chapter 10 mental health and drugs. introduction 33% of people with mental illness also abuse...
TRANSCRIPT
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CHAPTER 10 Mental Health and Drugs
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Introduction33% of People with mental illness also
abuse substances50-70% of drug abusers have mental
disordNeurotransmitters sameDrugs may cause symptoms
Stimulants – mania, anxiety, psychosisStimulant withdrawal – depression, anxietyDepressants – depressionPsychedelics – hallucination/psychosis
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Substance related disordersSubstance use
Dependence – impairment - continue in spite of consequences
Abuse – disruption of life function - continue in spite of consequences
Substance inducedIntoxicationWithdrawalDisorders – delirium, dementia, amnesia, etc.
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Determining factorsHeredityEnvironmentUse of drugs
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Determining factorsHeredity
SchizophreniaBipolarDepressionAnxietyBinge eatingGamblingADHDGreatly increased risk if stressed by
environment or drugs
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Determining factorsEnvironment
Stress depletes norepinephrineAbuse/molestation – 75% of female addictsEnvironment potentiates risk of abuse
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Determining factors
Psychoactive drugsChange balance of neurotransmittersDrugs may induce mental disorder in any
personPredisposed brain more likely to suffer
permanent harmType of drug impacts type of harmPredisposed to depression – alcohol/sed-hypPredisposed to schizophrenia - psychedelics
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Dual diagnosisMental disorder and substance abusePreexisting
Thought – psychotic/schizophreniaMood – affective - depression. BipolarAnxiety panic/ADHD
Substance inducedStimulant induced psychotic disorderAlcohol induced mood disorderMarijuana induced delirium
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Dual diagnosisMust distinguish between symptoms and the
diseaseAbusers often present with symptoms that
may disappear with sobriety
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Dual diagnosisEpidemiology
Alcohol 44%Drugs 64%Mentally ill 29-34% abusers
Manic depressive 61% Schizophrenia 47% Prisoners with mental illness 81%
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Dual diagnosisPatterns
Preexisting – self medicationSubstance induced – neurotransmitter
imbalance
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DiagnosisAddress all symptomsAvoid making diagnosis until abuser soberFactors
Particular patternPreexisting mental illnessSelf medicationAge of onsetRelationship of the symptoms to substance use
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DiagnosisIncreased population on streets
Decreasing IP facilitiesSubstance abuse upIncrease in number and expertise of
practitionersIncreased awarenessOP pays more – over-diagnosisDisruptive – unwanted at substance abuse
centers or at psychiatric treatment centers
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Mental health vs. substance abuseCure the disease, abuse will go awayGet them sober, MH problems will resolveMH – partial recovery OKMH – stigmaMH/some SA – medicationsMH – shepherding, SA – self-relianceMH – supportive, SA - confrontive
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Mental health vs. substance abuseMH sharing info easierMH – more professionals, SA recovering
addictsMH – scientific approaches, SA, less
structuredMH – prevent getting worse, SA hit bottomMH – individual, SA – one size fits all
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Mental health vs. substance abuseMust treat simultaneouslySA must connect with MHEach must see the other as a complementCase management improves outcome
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Multiple diagnosisPolydrug useOther medical problems
Chronic painHepatitisEpilepsyCancerHeart/kidney diseaseDiabetes Sickle cellSexual dysfunctionHIV – triple diagnosis
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DisordersThought – schizophrenia
Mostly inheritedHallucinationsDelusionsInappropriate affectAmbivalencePoor associationImpaired ability to care for oneselfAutismPoor job performanceStrained social relations
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DisordersThought – schizophrenia
Usually late teens/early adultDrugs mimic
Stimulants Steroids Mdma/marijuana Psychedelics Withdrawal from downers
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DisordersMajor depressive disorder
15% of all have in lifetime9% per yearDepressed moodDiminished interestDiminished pleasureSleep disturbanceInability to concentrateWorthlessnessSuicidal thoughtsMost of the day for 1 week
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DisordersMajor depressive disorder
AlcoholAmphetamine withdrawalPsychedelic 80% due to drugs, not heredity
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DisordersBipolar affective disorder
Depression/normalcy/maniaDepression can be suicidalMania
Persistent elevated, expansive, irritated mood Inflated self esteem Depressed need for sleep Talkative Flight of ideas Distractibility Goal directed activity Excessive involvement with pleasurable activities
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DisordersBipolar affective disorder
Usually begins in 20sDrugs
Stimulants Psychedelics
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DisordersAnxiety
16% of adults per yearPTSD – persistent re-experience
20-25% of those in drug treatmentPanic - intense fear/discomfort when no real
danger Agoraphobia Social phobia Simple (specific) phobia OCD GAD Toxic effects of stimulants Withdrawal from opioids, sed/hyp or alcohol
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DisordersDementias
Brain dysfunction due to physical changes Marijuana and prescription drugs mimic
Developmental disordersRetardationAutismCommunicationADHDPsychedelic use can be mistaken for DD
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DisordersSomatoform
Physical symptoms without obvious cause Hypochondria Munchausen’s Stimulant psychosis – bugs Psychedelics
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DisordersPersonality
Inflexible behavior leading to distress/impairment
AngerDisruptive behaviorHard to treat
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DisordersEating
Weak impulse controlCo-occur with many other disorders and
substance use – depression/PTSD
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DisordersGambling
Impulse controlAlcoholStimulants, esp. methamphetamine
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Substance-induced DisordersAlcohol induced
Impulse control Violence Suicide Unsafe sex High risk behavior
Sleep Suppresses REM Sleep
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Substance-induced DisordersAlcohol induced
Anxiety Withdrawal related Last 2-3 days
Depression 45% have concurrent major depressive disorder After 4 weeks of sobriety 6% Antidepressants contraindicated
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Substance-induced DisordersAlcohol
Psychosis Develop after decades of heavy drinking Hallucinations Delusional thoughts Antipsychotics effective (not during withdrawal)
Dementia Neurotoxic Cognitive deficits May regain some function Mimics Alzheimer’s
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Substance-induced DisordersStimulant induced
Impulse controlMania
Resolve without treatment if only induced Medication not indicated if non-abstinent
Panic Drug use increases panic focus – can become
chronic even if abstinent
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Substance-induced DisordersStimulant induced
Depression Imbalance of neurotransmitters Can last 10 weeks Antidepressants helpful during detox only
Anxiety Intoxication Withdrawal Treatment
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Substance-induced DisordersStimulant induced
Psychosis Short term and long term in some For those, each use increases frequency and duration Can last for months after last use
Cognitive impairment Transient damage Permanent damage Revealed by high tech imaging
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Substance-induced DisordersMarijuana
Delirium Disturbance of consciousness Change in cognition Memory Multi-step tasking 3 months to clear
Psychosis Paranoia Hallucinations Tend to be transient
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Substance-induced DisordersPanic
While intoxicatedAmotivational syndrome
Chicken and egg question
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TreatmentRebalancing brain chemistry
Education – primary preventionCannot change hereditary factorsImprove environment
Avoid stressors Leave abusive relationship Avoid drug users Sleep Avoid bad situations New friends Self-help Nutrition
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TreatmentStabilize both mental and substance abuse
problemsHomicidal/suicidal DetoxDiagnosis
Psycho-pharmaceuticals helpful
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TreatmentImpaired cognition
50% of patientsReasoning, memory impairedMay not be ready to help with treatment for
weeks/monthsTreatment must match patient capabilities
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TreatmentDevelopmental arrest
Arrested emotional developmentLack of maturation
Low frustration tolerance Can’t work toward goal independently Lie to avoid punishment Test limits Feelings expressed as behavior Shallowness of mood Fear of rejection Live in present (no hope) Denial, non-compliant For me or against me - absolutes
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TreatmentTherapies
CounselingGroupPsychopharmacology
Primary treatment for mental illness
1st Achieve abstinence2nd Maintain abstinence3rd Continued therapy – emphasis on
abstinence
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Psychopharmacology Used only after thorough assessmentShort term, medium term, lifetime basis
Increase neurotransmitter releaseBlock receptorInhibit reuptakeInhibit metabolism (MAO)Enhance Monitor and adjust dose - mandatory
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PsychopharmacologyPrescribed vs. street
Most not addictingCompliance is a problemSense of control
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PsychopharmacologyDepression
Serotonin/norepinephrine Most drugs increase SSRI – prozac, zoloft Serotonin syndrome Sexual dysfunction Tricylics work well for chronic MAOs – block metabolism – food drug interactions Stimulants increase norepinephrine - amps
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PsychopharmacologyBipolar
Lithium Stabilizes mostly highs Side effects Non-compliance Requires monitoring
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PsychopharmacologyPsychoses
PhenothiazinesHaldol, etc.Excess dopamine relatedMedications block receptorsTreat symptoms, not diseaseMuscle problems, tremor, sedation, apathy
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PsychopharmacologyAnxiety disorders
Benzodiazepines Safer than barbs/mepro Act quickly Addictive-poor choice for addict GABA
Buspirone Serotonin modulator 1-2 weeks for 1st response
SSRIsOCD – poor results in generalPanic - SSRIs
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PsychopharmacologyCompliance
Patient must take the med for it to workFeedback and face-to-face required