week 8 - dual diagnosis

Question 1

what is the treatment model of third specialist party?

Answer 1

treatment service that offers both MH and OH/drug services -
DISADVANTAGE: it is THE best possible one -> everyone will go to that, no point in having other ones -> people would not want to work there as they have to deal with BOTH MH and OH/drug disorder

Question 2

what is the collaborative treatment theory?

Answer 2

where MH and OH/drug treatment services work together to allow the patient to transition smoothly from one treatment service to the other. when you look at the diagram - only smalll overlap, and a much bigger overlap needs to be considered

Question 3

What is the integrated treatment model?

Answer 3

where A/D services is PART of the mental health (MH big ciricle, A/D small ciricle within the big circle). This makes it better for the client when they are moving from MH to A/D it is all wihtin the same organisation so it is much easier.

Question 4

what are some national level reponses to dual diagnossis?

Answer 4

“Can Do” - which focusses on building awareness, knowledge skills in managing and treating dual diagnosis within the practise setting. and managemnt within the practise settingr
Headspace - aims to reduce the burden of OH/D and M/H disorders in young people. Fudning of CYS to deliver awareness in the communitites of the clients to increase liklihood of adolescents seeking help and will allow communities and families to understanding emerging diseases/disorders
developing speacialist youth and cater-friendly CYS to allow youth to have access in servcies and for services to respond to them in a quick/smooth manner

Question 5

what are some barriers in treating dual diagnosis in australia - list in workers perspective and clients perspective

Answer 5

worker barriers:
lack communication between both MH and A/D services
lack of knowledge within the other field that the worker is not working in, frustration in trying to provide clinical service to the client
patients barriers:
homelessness, lack of specialised services,
conflicting interests in different services
challenging, violent and volitile behaviour

Question 6

why would workers feel frustrated in working in dual diagnosis services?

Answer 6

percetion of added work more than effective work
lack of knowledge, prevention and harms of the other sservice
theraputic nihilism - lack of confifence and their treatment service will be affective for the patient

Question 7

what is the 5-step change model?

Answer 7

precontemplation - when person is not willing/thinking about changing their behavours/habit and is reluctant to stop what he is doing. He is indenial that his behaviour is bad and sees nothing wrong with it

contemplation: when person begins to think of chanigng behaviour, at this point thye till may be indenial of thier problem but are open to the possibility of having a problem.
determination: person is willing to make a change - evaluates the pros and cons of changing and researches in treatment services/ways in which they are able to change.
action: when the planned behaviour sare actually done and , changes are made to their behaviour/habits. at this stage perosn tells family/parents/therapist problems. 90-180days
maintainance: person maintaining thier new behaviour. 1-time events will happen where some patients may fall back into their old habits but will soon go back to their newly improved behaviours. relapses can also occur here, and as well as patients planning ahead to ensure relapses dont happen.
termination: by this time the patient has demonstrated he/she is able to maintain new behaviour long term without any major slip ups and are able to do it by themselves without the help of therapist/concellor, and thus is when the patient and therapists relationship terminates.

Question 8

to facilitate change, should therapissts confront to the client that they defineley have a problem? why or why not?

Answer 8

more likley for the patient to find an argument and not realise their bad habits

Question 9

if a person relapses does it mean that the person if unmotivated in making a change? why or why not?

Answer 9

No, it may just mean that they were follwing a unrealistic plan, or their current plan needs changing. They are able to fall back into any stage of Proneshkas wheel of change. this can be seen as a posititve as the therapist can intervene with the patient in making new changes to his plan to avoid future relapse

Question 10

what is the difference between lapse and relapse?

Answer 10

lapse is when a person for example has quit smoking 2 packets a day, and on one occasion has 1 smoke since and. A relapse would be the person to fall back completely to their old habbits, in which in this case would be smoking back 2 packets a day

Question 11

what is motivational intervewigin

Answer 11

focusses on the client motivation for change
assists in determining what stage of change client is at
shifting the persons belief in the pros and cons by shifting the weight onto the cons side than the pros

Question 12

what are some critiques with M.I?

Answer 12

1. you cant just use M.I alone - M.I allows the clinent to become MOTIVATED in making a change - he or she still needs help in the actual changing process
2. cofnused with the transtheoretical 5 change step model

Question 13

what is decisional balane? what principal does this technique fall under?

Answer 13

under deeloping discrepency; asking the patient what are the good and bad things of smoking or the addiciton problem they are having. “

Question 14

what is rolling with resistance?

Answer 14

when there is resistance in the patient, rather than discouraging them and disagreeing with them, the therapist should take a step back and roll with it. This will prevent conflict between the patient and the therapist

Question 15

what are the four general principles with motivational interviewing?

Answer 15

Expressing empathy, support self-efficacy, roll with resistance, developing discrepeny

Question 16

what is dual diagnosis?

Answer 16

AKA comorbdidy/cooccurance and is when an indivsiaul suffers from two types of disorders at the same time

Question 17

what is hetero and homotypic dual diagnosis? give examples of each

Answer 17

hetero - two diff. types of disorders - 1 mental health and 1 substance abuse
homo - 2 mental health disorders - OCD + depression or alcohol/cannabis dependance

Question 18

what are the argyments of the nature and development of dual diagnosis? there are 4 broad ones

Answer 18

1. substance abuse is primary problem and exacerbates MH
2. MH causes substance abuse (self medication)
3. bidirectional - both MH and substnace abuse develop together and reinforce eachother (benzodiapines and depression)
4. both MH and SA develop idenpendently due to common factors (trauma/adversity both leading to both MH and substance abuse)

Question 19

does it matter whether or not SA or MH comes first?

Answer 19

No, overtime SA and MH integrate become interconnected with one another wiht results in the worsening of the two regardless of the hypothesis believed by the organisation

Question 20

what are some problems with dual diagnosis? what probems are faced wwhen it comes to treatment?

Answer 20

1. workers are usually specialised in either SA or MH NOT both
2. it is hard to tell which disorder has the worse symptoms
3. MH usually reserved for people with really serious illness and poeple with minor MH may not get treatment -> worsens the effect and should be dealt with immediately

Question 21

give examples of causual hypotheiss of primarly SB of drugs leading to MH of depression? particulary cannabis, alcohol and stimulants

Answer 21

• alcohol gives a depressant effect as it can interfere with already taking medication/affect family/friends/work relationshpips which can read to depression/anxiety
• cannabis long term -> depressant effect - amotivational syndrome
• stimulants - can cause preexisting depression to get worse as it disrupts sleep/wake cycle

Question 22

explain why one of the primary SB hypothesis saids that SB of drugs can cause anxiety?

Answer 22

alcohol -> alcohol abuse can cause new worries
cannabis -> paranoia/ anxiety symptom of intoxication
stimulants -> regular use results in panic and anxiety

Question 23

Give examples of hypothesis of primarily SB causing MH disorders of psychosis? give exampes of cannabis/stimulants

Answer 23

stimulants -> cause direct psychotic episodes that can last for days
cannabis -> hypotheiss to cause psychotic events but still in debate - must consider ratio of THC and CBD/if cannabis is synthetic or natural

Question 24

Give some examples of the hypothesis that dual diagnosis is primarily from MH which increases and worsens the SA

Answer 24

• people suffering from MH abuse the use of their prescription drugs which can result in dependance and further abuse of drugs
• ppl with depression use stimulants as “pick me up” drug which can lead to abuse of drug -> SA

Question 25

why is dual diagnosis a problem? outline problems faced with treatment services

Answer 25

• hard to integrate both MH and SA in one setting - workers are inexperienced in treated both and usually only cater for MH OR SA
• complex presentations - patient has more than 1 drug/MH issue
• perception of added work for workers who would work at DD -> easier and more effective to work at service that only treats either SA or MH

Question 26

why is dual diagnosis a concern? outline some issues for the client

Answer 26

1. double stigmitisation
2. worsen symptoms of SA and MH because you have both (relapse risk increased, more hallucinations, effects on medication)
3. loss of support/extra challenges
   - criminal justice
   - loss family/partner
   - double stigmitisation - the way ppl judged (when ppl at work find out she has drug induced psychosis - VERY JUDGED, treated differently)
   - harder to access services

Question 27

what are some issues with dual diagnosis in terms of diagnosing the patient?

Answer 27

1. symptoms of one mental health disorder may be very similar to the symptoms of another disorder and makes it indistinguishable - this makes it really hard for the workers to diagnose someone
   - Schizophrenia and halluciongenic drug use symptoms are very similar - both halluciantions, dellusional thinking, disorganised speech,
   - depression and negative symptoms of schizophrenia are very similar to DEPRESSANT DRUG symptoms
   (lack of motivation, low mood, appetite issues, sleep issues, sucicidal thoughts, lack energy)

Question 28

Look at the Bill example on DD PPT. he has problems of both SA and MH - does bill care which disorder is treated first?

Answer 28

• Bill doenst care!
• treating one symptom first is not going to be the most effective treatment
• need to treat them both at the same time for effective treatment
• if bills SA was to be treated first, he still has anxiety which is not being treated -> bill still suffers and the absence of alcohol may actually make his anxiety feel worse

Question 29

is there a clear answer on whether MH or SA comes first? what does the current research say?

Answer 29

• no clear answer on which disorder comes first
• demonstraed that both MH and SA are the cause
• arguing something that doesnt really matter BECAUSE the best way to manage it is to manage it cocurrently

Question 30

Would treating MH or SA be the better option? why or why not?

Answer 30

• neither should be treated independanlty
• treating both cocurrenlty is the best way to treat it
• it doesnt matter which one comes first because treating one independently, whether it is SA or MH wont make the situation better

Question 31

what are some factors that make treatment more effective?

Answer 31

1. no wrong door approach
2. MH and SA integrated
3. motivation and promoting treatment engagement to clinent so they do not slip out of treatment
4. extends over several months and is more long term

Question 32

what are some problems with SSRI treament for dual diagnosis?

Answer 32

1. activation of treatment only begins from 2-6 weeks - does not help BILL TODAY
2. less effective when person is having alcohol misuse

Question 33

what are two ways in facilitating change? what is the 5 step model to change and motivational interviewing?

Answer 33

MI: effective way in clinent and therapist to talk about change
- MI effective as most change is slow and hard so actually talking to the therapist about their difficulties in change is a goood way for the clinent to express emotions/get support from the therpist as appose to the therapist just telling what the clinent has to do in order to change
- when change is hard indivisuals become very ambivalent in change and leads to anxiety -> procastinate in making a change
- MI helps clinent overcome ambivalence and helps motivates client to change
5 step model : consists of 5 stages in which client goes through when adapting to a new behaviour and making a change

Question 34

what is the spirit of MI?

Answer 34

Partnership - clinent and therpaist work collaborativley together
Acceptance: accept the clinents autonomy - making own decisions for their life, potential, strengths and perspective
Compassion: keep the clinents best interest in mind
Evocation: best ideas come from the clinent

Question 35

what are the 4 general principles in MI?

Answer 35

1. express empathy - ensure that the clinent feels understood -> encourages clinent to speak out more/be more open and when clinent feels therpaist is being empathetic, they will be more open to challenges therapist may suggest + less likely to defend their ideas and be more open about their ambivalence
2. self-efficacy - allows clinent to know that they are capable of amking a change - highlighting some of previous clinents behavioural changes to become healthier so clinent sees that she/he has potential to change
3. rolling with resistantance - therapist does not fight with clinents resistance but rolls with it. Clinent and therapist are mutual level and clinent is in charge of his/her own change and therapist does not argue that. This results in resistance of clinent to actually decrease overtime as it does not reinforce clinent to be argumentative.
4. develop discrepency - motvation for change is brought by clinents perceving discrepency of where they are now and where they want to be. therapists help clinents recognise this and when clinents recognise that their current behaviour is preventing them from reaching their goal, they will become more motivated to change.

Question 36

what is the decisional balance technique?

Answer 36

elicits own clinents argyment for change “AKA change talk” - the more likely the clinent talks about change -> more likely they will actually make the change
- asks 4 Q’s about good/bad things on making/not making change
1. advantages of status quo? what are the advanatges of your current eating habits? - gets ppl talking in a non-defensive way
2.