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Addiction FSWP4029K > W4: Comorbidity and behavioral addictions > Flashcards

W4: Comorbidity and behavioral addictions Flashcards

1
Q

People who are likely to require a combination of mental health and SUD services

A
  • disabled by comorbid mental health and SUD (integrated approach)
  • disabled by MH and affected by SUD (MH service primarily)
  • disabled by SUD and affected by MH (SUD service)
  • mildly disabled by dual diagnosis (GP)
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2
Q

How many people have comorbid psychiatric conditions

A

37% of alcohol disorders

53% of other SUD

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3
Q

Consequences and correlates of dual diagnosis

A
  • big rates of treatment noncompliance
  • relapse
  • disorted perception and cognition
  • suicidal ideation
  • social exclusion
  • homelessness
  • agression and injury
  • HIV, hepatitis, cardio/liver/gastro diseases
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4
Q

Four explanations for SUD among schizophrenia Gregg

A
  • SUD causes schizophrenia (Cannabis)
  • SU as self-medication
  • Etiological factors (vulnerability = childhood / bu no genetic evidence)
  • Schizophrenia and SUD maintain each other
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5
Q

Treatment issues

A
  • less motivation to change
  • harder to engage
  • drop out
  • slow progress
  • psychosis may inhibit process
  • narrow coping skills
  • idiosyncratic avoidance methods to manage positive symptoms
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6
Q

5 stages of readiness to change Prochaska

A
  • precontemplation
  • contemplation
  • preparation
  • action
  • maintenance
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7
Q

Intervensions for Dual Diagnosis

A
  • Motivational Interviewing
  • CBT
  • Family support
  • group interventions
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8
Q

Group interventions

A
  • relapse prevention approaches
  • assertive community treatment
  • lower intensity treatment
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9
Q

Motivational interviewing

A
  • essential in early stages
  • individual might not be aware of problem
  • personal choice, responsibility, awareness of risk
  • make links between life goals and SUD problems
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10
Q

CBT

A
  • recognize symptoms
  • coping with cravings
  • healthy alternatives
  • normalizing lapses
  • plan for relapse
  • cognitive restructuring to counteract positive beliefs of SUD
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11
Q

Relapse prevention approaches

A
  • tailored to each participant abilities
  • traditional 12 step approach
  • uneffective for dual diagnosis
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12
Q

Assertive community treatment

A
  • structured health care service
  • conventional model of case management to needs of cohort
  • better outcomes on SU and quality of life, but equal on other
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13
Q

Lower intensity treatment

A
  • freedom to leave facility
  • community based daily attendance
  • less responsibility for peers
  • direct staff involvement
  • less intense therapy
  • better outcomes at 1-2 y follow up
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14
Q

Treatments that work for dually diagnosed

A
  • effective psychiatric

- reducing SUD treatments

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15
Q

People with schizophrenia and SUD can benefit from

A

CBT + MI

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16
Q

Women with SUD, PTSD and depression can benefit from

A

CBT

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17
Q

Tiet and Mausbach that evidence of integrated treatment having superior outcome is

A

weak

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18
Q

Broad service models of potential treatment

A
  • sequential (one condition, then another)
  • parallel (by isolated providers)
  • integrated (by same team)
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19
Q

Initial focus on treatment plan

A
  • therapeutic alliance
  • MI
  • relapse prevention
  • case management
20
Q

Adherence can be facilitated by

A

atypical antipsychotic medications

21
Q

Behavioural addictions

Grant

A

diminished control as core

DSM-4 impulse control disorders

22
Q

Similarities of behavioural addictions and SUD

A
  • failure to resit impulse and drive to harm person or others
  • repetitive engagement
  • less functioning in other domains
  • onset in teen or young adult
  • chronic relapse paterns
  • ego syntonic nature (except OCD which is dystonic) => with time become more dystonic
  • dysphoric state while abstinence
  • tolerance
  • no reports on serious withdrawal states
23
Q

types of behavioural addictions

A
  • pathological gambling
  • kleptomania
  • skin picking
  • compulsive sexual behaviour
  • internet addiction
  • compulsive buying
24
Q

Personality attributes of behavioural addictions

A
  • high scores on impulsivity and sensation seeking, compulsivity
  • low scores of harm avoidance
25
Q

Personality of internet addictions

A
  • psychoticism
  • interpersonal conflict
  • self directness
26
Q

Personality of OCD

A
  • high harm avoidance

- low on impulsivity

27
Q

Highest rate of comorbidity of SUD and BA

A

gambling
alcohol
antisocial personalities

28
Q

Study on neurocognition of gamblers and alcoholics

A
  • diminished inhibitions, cognitive flexibility and planning tasks
  • no difference in executive functioning
29
Q

High levels of impulsivity and sensation seeking correlate

A

with low CSF-5-HIAA metabolite

30
Q

Urge driven disorders are receiving incoming reward input from

A

ventral tegmental area
nucleus accumbens
OFC circuit

31
Q

Antagonists of D2/D3 receptors enhance

A

gambling related motivations

32
Q

Twin studies one co-occurence of gambling and alcohol use show that

A

genes influence both disorders

33
Q

higher frequencies of serotonin transporter gene 55HTTPLR

A

higher harm avoidance => internet users

34
Q

Behavioural addictions and dopamine

A
  • learning, motivation, reward
  • DA release => adaptive and maladaptive decision making
  • internet addiction => reduced D2/D3 activity in striatum
35
Q

DA receptor availability is negatively correlated with (a) and positively correlated with (b)

A

a- mood related impulsivity within striatum

b-gamling severity within dorsal striatum

36
Q

In Parkinsons patients, DA agonist medication are associated eith

A

-gambling and other B.A

37
Q

Serotonin and BA

A
  • emotions, motivation, inhibition, control

- dysregulation => mediate behavioural inhibition and impulsivity in gambling

38
Q

Gambling depicts dysregulations is

A

HPA axis

increases level of noradrenergic moieties

39
Q

Better than placebo in treatment of gambling are

A

opioid antagonists

40
Q

Simulated gambling and decision making task are linked to

A

vmPFC

mesolimbic reward pathway from VTA to NA

smaller amygdala and hippocampal volumes

41
Q

3 phases of treatment for BA

A
  • detoxication
  • recovery (sustained motivation, strategies of craving)
  • relapse prevention
42
Q

Pharmacological interventions of BA

A
  • opiod receptor antagonist (most evidence)
  • SSRIs (mixed)
  • glutamatergic (small)
43
Q

There is a high genetic effect on

A

the latent externalising propensity

44
Q

Chromosome 7 is offering

A

risk for externalising outcomes

45
Q

Single nucleotide polymorphism in CHRM2 gene are associated with

A
  • risk of alcohol dependence

- comorbid alcohol and drug

46
Q

Valiadated markers for mental disorders

A
  • PFC: disinhibition
  • orbitomedial PFC: cognitive over emotional
  • P300 evoked potential: reduced in externalising disorders and SUD
47
Q

The independence of factors in the hierarchical models states for

A

multiple underlying pathways can lead to same clinical outcomes

Addiction FSWP4029K (5 decks)

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