Download CDC Presentation - International Panel Physicians Association

Mental Health:
Substance and Alcohol use
Disorders
Linda Harvey, MD
Consultant Psychiatrist
Immigrant, Refugee, and Migrant Health Branch
Division of Global Migration and Quarantine
Centers for Disease Control and Prevention
National Center for Emerging and Zoonotic Infectious Diseases
Division of Global Migration and Quarantine
Learning Objectives
After this session, you should be able to:
Implement the DSM-V criteria
Understand the basics of diagnosis for substance-use and
mental disorders
Distinguish the complexities of DUI
Clarify the concept of remission
Question 1
A 35 year old worker visa applicant is referred to
you by the consular section due to a history of
marijuana use. What is your goal as a panel
physician?
A.
B.
C.
D.
E.
Get paid
Determine if the DMS V criteria are met
Perform the mental health examination
Submit completed DS forms to the consular
section
Make a classification
Goal?
Make a classification.
Question 2
In order to make a correct classification for this
applicant, which of the following is the best
answer for what you need to know?
A.
B.
C.
D.
E.
How often he uses marijuana
If he meets the DSM V criteria for a substancerelated disorder
If there is associated harmful behavior
Where he will be employed while in the U.S.
If he also drinks
Information Needed
1) Evidence of a non-substance related mental disorder?
– Are DSM V criteria met for diagnosis?
2) Any substance use?
– Controlled Substances Act (CSA) list?
– Are DSM V criteria met for substance use or substance-induced
disorder?
3) Is associated harmful behavior present?
– Current?
– Past harmful behavior judged likely to recur?
Mental Health Evaluation
1. Review medical/psychiatric history
2. Interview applicant
3. Review laboratory results, if indicated
4. Mental status evaluation
THE DIAGNOSTIC
AND STATISTICAL
MANUAL OF
MENTAL
DISORDERS
(DSM-5)
Question 3
Which of the following is NOT included in the
diagnostic criteria for substance-use disorders?
A.
B.
C.
D.
E.
Cravings
Tolerance
Harmful behavior
Using substance when physically hazardous
Failure to fulfill obligations at work
Substance-use Disorder Criteria
Impaired control
1. Use larger amounts over time
2. Desire to reduce use
3. Spend time obtaining, using, or recovering from effects of
substance
4. Craving
Social impairment
5. Failure to fulfill obligations at work, school, or home
6. Continued use despite problems caused by substance
7. Stops doing activities
Risky use
8. Use when physically hazardous
9. Continued use despite problems
Pharmacologic
10.Tolerance
11.Withdrawal
Severity
Mild
– 2-3 symptoms met
Moderate
– 4-5 symptoms met
Severe
– ≥6 symptoms met
Question 4
An applicant reports increasing alcohol use over
the past 2 years, needing to drink more to get the
desired effect and drinking while driving once. He
also says that he wants to drink less. All other
history is negative. The applicant should be
diagnosed with which of the following?
A.
B.
C.
D.
Mild substance use disorder
Moderate substance use disorder
Severe substance use disorder
Defer for more information
Question 5
An 22 year old female is diagnosed with a
substance-use disorder for alcohol use. She was
recently arrested for driving with an expired
drivers license. All other history is negative. What
is her classification?
A.
B.
C.
D.
Class A
Class B
Class B Other
No Class
Alcohol-use: Reminders
Alcohol is not on the CSA list – therefore, it is
treated the same as a mental disorder:
1. Go through the 11 criteria for diagnosis (DSM5)
2. Does it meet at least two of the criteria?
3. If no – No Class
4. If yes – must look at harmful behavior
5. No harmful behavior – Class B
6. Harmful behavior – Class A
Basics of Remission
• DSM-5 defines sustained, full remission as a period of at least 12
months during which no substance-use or mental disorderassociated behaviors have occurred.
• The panel physician/consultant must use clinical judgment
when determining if 12 months is an acceptable period of time
to demonstrate sustained, full remission.
• The time period should be based on the reliability of the
evidence provided
Case Discussions
Thank you
[email protected]
http://www.cdc.gov/panelphysicians
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The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the
Centers for Disease Control and Prevention.
National Center for Emerging and Zoonotic Infectious Diseases
Division of Global Migration and Quarantine