session 2 - classification

7/25/2019 Session 2 - Classification

1/36

1

Co-occurring Alcohol and Other Drug

and Mental Health Conditions inAlcohol and other Drug Treatment

Settings

Session 2:

Classifcationo MentalDisorders


2/36

2

Comorbidity uidelines !eer to:

Cha"ter #


3/36

$

Classifcation - %ey &oints

Disorders re"resent "articular combinationso signs and sym"toms grou"ed together to

orm criteria as "er DSM-'(-T! Certain number o criteria need to be met

)ithin a certain time rame or a "erson tobe diagnosed as ha*ing a disorder

+ot all AOD )or,ers are able to ormallydiagnose the "resence or absence omental health disorders


4/36

Classifcation . %ey &oints /20

Diagnoses o mental health disordersshould only be made by suitably

1ualifed and trained health "roessionals seul or all AOD )or,ers to be a)are o

characteristics o disorders so are able todescribe and elicit mental health

sym"toms )hen underta,ing screeningand assessment3 and to inormtreatment "lanning


5/36

#

Sym"toms )ithout

Diagnosis Classifed as mental health disorder must

meet diagnostic criteria

Ho)e*er3 large number in AOD ser*ices)ho dis"lay sym"toms but do not meetcriteria

/4g: an5iety but )ithout an an5iety

disorder0 Can still im"act signifcantly on

unctioning and treatment outcomes


6/36

6

Categories o MH Disorders inComorbidity uidelines

Mood disorders

An5iety disorders

&ersonality disorders

&sychotic disorders

Substance-induced disorders


7/36

7

Mood Disorders

Ma8or de"ressi*e e"isodes

Manic e"isodes

Mi5ed e"isodes Hy"omanic e"isodes9

Manic

episode

Hypomanic

episode

Normal moodDepressed mood Elevated mood

Major

depressive

episode


8/36

Ma8or De"ressi*e 4"isode

Some o ollo)ing sym"toms e5"eriencednearly e*ery day or at least 2 )ee,s:

De"ressed mood or loss o interest oren8oyment in acti*ities !educed interest or "leasure in almost

all acti*ities

Change in )eight or a""etite Di;culty concentrating or slee"ing /i9e93

slee"ing too much or too little0


9/36

ina""ro"riate guilt

!ecurrent thoughts o death3 suicidalthoughts3 attem"ts or "lans


10/36

?@

Manic 4"isode

&erson e5"eriences abnormally ele*ated3e5"ansi*e3 or irritable mood or at least ?)ee, characterised by:

'nated sel-esteem Decreased need or slee" 'ncreased tal,ati*eness or racing thoughts Distractibility Agitation or increase in goal directed acti*ity

/e9g93 at )or, or socially0 45cessi*e in*ol*ement in "leasurable acti*ities

that ha*e a high "otential or negati*econse1uences9


11/36

??

Hy"omanic and Mi5ed4"isodes

Hy"omanic same as manic e"isode butis less se*ere

May only last days and does notre1uire the e"isode to be se*ere enoughto cause im"airment in social oroccu"ational unctioning

'n mi5ed e"isode3 "erson e5"eriencesboth a manic e"isode and ma8orde"ressi*e e"isode or at least ? )ee,


12/36

?2

An5iety Disorders

Many "eo"le eel an5ious because theyha*e reason to eg: trouble )ith la)3homelessness

Many in AOD treatment )ill e5"eriencean5iety as conse1uence o into5ication3)ithdra)al3 or li*ing )ithout using AOD

sually reduces o*er time )ith "eriod oabstinence

&roblematic )hen "ersistent3 or so re1uentand intense that "re*ents "erson rom li*inghis>her lie in the )ay that he>she )ould li,e


13/36

?$

&anic Attac,

S)eating

Sha,ing

Shortness o breath =eeling o cho,ing

Bight headedness

Heart "al"itations3

chest "ain ortightness

+umbness or tinglingsensations

Chills or hot ushes +ausea and>or

*omiting =ear o losing

control3 going crayor dying

=eelings o unreality

or being detachedrom onesel


14/36

?

Ty"es o An5iety Disorders

eneralised an5iety disorder /AD0

Obsessi*e com"ulsi*e disorder /OCD0

&anic disorder Agora"hobia

Social "hobia

S"ecifc "hobia &ost traumatic stress disorder /&TSD0

Acute stress disorder9


15/36

?#

&TSD

Can de*elo" ater traumatic e*ent May e5"erience some o ollo)ing:

'ntrusions: re-e5"eriencing e*ent asnightmares3 or ashbac,sE

A*oidance: a*oiding thoughts3 eelings3"eo"le3 "laces or acti*ities that remindhim>her o the e*ent3

Hy"erarousal: increased startle res"onse3irritability or anger3 di;culty slee"ing andconcentrating


16/36

?6

&ersonality Disorders

4nduring destructi*e "atterns o thin,ing3eeling3 beha*ing3 and relating to other"eo"le across )ide range o social and"ersonal situations

Malada"ti*e traits are stable and long lasting

Tend to de*elo" in adolescence or early

adulthood and are generally lielong Most common in AOD conte5t AS&D and F&D


17/36

?7

AOD and &ersonalityDisorders

AOD use disorders may cause uctuatingsym"toms that mimic sym"toms o"ersonality disorders

4g: im"ulsi*ity3 aggressi*eness3 sel-destructi*eness3 relationshi" "roblems3 )or,dysunction3 engaging in illegal acti*ity3dysregulated emotions and beha*iour

Can be di;cult to determine )hether a"erson has a "ersonality disorder


18/36

?

Antisocial &ersonalityDisorder

=ailure to conorm to social norms )ithres"ect to la)ul beha*iour

Disregard or the )ishes3 rights andeelings o others

Dece"ti*e and mani"ulati*e in order togain "ersonal "roft or "leasureG may

re"eatedly lie or con others !ec,less disregard or o)n or others

saety


19/36

?)ithdra)al - sym"toms ode"ression or an5iety

Manic sym"toms induced by into5ication)ith stimulants3 steroids3 hallucinogens

&sychotic sym"toms induced by)ithdra)al rom alcohol3 into5ication )itham"hetamines3 cocaine3 cannabis3 BSD

or &C& Other disorders - substance-induced

delirium3 amnestic disorder3 dementia3se5ual dysunction3 slee" disorder


32/36

$2

Substance-'nduced&sychosis

Di;cult to distinguish substance-induced"sychosis rom other "sychotic disorders

Substance-induced "sychosis - sym"tomsa""ear 1uic,ly and last relati*ely shorttime3 rom hours to days until the eIectso drug )ear oI

&sychosis can "ersist or days3 )ee,s3

months or longer &ossible indi*iduals already at ris, or

de*elo"ing "sychotic disorder triggeredby substance use


33/36

$$

Substance-'nduced &sychosis/20

(isual hallucinations more common insubstance )ithdra)al and into5ication

Stimulant into5ication more commonlyassociated )ith tactile hallucinations3"erson e5"eriences "hysical sensationinter"ret as ha*ing bugs under s,in /KicebugsK or Kcocaine bugs0

Tactile hallucinations can occur in alcohol)ithdra)alG auditory and *isualhallucinations are more common


34/36

$

Substance-'nduced &sychosis/$0

Stimulant "sychosis sometimes moreagitated3 energetic3 more di;cult to

calm )ith sedating or "sychiatricmedication com"ared to non-druginduced "sychosis

DiIerence )ith schio"hrenia - lac, o

negati*e and cogniti*e sym"toms )ithreturn to normal inter-e"isodeunctioning during "eriods o abstinence


35/36

$#

Delirium

Disturbance o consciousness andcognition that re"resents signifcantchange rom "re*ious le*el o unctioning

!educed a)areness o surroundings3di;culty concentrating3 may be di;cult toengage him>her in con*ersation

Changes in cognition include short-term

memory im"airment3 disorientation /inregards to time or "lace03 languagedisturbance /eg di;culty fnding )ords3naming ob8ects3 )riting0


36/36

$6

'n sumL

+ot all clients )ith sym"toms o mentalillness )ill meet diagnostic criteria

Diagnostic labels can be *ery useul butshould not be limitingJ

Diagnosis needs to be underta,en bytrained "roessionals ho)e*er im"ortantto be a)are o sym"toms and to be ableto communicate )ith other"roessionals3 clients and amilies>carers

session 2 - classification

Documents