Week 9 - Dual Diagnosis Flashcards
What is dual diagnosis?
AKA: Co-morbidity/Co-occurrence
More than one diagnosis
- 2 or more health problems
- Medical, Mental health, Alcohol and Drug, Intellectual Impairment, etc..
Mostly refers to alcohol and drug issue in combination with mental health
The term is useful in a health setting when there is a relationship between them and one issue is complicating the other
Distinctions
Heterotypic / Homotypic
▪ E.g. mental health and physical disorder vs 2 mental health disorders
Concurrent / Successive
▪ E.g. alcohol dependence and depression at same time vs panic disorder in teenage years and cannabis abuse in twenties
Continuum
▪ ranging from mild symptoms to severe disorders
Incidence of dual diagnosis
“The statistics on sanity are that one out of every four Americans is suffering from
some form of mental illness. Think of your three best friends. If they’re okay, then it’s you.”
National Study of Mental Health and Wellbeing (2020-2022)
42.9% of population will experience MH disorder in lifetime
21.5% in the prior 12 months, with Anxiety being the most common 17.2%
38.8% aged 16-24 had a MH disorder in the prior 12 months
If have MH disorder
- likely to have substance use issues and vice
versa
Incidence of dual diagnosis (how likely)
– considerable variation in the answer
DD prevalence estimates range from 30-90%
Why does it vary?
▪ Depends on diagnostic criteria (Severe, Axis I/II, PD, Sub-clinical)
▪ In general, higher prevalence in A&D settings and higher in treatment settings
▪ More prevalent for Indigenous Australians
▪ Gender also a factor (higher among females)
Prof John McGrath QBI
Pervasive nature, so it didn’t really matter what disorder you had first, you were at increased risk of getting every other type of disorder.
Increased risk for developing other types
of disorders persisted 10, 15 or more years later than your first onset
The risk of getting a second comorbid
disorder is related to your age of onset
Incidence of dual diagnosis (DD) In A&D settings
48% of females with alcohol use disorder also have anxiety, affective, or drug use disorder.
34% of males with alcohol use disorder had another mental disorder,
Compared to 9% of males that didn’t have alcohol use disorder
If Alcohol dependant, 4.5 times more likely to have affective disorder and 4.4 times more likely to have anxiety disorder.
If Cannabis-dependent, 4.3 times more likely to have anxiety disorder.
Tobacco users 2.2 times more likely to have affective disorder and 2.4 times more likely to have anxiety disorder
Methamphetamine
Aus survey of people with meth dependence found 88% had major depression or an anxiety disorder in the
past year
Approximately 30% of dependent users experience psychotic episodes each year.”
Incidence of dual diagnosis (DD) in Mental Health
17% with affective disorder, also had alcohol use disorder,
16% with an anxiety disorder also had alcohol use disorder
Symptoms of Depression
Include
feeling sad or depressed
a loss of interest and pleasure in normal activities
loss of appetite or weight
inability to get to sleep or waking up early
feeling tired all the time
having trouble concentrating
feeling restless, agitated, worthless or guilty
feeling that life isn’t worth living
How could drugs cause depression
Alcohol
▪ Interferes with medications
▪ Long term effect on relationships, employment, health, etc…
Cannabis
▪ Long-term use may cause ‘depression-like’ symptoms
▪ Hypothesised ‘Amotivational syndrome’
Opioids
▪ Lifestyle related factors associated with opioid dependence
Stimulants
- Existing depression may get worse when coming down
- Common in the months following cessation
- Use/abuse may worsen the sleep / wake cycle
More Common Symptoms of Anxiety Disorders
feeling worried all the time
getting tired easily
unable to concentrate
feeling irritable
irregular heartbeats or palpitations
dizziness
muscle tensions and pains
How could drugs cause anxiety?
Depressants - Agitation, anxiety, and irritability common features of withdrawal
Alcohol
▪ Alcohol related problems can create new worries
Cannabis
▪ Paranoia a common symptom of intoxication
Stimulants
▪chronic use - anxiety states and panic
▪high doses - obsessive cognitions and compulsive behaviours
Hanxiety
Brain activity involving dopamine is lower during a hangover
Heightened stress during a hangover can also make it difficult for someone to cope with any additional stress
More trouble regulating emotions
Worse performance in key aspects of executive functions
People who “catastrophise” pain are more likely to experience anxiety
How could drugs cause psychosis
Reinforcing effect of drugs related to dopamine (dopamine hypothesis)
Cannabis
- Hypothesised to precipitate psychotic episodes
- Some evidence suggests a causal link, but still debated in literature
- Pharmacology and potency (THC vs CBD)
- Cannabis use known to increase rates of hospitalisation, psychotic relapse and psychotic symptoms
- Synthetic Cannabis a largely unknown area, but
anecdotal reports are concerning
Alcohol
- Negative symptoms worse and affects treatment
- Non-compliance with medication
- Higher relapse rates
Stimulants
- May directly cause psychotic episodes
- Amphetamine psychosis: brief psychotic reaction
that may last for several weeks
