Comorbid disorders

Sullivan LE, O Connor PC Medical disorders in substance abuse patients, in Dual Diagnosis and Psychiatric Treatment Substance Abuse and Comorbid Disorders, 2nd Edition. Edited by Kranzler HR, Tinsley JA. New York, Marcel Dekker, 2004, pp 515-553... 

Selective serotonin reuptake inhibitors (SSRIs) are considered the drugs of choice based on their tolerability and efficacy for social anxiety disorder as well as comorbid disorders. 

The main objectives of treatment are to reduce the severity and frequency of panic attacks, reduce anticipatory anxiety and agoraphobic behavior, and minimize symptoms of depression or other comorbid disorders.48 The long-term goal is to achieve and sustain remission. 

Co-occurring disorders. The occurrence of other disorders along with the drug problem also called dual diagnosis or comorbid disorders. 

Families also can be helpful to monitor adherence for those clients who may have to take medicines to treat a comorbid disorder. If family members note that a client is not taking the medicines as prescribed, they can alert the counselor, therapist, or treating physician to the problem. Family members also may observe... 

From our clinical experience, we have found that youth with more severe and chronic depressions and those with significant comorbid disorders or who experience parental conflict often fail to respond to either monotherapy alone (Clarke et ah, 1992 Brent et ah, 1998 Emslie et ah, 1998). Therefore, severe and chronic depressions should be treated with both antidepressants and psychotherapy, and other risk factors for poor outcome (e.g., parent depression, ADHD) should be addressed with additional psychosocial and/or pharmacological interventions. 

The initial choice of therapy is also dictated by the severity of the depression (e.g., the severity of depressive symptoms impedes an adequate trial of psychotherapy), subtype of depression (e.g., presence of psychosis, seasonal depression, or treatment-resistant depressions) presence of comorbid disorders, prior treatment history, child and parent motivation toward treatment, and the clinician s motivation and expertise in implementing any specific intervention. 

Comorbid disorders may influence the onset, maintenance, and recurrence of depression (Birmaher et al., 1996a,b). Therefore, in addition to the treatment of depressive symptoms, it is of prime importance to treat the comorbid conditions that frequently accompany the depressive disorder. 

The recommendation for maintenance therapy depends on several factors, such as severity of the present depressive episode (e.g., suicidality, psychosis, functional impairment), number and severity of prior depressive episodes, chronicity, comorbid disorders, family psy-... 

These data suggest that there is more available information for use of lithium than for other mood stabilizers, and that adolescents hospitalized with adolescent-onset, acute mania have rates of response between 50% and 80%. Supplementation with sedating medication appears to be common but not systematically evaluated. Children hospitalized with mania also respond to lithium, but their comorbid disorders often need separate attention. Open trials with DVP in hospitalized adolescents are also supported. There is much less information on CBZ and there are no data on newer anticonvulsants such as lamotrigine, topiramate, or gabapentin. These data are largely consistent with data from studies of hospitalized adults with classic mania. 

Significant efficacy not noted until sixth week of treatment Inpatient group with severe comorbid disorders, including anorexia and schizophrenia... 

Children and adults with PTSD commonly meet criteria for other psychiatric disorders (Breslau et ah, 1991 Goenjian et ah, 1995 Brady, 1997 De Beilis, 1997). In the adult PTSD literature, comorbidity is clearly the rule rather than the exception and multiple comorbidities are the rule within the rule. Kessler et al. (1995) provide data from interviews with over 6000 individuals ages 15-54 in the National Comorbidity Survey indicating that 88% of men and 79% of women with PTSD had at least one comorbid disorder. Affective disorders, anxiety disorders, and substance use disorders are the most common comorbid conditions in individuals with PTSD (Kessler et ah, 1995 Brady, 1997 Solomon and Bleich, 1998). 

S. M. Turner et al. (1994) compared the uses of atenolol, flooding, and placebo in social phobia. Atenolol was used with a dose range of 25-100 mg/day. In this study, atenolol was shown to be the least effective treatment in terms of symptomatic improvement. Only 27% of atenolol-treated subjects displayed improvement, but the flooding and placebo groups, respectively, demonstrated 89% and 44% response rates. Weaknesses of this study included a high rate of comorbid disorders and dramatic placebo response rates. Additionally, the difference between response rates of the subtypes of social phobia was not addressed. 

The commonly used classes of antidepressants are discussed in the following sections, and information about doses and half-lives is summarized in Table 2-1. The antidepressant classes are based on similarity of receptor effects and side effects. All are effective against depression when administered in therapeutic doses. The choice of antidepressant medication is based on the patient s psychiatric symptoms, his or her history of treatment response, family members history of response, medication side-effect profiles, and comorbid disorders (Tables 2-2 and 2-3). In general, SSRIs and the other newer antidepressants are better tolerated and safer than TCAs and MAOIs, although many patients benefit from treatment with these older drugs. In the following sections, clinically relevant information is presented for the antidepressant medication classes individually, and the pharmacological treatment of depression is also discussed. The use of antidepressants to treat anxiety disorders is addressed in Chapter 3. 

It is also important to recognize that with disorders that are degenerative, different treatments may be required at different stages of illness. This may be due to changes in the intensity of symptoms, or changes in the nature of symptoms associated with disease progression. In addition, it is common for the incidence of comorbid disorders, such as depression or OSAS, to increase in the later... 

Differentiating SAD from other anxiety disorders can be difficult. Panic attacks occur in both SAD and panic disorder, but the distinction between the two is the rationale behind fear fear of anxiety symptoms is characteristic of panic disorder, while fear of embarrassment from social interaction typifies SAD. GAD is hkely the diagnosis if anxiety regarding social situations are part of a pattern of worries about multiple fife areas or numerous potential negative outcomes. A majority of SAD patients have a comorbid mood, anxiety, or substance abuse disorder. The SAD typically precedes the development of comorbid disorders, which is associated with increased suicidal ideation. ... 

Sexual function in alcohol-dependent women is less clearly understood. Many female alcoholics complain of decreased libido, decreased vaginal lubrication, and menstrual cycle abnormalities. Their ovaries often are small and without follicular development. Some data suggest that fertility rates are lower for alcoholic women. The presence of comorbid disorders such as anorexia nervosa or bulimia can aggravate the problem. The prognosis for men and women who become abstinent is favorable in the absence of significant hepatic or gonadal failure. 

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