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OBJECTIVE
• To learn to identify and assess
patients/clients/consumers suffering from
concurrent disorders.
ECA: DUAL DIAGNOSIS
• 29% with psychiatric illness have had a
substance abuse d/o.
• 37% of alcoholics have a mental illness
other than a substance abuse d/o
• 53% with drug abuse or dependence have
at least one other psychiatric dlo
• 64% of drug abusers in treatment have a
mental d/o.
DEFINITION OF MENTAL
DISORDER
“A clinically significant behavioral or psychological
syndrome or pattern that occurs in an individual
and that is associated with present distress (e.g.,
a painful symptom) or disability (i.e., impairment
in one or more important areas of functioning) or
with a significantly increased risk of suffering
death, pain, disability, or an important loss of
freedom.”
MENTAL ILLNESSES
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Anxiety Disorders
Mood Disorders
Posttraumatic Stress Disorder
ADHD
Eating Disorders
Psychotic Disorders
ANXIETY DISORDERS
• Generalized: anxiety is unvarying and
persistent.
• Phobic: anxiety is intermittent and arises in
particular circumstances.
• Panic: anxiety is intermittent and unrelated
to particular circumstances.
• OCD: obsessional thinking, compulsive
behaviour.
ANXIETY DISORDER Qs
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Have you ever had a panic attack, when
you suddenly felt frightened or anxious or
suddenly developed a lot of physical
symptoms?
In the last six months, have you been
particularly nervous or anxious?
Do you worry a lot about bad things that
might happen?
MOOD DISORDERS
• Depressive: depressed mood, loss of
interest.
• Mania: elated mood, irritable
• Dysthymia: long-term mild depression.
• Hypomania: elated, irritable, but
functioning.
MOOD DISORDER Qs
• In the last month, has there been a period
of time when you were feeling depressed
or down most of the day nearly every day?
(What was that like?)
• What about losing interest or pleasure in
things you usually enjoyed?
PTSD
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History of trauma.
Flashbacks, intrusive memories.
Hypervigilance, disturbed sleep.
Avoidance of reminders.
PTSD
• Most mental disorders improve with abstinence.
PTSD is often an exception.
• Venlafaxine and the SSRIs are likely useful.
• Generally, substance use should be under good
control and not likely to be triggered before
imaginal or literal exposure to traumatic cues.
PTSD Q
Sometimes things happen to people that are
extremely upsetting – things like being in a life
threatening situation like a major disaster, very
serious accident or fire; being physically
assaulted or raped; seeing another person killed
or dead, or badly hurt, or hearing about
something horrible that has happened to
someone you are close to. At any time during
your life, have any of these kinds of things
happened to you?
AD/HD
• We have known for a long time that
children with AD/HD are likely to have or
develop substance dependence.
• Restlessness, fidgeting, variable
attentiveness make AD/HD part of the
differential diagnosis.
• The Wender Utah Rating Scale (WURS) is
a useful screening instrument.
• Onset in childhood.
EATING DISORDERS
• Anorexia: underweight, loss of periods.
• Bulimia: binges, vomiting.
• All: distorted body image.
EATING DISORDER Qs
• Have you ever had a time when you
weighed much less than other people
thought you ought to weigh?
• Have you often had times when your
eating was out of control? Tell me about
those times.
PSYCHOTIC DISORDERS
• Delusions: incredible beliefs.
• Hallucinations: hearing, seeing, smelling
what is not there (when fully awake).
• Loss of reality testing.
PSYCHOTIC SYMPTOM Qs
• Now I am going to ask you about unusual
experiences that people sometimes have.
• Has it ever seemed like people were talking
about you or taking special notice of you?
• Did you ever hear things that other people
couldn’t hear, such as noises, or the voices of
people whispering or talking? (Were you awake
at the time?)
PERSONALITY DISORDERS
“The difficult patient”.
• Antisocial PD
• Narcissistic PD
• Borderline PD
HOW IS PERSONALITY
DISORDERED?
• Personality traits are inflexible and
maladaptive and cause significant
functional impairment or subjective
distress.
• Personality traits: enduring patterns of
perceiving, relating to, and thinking about
the environment and oneself.