Psychiatric Comorbidity and the FamilySpecial Guest Lecture with Bud Elliott, Lynnette Kring, Kim KringOverviewDefinitions and SignificanceComorbidityDual DiagnosisTreatment ImplicationsPsychiatric Disorders and Substance UseFamily IssuesGuest SpeakerPanel Q&AAnnouncements2 extra credit questions todaySpecial guests in lecture- please prepare questions for the Q&A sectionComorbidityThe presence of more than one diagnosable condition in an individualE.g. drug or alcohol use disorder plus depressionOr can be used when ANY two disorders co-occur (a broader term)Can be two things from the DSM. Or two medical conditions. Can be two anything. Comorbidity doesn’t mean just what we are talking about today; it can be any two things.50% of people with substance use disorders have another psychiatric problemReasons for this are because:Same neurotransmitters are involved in both psychiatric disorders and substance useSubstance use can mimic, mask or exacerbate symptoms of psychiatric disordersOver time increases the complexity / severity of one’s problemsIn the reading the author was talking about the idea that when you get into a treatment setting you see around 60-80% of people have a psychiatric disorder. Why higher in treatment? People are more likely to get treatment if people have comorbidity. Also issues are more likely to be severe or progressed a bit further if they end up in treatment.It seems to be less severe if people are not in treatment.Dopamine, serotonin, etc. are all involved in psychiatric disorders and substance use disordersThe way that they overlap and how they affect each other, the two can mimic, mask or exacerbate symptoms when people have both disorders.Dual DiagnosisIn AODA (for the purpose of this course)Used to specify when someone has a substance-related disorder addiction disorder and a co-occurring major mental disorder that is independent from the addictionE.g., alcohol dependence and bipolar disorderIn Developmental Disability and Mental HealthUsed to described when someone has a developmental disability and another co-occurring psychiatric disorderE.g., intellectual disability and major depressive disorderOther complexityPolydrug abuse, co-occurring medical disorders, triple diagnosisSome medical disorders can explain why some people may be taking multiple types of drugs. Need to understand everything going on in the person to be able to understand everything.Dual diagnosis with another diagnosis of HIV is known as triple diagnosisTriple Diagnosis has to be: Substance use and a psychiatric disorder and then also HIVIClicker Question #1According to Mueser (2006) which model has strong empirical support across all types of psychiatric conditions in explaining comorbidity for substance abuse:Self-medication hypothesis: people use drugs to medicate their disorderMueser said that this hypothesis was generally for anxiety disorders. People sometimes take drugs that exacerbate their disorders. It definitely does not work for all psychiatric symptoms.Supersensitivity model: When the disorder makes people more sensitive to the different types of drugs they are more vulnerable to the affects of the drugs and that means that the drugs have a much bigger affect on them than it would a more typical person. This is opposite of the self-medication model. People who take cocaine who have a disorder might have different highs and don’t come down from it easily. This one hasn’t shown the exact same support. But they have shown that psychotic disorders have this affect.Common factors model: When there is one variable that predicts the use of both types of disorders. Both psychiatric disorders and substance use disorders. This model is particularly true for people who have antisocial personality disorder and conduct disorder. This doesn’t predict other disordersBidirectional model: Hasn’t been studied much, only for PTSD. The onset of PTSD and use substances and that will make someone’s PTSD symptoms worse which will cause people to use more substances and will make it even worse.The answer was none of the above. None have strong empirical support.They were trying to say that none of these models explain how all psychiatric disorders work, but they can be helpful in understanding how some psychiatric disorders will work for some people and how substance will act in some of these models.Treatment ImplicationsSubstance use is complexSubstance use can be a symptom of a disorder (Bipolar disorder, Antisocial Personality Disorder)Understanding why the person is using or having a model is important –because it can drive treatmentSomeone who is using substances of self-medication to treat anxiety disorder (or PTSD-related anxiety) vs. someone who is exacerbating symptoms of anxiety or PTSD using substances.How might you treat them differently?Someone who is using some medication to treat anxiety disorder should have someone else to make sure they are taking it correctly. Whereas someone who is exacerbating symptoms of anxiety of PTSD from substances maybe should be treated and told to try to stop taking the substances.Self-medicating means using drugs, alcohol or other drugs in order to treat anxiety disorder. Want to make sure they have support they need, it may be completely untreated anxiety disorder. Might want to get it managed and the symptoms managed in that type of situation.IClicker #2According to the McCrady reading, when is family involvement most likely to be successful for a client with a substance use disorder?A) When there is absence of alcohol or other drug problems in the other family membersB) When the client comes to treatment after a crisis, especially a crisis that threatens the integrity of the family unitC) When several of the family members have severe substance use disordersD) All of the aboveE) Both a and bIt is harder when several of the family members have severe substance use disorders.Family IssuesWhy is it important to think about family when considering psychiatric comorbidity and dual diagnosis?Think about both of the readings and what issues might apply to both AODA issues as well as psychiatric comorbidity1 minute discussionThe family environment and things like acceptance can really change how well people do in treatment.Psychiatric disorders can run in the familyEven in caregiving it can cause disorders. It can cause even things like arthritis, pain, and depression.Guest SpeakerBud ElliottTake notes on:What are some of the