Psychiatry-Psych Comorbidities with Drug Abuse Flashcards Preview

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Flashcards in Psychiatry-Psych Comorbidities with Drug Abuse Deck (14)
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1
Q

Use drugs in moderation vs. not using drugs at all

A

Moderation = harm reduction (like e-cigarettes for nicotine use with decreased risk of lung cancer). Not at all = abstinence.

2
Q

Substance use disorder diagnostic criteria

A

2+ in 12 months: Used larger amounts or longer time period, can’t cut back, lots of time spent obtaining, using & recovering, urge to use, failure to fulfill major obligations and continued use despite problems, reduced social activities, use in hazardous situations, tolerance, withdrawal

3
Q

Substance use disorder specifiers

A

Early remission (3-12 months), sustained remission (>12 months, can have continued cravings), controlled environment (access to substance restricted). Mild severity = 2-3 symptoms. Moderate = 4-5. Severe = 6+.

4
Q

Symptoms directly related to physiologic effects of the substance

A

Substance-induced syndrome (intoxication = depression w/alcohol & anxiety w/cocaine and withdraw = anxiety w/alcohol & depression w/cocaine). This is an additional diagnosis to SUD.

5
Q

Symptoms not directly related to physiologic effects of the substance

A

Co-morbid condition. This is an additional diagnosis to SUD.

6
Q

How do you determine if it is a substance-induced syndrome or a co-morbid illness?

A

History: prior associated symptoms in absence of substance abuse favors co-morbid conditions. Temporal relationship of substance abuse and symptoms favors substance-induced symptoms. Resolution of associated symptoms after abstinence from substance favors substance-induced symptoms.

7
Q

46 yo female presents with recurrent episodes of depression for 21 years ago. 5 months ago she was depressed and 3 months ago she started drinking. She currently meets criteria for major depressive disorder and alcohol dependence. Are her symptoms co-morbid or substance-induced?

A

Co-morbid, Hx of depression w/o alcohol use and depression prior to alcohol use.

8
Q

A 21 year old male presents with 2 episodes of mania lasting 2-3 days. Episodes start shortly after using ecstasy and resolve 36-48 hours later. Are his symptoms co-morbid or substance-induced?

A

Substance-induced. He has no prior history of mania, mania started after ecstasy use, symptoms resolve after ecstasy is discontinued.

9
Q

Most common occurring psychiatric disorders that are co-morbid with substance use disorders?

A

Mood and anxiety disorders. Other common conditions include PTSD, ADHD and personality disorders.

10
Q

Critical history to take in a mental health evaluation?

A

Substance use. The reverse is true for people presenting with substance use disorders. Also assess the stage of change if SUD is present, don’t overlook co-morbidities that may worsen prognosis.

11
Q

Stages of Change

A

1) Pre-contemplation = “I don’t have a problem.” 2) Contemplation = “I might have a problem.” 3) Preparation = “I’m ready to change.” 4) Action = “Working to change now.” 5) Maintenance = maintaining sobriety 6) Relapse = part of recovery cycle and should be anticipated

12
Q

When is motivation interviewing effective

A

Contemplation stage and beyond. This is an exploration and inquiry of current behaviors that make change more difficult but more desirable.

13
Q

Treatment of a patient with SUD and comorbid psychiatric conditions.

A

Concurrent and integrated treatment of SUD and co-morbid psychiatric illness has best results.

14
Q

Since alcohol dependence is comorbid with an anxiety disorder, what drugs should you not give them if they have panic attacks?

A

Benzodiazepines