
  • adhd
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5
Q

waarom is comorbiditeit relevant

A
  • more severe symptoms
  • lower treatment compliance
  • higher drop-out
  • worse treatment outcome
  • higher probability of relapse (want veel meer cues zoals stress of angst bij angststoornissen)
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6
Q

4 explanatory models of comorbidity

A
  1. self-medication hypothesis (CO -> SUD)
  2. susceptibility hypothesis & high-risk hypothesis (CO <- SUD)
  3. bidirectional hypothesis (CO <-> SUD)
  4. 3rd factor hypothesis (CO <-> SUD)
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7
Q

self-medication hypothesis=

A

mental disorder leads to excessive use of a substance, because substances are used to control emotional pain

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8
Q

high risk hypothesis =

A

by leading to behaviour that increases the risk for eg. trauma exposure

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9
Q

susceptibility hypothesis=

A

through biological processes induced by the substance use that render them more susceptible to developing ptsd following exposure to traumatic event

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10
Q

third-factor hypothesis=

A

there is no direct relationship, but the association occurs because the sud and the other mental disorder share the same cause (genetics, brain abnormalities, environmental risk factors)

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11
Q

bidirectional hypothesis =

A

Substance use and other mental disorders may also influence each other / have bidirectional interrelations

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12
Q

alcohol influence of psychological symptoms

A
  • depressed mood
  • fear
  • confusion
  • mood swings
  • sleep problems
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13
Q

alcohol withdrawal symptoms

A

<8-12 hours:
- General bad/sick feeling
- Headache, nausea, vomiting
- Light shaking, fear, not eating

12-36 hours:
- Insomnia
- Restless, agitation
- Tremors
- Sweating, palpitations

48 hours:
- Withdrawal feeling / delirium
- Tremor
- Sweating
- Agitation
- Slight fever
- Hypertension

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14
Q

cannabis: influence on psychological symptoms

A
  • Concentration issues
  • Memory impairment
  • Fear
  • Suspicion / paranoia / psychosis
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15
Q

cannabis withdrawal symptoms

A
  • insomnia
  • depressed mood
  • agitation
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16
Q

cocaïne symptoms

A
  • lack of energy
  • depressed mood
  • insomnia
  • fear and panic
  • suspicion/paranoia
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17
Q

wat is belangrijk om te vragen als iemand zegt “i only drink in the weekend”

A

how long is your weekend?
voor sommige mensen een aantal dagen, en dan kan het een withdrawal zijn in die paar dagen voordat ze weer drinken

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18
Q

cannabis zit na … nog in bloed

A

6 weken

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19
Q

waarom kunnen mensen geirriteerd raken tijdens withdrawal

A

drugs numb the senses: als je stopt dan gaat deze blanket weg, en dan raak je opeens heel gestimuleerd door letterlijk alles. dus dan raken mensen geirriteerd.

20
Q

wat is er met diagnoses en SUD

A

in order to be able to finalise a diagnosis, a client must always quit using a substance.

two exceptions; ADHD and PTSD

21
Q

SUD and depression

A
  • A lot of comorbidity addiction and depression, especially in the case of excessive alcohol consumption
  • In about 80% of the clients, symptoms of depression disappear after quitting alcohol
  • However, clients often perceive their substance use as self-medication!! -> timeline can be helpful
22
Q

waar kan abstinence dus voor zorgen bij depressie

A

abstinence kan zorgen voor remission of depressive symptoms, al na 2 weken. zelf voor mensen zonder SUD: dus treatment voor depressie zou kunnen zijn om een verslaving te ontwikkelen en dan te stoppen (maar ofc niet ethisch)

23
Q

substance use and anxiety

A
  • symptoms can be the result of SUD: withdrawal and intoxication can lead to anxiety
  • SUD may also have masked anxiety (drinken waardoor je minder sociale angst hebt)
  • anxiety disorders can maintain SUD and cause relapses (veel anxiety -> middel gebruiken)
  • anxiety decreases after alcohol abstinence, returns after relapse
24
Q

SUD and PTSD: prevalentie

A

11-41% van mensen met SUD hebben ook PTSD

25
Q

SUD and PTSD kenmerken

A
  • abstinence not required for diagnosis ptsd
  • integrated treatment is indicated
  • exposure is possible
26
Q

why do SUD and PTSD co-occur

A
  1. at risk hypothesis: substance use increases risk of trauma
  2. self medication hypothesis: more substance use to cope with ptsd (meest supported hypothesis)
  3. no habituation of trauma due to being under the influence
  4. substance use triggers symptoms
  5. underlying causal factor (eg. genetics)
27
Q

hoelang moet je bij anxiety diagnosis wachten

A

2-3 weken, omdat SUD may have masked anxiety symptoms.

exceptions:
- social anxiety
- OCD
- specific phobia
- PTSD
- GAD

28
Q

SUD and ADHD: prevalence

A

23.1% of people with SUD also have ADHD
1/5 mensen dus. vooral veel alcohol

also: many people with ADHD use alcohol/cocaine/cannabis as self medication.

29
Q

adhd diagnosis during sud

A

kan wel, maar je moet wel echt goede info krijgen over vroeger want de symptomen overlappen met de effecten van alcohol en withdrawal

30
Q

SUD and bipolar disorder

A

50% of patients with BP also have SUD.
diagnosis is challenging because of the overlap with symptoms of substance induced toxication

31
Q

SUD and personality disorders

A

especially borderline and anti-social personality disorders.
anti-social behaviour can be a consequence of addiction -> screening only indicated if suicidality or self-harm interferes with treatment

32
Q

SUD and psychotic symptoms

A

low prevalence of schizophrenia. maar psychotic symptoms can occur while influencesd/withdrawal.

cannabis use can lead to psychosis if vulnerable.

also often suspicion/paranoia with excessive use of cannabis/cocaine, which disappears after quitting. also delirium during alcohol withdrawal

33
Q

conclusie van diagnostics;

A
  • screening at intake for ptsd and adhd, anxiety and mood disorders
  • 2-3 weeks of abstinence for diagnosis of other syndrom disorders
  • no general guidelines ofr other substances, suggestion is half-life of the drug
  • exceptions: social anxiety, ocd, specific phobia and ptsd, GAD
  • if no abstinence: draw a timeline
  • clinical admission if abstinence is too hard
34
Q

dual disorder treatment

A
  • comorbid disorders can be treated effectively, but this treatment has no additional effect on the addiction. so addiction has to be treated anyways.
  • psycho-education, parallel treatment, functional analysis, risk factors for substance use
35
Q

dual diagnosis in practice…

A
  • GGZ registration> referral to addiction care
  • Registration GGZ > underestimation of substance use
  • Registration for addiction care> underestimation of psychological symptoms
  • Due to waiting lists / relapse, clients are often sent back and forth between psychiatric and addiction services and fail to receive proper diagnosis/treatment

solution: work together! consultation, integrated treatment, treatment at one location

36
Q

overview depression in SUD

A

for 80% of clients depressive symptoms dissapear after quitting drinking. however, they often regard their drinking as self-medication, therefore it can be useful to draw up a timeline to help them see that drinking worsened their symptoms

37
Q

overview anxiety and SUD

A

a lot of overlap between anxiety symptoms and withdrawal. also SUD can mask true anxiety symptoms. anxiety symptoms can maintain SUD and cause relapse

38
Q

overview adhd and SUD

A

many patients self-medicate, so there is a preference for CBT because of the risk of abusing medication. thereis an integrated programme for people with ADHD and addiction: diagnosis of ADHD during using is possible

39
Q

overview PTSD and SUD

A
  • SUD increases the risk of traumatic events.
  • people who have PTSD often selfmedicate
  • SUD can trigger PTSD symptoms and might result in the fact that one does not habituate to trauma because of being under the influence all the time
40
Q

overview personality disorders and SUD

A

esp. borderline and antisocial PD are related. but antisocial can be a consequence of SUD, therefore look at timeline

41
Q

importantly: comorbid disorder can be treated effectively but this does not lead to an additional effect on the addiction itself. SUD has to be treated either way

A

oke

42
Q

in general, a patient should always quit the substance before making any other comorbid diagnoses next to SUD. this is because…

A
  • symptoms might resolve themselves after a period of abstinence
  • SUD can result in cognitive control problems that make the treatment less effective
43
Q

abstinence guidelines

A
  • 2-3 weeks for alcohol
  • 4-6 weeks for other substances
44
Q

exceptions to this abstinence guideline

A
  • SAD, OCD and specific phobia: most symptoms cannot be a direct effect of a substance, and their presence can interfere with treatment. therefore it could be necessary to diagnose SAD, OCD and specific phobia before treating SUD
  • PTSD: treatment should start as soon as possible, and symptoms often increase during abstinence
  • GAD: SUD often involves a lot of neglect in major life aspects -> which can result in a lot of logical worry, therefore you should wait longer for diagnosing GAD until these problems are resolved.
45
Q
A

Addictieve en compulsieve stoornissen (24 decks)

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