Substance-abuse disorders pharmacologic

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. 

Future Outlook for Pharmacologic Treatment of Abuse and Dependence. The importance of the psychosocial dimension ia predisposiag iadividuals toward substance use disorders and subsequentiy maintaining the disorder caimot be overestimated. Additionally, genetic influences have been found to exert an important influence on HabiUty for dmg abuse. A high comorbidity of psychiatric illnesses with substance use disorders further compHcates therapeutic iaterventions ia such patients (236). 

Methylphenidate shares the pharmacological properties and the abuse potential of the amphetamines. When given intravenously, it activates psychotic symptoms in schizophrenic patients if administered during the active phase of their illness, but not after remission. It failed to produce a psychotic reaction in most manic or depressed patients or in healthy subjects (27). Adults with childhood-onset ADHD had an earlier onset of psychoactive substance use disorders, independent of any psychiatric co-morbidity (33). However, bipolar disorders conferred a significantly increased risk for early onset psychoactive substance use disorders independent of ADHD. The question arises as to the contribution of stimulant treatment to psychoactive substance use disorders. There were no differences in medicated versus unmedicated adolescents with ADHD in a review of eight outcome studies comprising 580 adolescents briefly treated with stimulants for six months to five years (34). 

Dual-diagnosis treatment program substance abuse plus standard pharmacologic/ nonpharmacologic treatments for bipolar disorder hepatic dysfunction from chronic alcohol abuse or from hepatitis may alter the metabolism of some agents Lithium long-term treatment associated with reduction of suicide risk and mortality... 

SAD can present in children of preschool to elementary school age. If the disorder is not treated, it can persist into adulthood and increase the risk of depression and substance abuse. CBT and social skills training are effective nonpharmacological therapies in children. Pharmacological evidence is limited to case studies or open-label trials. SSRIs are considered first-line therapy because of tolerability and effectiveness. Fluoxetine, fluvoxamine, sertraline, and paroxetine were effective in children with SAD. Headache, nausea, drowsiness, insomnia, jitteriness, and stomach aches were reported in children receiving SSRIs. 

Anxiety disorders (generalized anxiety disorder, obsessive-compulsive disorder, or panic disorder) Substance abuse (alcohol or sedative-hypnotic withdrawal) Pharmacologically induced Anticonvulsants Central adrenergic blockers Diuretics... 

Pharmacological treatment of anxiety disorders in individuals actively abusing substances is often difficult. Two to four weeks of abstinence is recommended, during which time alternative interventions can be initiated. Agents that have low abuse liability, such as the SSRls, TCAs, or buspirone (Buspar), are recommended. If benzodiazepines are clinically indicated, it... 

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