Substance-abuse disorders depression with

It is important to screen patients for co-occurring mental disorders, and their presence may become more apparent during the stabilization or maintenance phases of schizophrenia treatment. Examples include substance abuse disorders, depression, obsessive-compulsive disorder, and panic disorder. As co-occurring disorders will limit symptom and functional improvement and increase the risk of relapse, it is critical that they be appropriately treated. Pharmacological and nonpharmacological interventions specific for the co-occurring disorder should be implemented in combination with evidence-based treatment for schizophrenia. 

Although ADHD generally is considered a childhood disorder, symptoms can persist into adolescence and adulthood. The prevalence of adulthood ADHD is estimated to be 4%, with 60% of adults having manifested symptoms of ADHD from childhood.8,9 Further, problems associated with ADHD (e.g., social, marital, academic, career, anxiety, depression, smoking, and substance-abuse problems) increase with the transition of patients into adulthood. 

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. 

Offspring of parents with bipolar disorder have an almost three fold increased risk for developing a mental disorder, and a fourfold risk for an affective disorder, as compared to the offspring of parents with no mental disorder (LaPalme et ah, 1997). Families of patients with early-onset bipolar disorder have higher than expected rates of substance abuse, unipolar depression, antisocial personality, and comorbid bipolar disorder with ADHD. Biederman et al. (2000) have concluded that this comorbid bipolar plus ADHD condition is familial, as evidenced by the fact that the two conditions... 

Huang YY, Oquendo MA, Friedman JM, et al. Substance abuse disorder and major depression are associated with the human 5-HT1B receptor gene (HTR1B) G861C polymorphism. Neuropsychopharmacology 2003 28(1) 163-169. 

Several subtypes of depression require specific treatment strategies that go beyond a simple course of conventional antidepressant therapy (these subtypes include bipolar depression, major depression with psychotic features, seasonal depression, atypical depression, comorbid anxiety disorder, comorbid substance abuse, double depression [major depression... 

The psychiatrist may have anywhere from 30-50 minutes for an initial evaluation, whereas the primary care physician will probably have 15-30 minutes for the first visit. Both of them will probably have about 15 minutes for follow-up visits, sometimes less. Visits are often rushed, and any patient can look like anything for an hour. Patients can look healthy when they are psychotic, they can look happy when they are depressed and suicidal, they can successfully sublimate personality-disordered behavior, and they can (and usually do) hide substance abuse disorders. Whomever is chosen, it is critical to communicate the reasons for referral never assume that the presenting problem or diagnosis will be obvious in the visit with the physician. 

Bipolar patients with substance abuse disorders are more likely to have an earlier onset of illness, mixed states, higher relapse rates, poorer response to treatment, higher suicide risk, and more hospitalizations. Approximately 10% to 15% of adolescents with recurrent major depressive episodes subsequently have an episode of mania or hypomania. 

HCPC has 250 beds and an average of about 5,000 admissions per year. The mean age of patients treated at HCPC is 36 years. The most common psychiatric disorders treated at HCPC are schizophrenia, other psychotic conditions, bipolar disorders, ma-j or depression, and other mood disorders. Many of these disorders are caused by substance abuse or are present in patients with substance abuse disorders or conditions. 

The mean age of onset of bipolar disorder is 20, although onset may occur in early childhood to the mid-40s.1 If the onset of symptoms occurs after 60 years of age, the condition is probably secondary to medical causes. Early onset of bipolar disorder is associated with greater comorbidities, more mood episodes, a greater proportion of days depressed, and greater lifetime risk of suicide attempts, compared to bipolar disorder with a later onset. Substance abuse and anxiety disorders are more common in patients with an early onset. Patients with bipolar disorder also have higher rates of suicidal thinking, suicidal attempts, and completed suicides. 

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 ... 

Children of opiate addicts have been shown to have poorer social, educational and health status and to be at higher risk of abuse than their peers (Keen et al., 2000). However, given the high rates of psychiatric comorbidity (in particular, depression) in opiate-dependent patients (Brooner et al., 1997 Khantzian and Treece, 1985), it may be that some of the increased risk in children stems from this greater parental depression. Nunes et al. (1998) reported higher incidence of conduct disorder and global and social impairment for children of addicts with major depression compared to addicts without depression and controls, but not compared with children of depressed patients without substance use disorders. 

It is considered a second-line agent for GAD because of inconsistent reports of efficacy, delayed onset of effect, and lack of efficacy for comorbid depressive and anxiety disorders (e.g., panic disorder or SAD). It is the agent of choice in patients who fail other anxiolytic therapies or in patients with a history of alcohol or substance abuse. It is not useful for situations requiring rapid antianxiety effects or as-needed therapy. 

Valproate is as effective as lithium and olanzapine for pure mania, and it can be more effective than lithium for rapid cycling, mixed states, and bipolar disorder with substance abuse. It reduces the frequency of recurrent manic, depressive, and mixed episodes. 

Once chronic insomnia has developed, it hardly ever spontaneously resolves without treatment or intervention. The toll of chronic insomnia can be very high and the frustration it produces may precipitate a clinical depression or an anxiety disorder. Insomnia is also associated with decreased productivity in the workplace and more frequent use of medical services. Einally, substance abuse problems may result from the inappropriate use of alcohol or sedatives to induce sleep or caffeine and other stimulants to maintain alertness during the day. 

Numerous studies found that childhood sexual, physical, and emotional abuse also predisposes victims of such abuse to the development of depression in adulthood (e.g., McCauley et ah, 1997). The risk for depression increases with early onset and severity of the abuse as well as with the experience of multiple types of abuse. In addition, child abuse is related to an array of anxiety disorders, including generalized anxiety disorder and PTSD (e.g., Kendler et ah, 2000). Other disorders related to childhood abuse include substance abuse, eating disorders, dissociation, and so-... 

Patients whose first episodes of mania or bipolar depression occur between ages 30 to 60 years appear to have clearer episodes of mood disorder, have mania characterized by euphoria and irritability (rather than irritability alone), and be less likely to develop substance addiction (though they may engage in substance abuse as part of their acute episodes). Although psychosis occurs frequently and can be severe, in such late-onset cases confusion with other disorders is usually not a problem. Finally, this more classical presentation is generally responsive to lithium (Carlson, 2000). 

Children with PTSD may be more likely to have comorbid conditions because traumatic insults occur in developmentally sensitive periods. Early life trauma is particularly toxic in its effects on development. Adults with severe sexual abuse histories exhibit high rates of debilitating disorders such as depression, anxiety disorders, alcoholism, substance abuse, and personality disorders (Herman and Van der Kolk, 1987 Putnam and Trickett, 1993). 

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