Substance abuse diagnosis

Mirin SM, Weiss RD, Michael J Psychopathology in substance abusers diagnosis and treatment. Am J Drug Alcohol Abuse 14 139—157, 1988... 

Kranzler HR, Rosenthal RN Dual diagnosis alcoholism and co-morbid psychiatric disorders. Am J Addict 12 (suppl 1) S26—S40, 2003 Kranzler HR, Tinsley JA (eds) Dual Diagnosis Substance Abuse andComorbid Medical and Psychiatric Disorders, 2nd Edition. New York, Marcel Dekker, 2004... 

Comparable findings for lifetime prevalence of psychiatric disorders were obtained in another study of 133 persons, which also found that 47% received a concurrent DSM-III diagnosis of substance abuse or dependence (Khantzian and Treece 1985). The most frequently abused substances were sedative-hypnotics (23%), alcohol (14%), and cannabis (13%). Similar rates of psychiatric disorders were found in other studies of drug abusers (Mirin et al. 1986 Woody et al. 1983). Although such diagnoses do not imply causality, and, in many cases, opioid dependence causes or exacerbates psychiatric problems, some causal link seems likely (Regier et al. 1990). 

In the absence of a diagnosis of substance abuse, most patients taking benzodiazepines continue to benefit ftom treatment over extended periods of... 

Bipolar I disorder affects men and women equally bipolar II seems to be more common in women. Rapid cycling and mixed mania occur more often in women. Individuals with bipolar disorder commonly have another psychiatric disease with 78% to 85% reporting another Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR) diagnosis during their lifetime. The most common comorbid conditions include anxiety, substance abuse, and eating disorders.2... 

Bipolar disorder can be conceptualized as a continuum or spectrum of mood disorders and is not comprised solely of bipolar I disorder.9 They include four subtypes bipolar I (periods of major depressive, manic, and/or mixed episodes) bipolar II (periods of major depression and hypomania) cyclothymic disorder (periods of hypomanic episodes and depressive episodes that do not meet all criteria for diagnosis of a major depressive episode) and bipolar disorder, NOS. The defining feature of bipolar disorders is one or more manic or hypomanic episodes in addition to depressive episodes that are not caused by any medical condition, substance abuse, or other psychiatric disorder.1... 

Lifetime prevalence rates of psychiatric comorbidity co-existing with bipolar disorder are 42% to 50%.16 Comorbidities, especially substance abuse, make it difficult to establish a definitive diagnosis and complicate treatment. Comorbidities also place the patient at risk for a poorer outcome, high rates of suicidal-ity, and onset of depression.2 Psychiatric comorbidities include ... 

Although ADHD is considered a childhood disorder, signs and symptoms persist into adolescence and adulthood in approximately 40% to 80% and 60% of cases, repectively.1,9 Adult ADHD is difficult to assess, and diagnosis is always suspect in patients failing to display clear symptoms prior to 7 years of age.4 Adults with ADHD have higher rates of psychopathology, substance abuse, social dysfunction, and occupational underachievement. 

Growth suppression or delay is a major concern for parents of children taking stimulants. However, the evidence of this side effect is not dear. At present, growth delay appears to be transient and to resolve by midadolescence, but more data are needed to firmly resolve this issue.10 Another concern is the risk of substance abuse with stimulant use. A diagnosis of ADHD alone increases the risk of substance abuse in adolescents and adults. However, stimulant use has not been shown to further increase this risk but actually may decrease this risk, provided ADHD is treated adequately.15... 

Miller NS and Gold MS (1989). The diagnosis of marijuana (cannabis) dependence. Journal of Substance Abuse and Treatment, 6, 183-192. 

When a patient with depression does not respond to an antidepressant, the first step is to ensure that the patient received an adequate trial. The diagnosis should be reassessed with particular attention given to the possibility of comorbid substance abuse, anxiety, or an undetected medical cause of the depression. In addition, adherence must be assessed thoroughly. If the patient has not been adherent, then the reasons should be explored. Finally, the antidepressant must have been administered at a known effective dose for a reasonable amount of time. 

Substance Use Disorder. Patients abusing alcohol or other substances may be prone to erratic behavior reminiscent of the Cluster B personality disorders. If these behaviors occur exclusively in a context of intoxication or during periods of heavy substance use, then the diagnosis of a Cluster B personality disorder is not warranted. Instead, treatment should be focused on the substance use disorder. This is not to say, however, that substance use disorders and Cluster B personality disorders cannot occur together. In fact, the difficulty that these patients have in self-soothing leaves them especially vulnerable to substance abuse. 

Analysis of substances of abuse involves different fields of application including diagnosis of acute/ lethal intoxication, differentiation between chronic and occasional substance abuse (as it may imply different legal consequences for the substance abuser), enforcement of drug traffic safety (driving under influence), and the identification of the source of origin of illicit drugs. 

In a 1994 study Teplin evaluated 728 male jail detainees, and found that nearly two-thirds of this population had a psychiatric disorder with antisocial personality disorder (ASP), the most common diagnosis at 50%. However, 35% of the population had a current diagnosis other than ASP, and two-thirds had previously been given a lifetime diagnosis other than ASP. Substance abuse was common, with a 62% lifetime prevalence. More than one out of three detainees had a severe mental disorder (schizophrenia, bipolar affective disorder, or major depression). In another study, 693 homicide offenders were evaluated and elevated rates of schizophrenia and ASP were found (Eronen et al., 1996). Earlier studies found schizophrenia in 29%-75% and affective disorders in 4%-35% of prisoners. 

Wise, B., Cuffe, S., and Fischer T. (2001) Dual diagnosis and successful participation of adolescents in substance abuse treatment. Journal of Substance Abuse Treatment 219 161-165. 

A group of clinical researchers in New Hampshire, USA, who are highly experienced in the treatment of substance abuse in the severely mentally ill have identified certain key principles of management (Drake et al. 1993, 2001), which are shown in Table 7.4. They consider that a special approach is necessary because the severely mentally ill do not identify problems in the same way, they typically have difficulty with addiction treatment approaches such as group therapy, and there is an ever-present danger that this group fall between two sets of services. Their work is in a unit specifically for dual diagnosis patients. 

An important related problem is the trend toward demedicalization of state mental health facilities. Given a host of clinical and economic realities, many HIV-infected patients can only be served by such institutions ( 472). Their complicated psychiatric and medical presentations, however, require a high level of clinical sophistication, particularly in recognizing and managing their physical co-morbidities ( 473, 474). Indeed, an increasing number of patients suffer from a triple diagnosis (i.e., a psychiatric disorder with co-morbid substance abuse and HIV-positive status) ( 475). 

Compared with persons without a psychiatric diagnosis, the one year prevalence of violence is five to six times higher in patients with serious mental illness in the community (Swanson et al., 1990). The risk for aggression is increased further in patients with severe mental illness who are hospitalized (Tardiff et al., 1997 Owen et al., 1999 Barlow et al., 2000) and in patients with comorbid schizophrenia and substance abuse (Steadman et al., 1998 Elbogen Johnson, 2009). Thus, patients with schizophrenia represent a group at elevated risk for violence. 

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