Substance-abuse disorders specific substances

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. 

When diagnosing a substance use disorder, it is named in accordance with the substance that is being misused. Patients can be said to have alcohol abuse or dependence, cocaine abuse or dependence, opiate abuse or dependence, and so forth. In severe cases when the patient is misusing several substances, (s)he is diagnosed with polysubstance dependence. The complete list of DSM-IV substance use disorders is shown in Table 6.3. Although the diagnostic criteria for the specific substance use disorders are uniform from substance to substance, certain features of the addiction are specihc to the substance being misused. The typical age of onset, the course of the disorder, and the treatment of the disorder vary by substance. Nevertheless, many features of substance abuse and substance dependence are similar across substances. 

Within any of these treatment settings, any of several specific psychiatric treatments can be applied. A comprehensive treatment plan that incorporates both medications, if indicated, and psychosocial treatments is generally believed to be most effective. The treatment plan should be customized to meet the patient s particular needs. Treatment planning should take into account not only the primary substance that is being abused but also family dynamics, the physical and social impact of the substance use disorder, and the presence of any complicating medical or psychiatric illnesses. Psychosocial treatments encompass several formats such as individual psychotherapy, support groups, and behavioral modification. 

It is in this context, in which psychosocial treatments have been mobilized and an appropriate treatment setting has been chosen, that medications can be helpful. The use of psychiatric medications to treat substance use in isolation, apart from such a comprehensive treatment plan, sends the wrong message. The substance abuser typically already leans too heavily on substances to either escape or solve problems. We can quickly succumb to the temptation to join in this dependence on substances to resolve all problems. However, in the context of a comprehensive treatment plan, the substance abuser can benefit from psychiatric medication without unduly seeing it as a panacea. Just like the psychosocial treatments, the use of psychiatric medications should be tailored to the individual s specific treatment needs as well. This includes both medications to treat the substance use disorder by detoxification or craving reduction and medications to treat comorbid psychiatric and medical conditions that may be underlying much of the incentive for continued drug use. 

Progressive inactivity, dissatisfaction with social life, and presence of medical and psychiatric illness can be most predictive of insomnia in old age [6, 7], In modern societies higher rates of insomnia are present in women, people who are less educated or unemployed, separated or divorced, the medically ill, and those with depression, anxiety, or substance abuse [8], In a number of studies, insomnia has been found to be correlated with frequent use of medical facilities [9-13], chronic health problems [13-18], perceived poor health [17], increased use of drugs [10,14], and specific medical conditions including respiratory diseases [19-21], hypertension [21], musculoskeletal and other painful disorders [19-24], heart diseases [19, 23], and prostate problems [19], On the other hand, chronic insomnia predisposes to the development of psychiatric disorders [25-27], Therefore, it is important to clearly establish whether co-morbidities are causative for, or simply co-exist with insomnia, in order to recommend the most appropriate treatment. This is why it is better to categorize insomnia as a disease rather than as a symptom [28],... 

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... 

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