Week 9 - Dual diagnosis

Question 1

What is dual diagnosis?

Answer 1

Co-morbidity/ co-occurrence. Two or more health problems.

Question 2

What is heterotypic, VS homotypic?

Answer 2

Heterotypic = mental health and physical disorder 
Homotypic = 2 MH disorders

Question 3

What is concurrent VS successive?

Answer 3

Concurrent = alcohol dependence & depression at the same time.

Successive = e.g. panic disorder in teenage years, then cannabis use following in twenties.

Question 4

What are factors to dual diagnosis?

Answer 4

Gender = women more likely to develop dual diagnosis. 48% of females with alcohol disorder also have other MH issues such as anxiety or drug use disorder.

34% of males had another MH disorder.

Alcohol dependent individuals are 4.5 more likely to have affective disorder.

Cannabis dependent, 4.3 times more likely to have anxiety disorder.

Question 5

Describe symptoms of dual diagnosis in alcohol and drug settings

Answer 5

Anxiety, depression, personality disorders, psychosis, schizophrenia

Question 6

What dual diagnosis do we see in MH settings?

Answer 6

Alcohol & tobacco use, some cannabis, heroin or amphetamine use.

Question 7

Symptoms of anxiety disorders

Answer 7

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

Question 8

List the concerns of dual diagnosis

Answer 8

Greater severity of disorders:

• more hallucinations, depressive symptoms, suicide ideation
• relapse increased risk
• rehospitalisation
• loss of support network
• unstable accomodation
• family / relationship issues
• double stigma

Question 9

What are issues for treatment services?

Answer 9

• complex presentations where there are more than one MH issue or substance dependence issue, and therefore diagnosis can be often unclear.

Question 10

Describe the positive and negative schizophrenia symptoms

Answer 10

Positive symptoms:

• hallucinations
• delusional thinking
• disorganised speech

Negative symptoms:

• flattened effect
• lack of motivation
• poverty of speech

Question 11

What are some issues for treatment services?

Answer 11

Conflicting perspectives:

e. g., harm minimisation VS zero tolerance (ambulance VS police)
- what to treat first?
- may not benefit from standard interventions –> poorer treatment response and outcomes

Question 12

What are the 5 different treatment models for dual diagnosis?

Answer 12

1. Sequential.
2. Parallel
3. Third specialist service.
4. Collaborative
5. Integrated

Question 13

What has been evidence based treatment? The most effective?

Answer 13

integrated 
maintaining motivation & promoting treatment engagement
assertive case management 
extends over several months 
based on 'no wrong door' approach 

CBT for depression in conjunction with alcohol abuse.

Group treatment - substance use and bipolar disorder

Preferable to cease substance use to assist MH treatment