As our knowledge about addiction is increasing the association between mental illness and addiction is better understood. The controversy about the appropriateness of the term Dual Diagnosis to describe such a heterogeneous group of patients has sparked a debate on treatment and assessment models. It highlighted the fact that as far as treatment modalities are concerned, one size might just not fit all. Dr Mouton reviews current knowledge on comorbidity in the addiction field. Focusing on more than psychiatric comorbidity, he also looks at physical, social, psychological, spiritual and cultural components affected by addiction. Describing the role of the psychiatrist in addiction care he poses the questions: What if dual diagnosis is actually the key to better understanding of our patients? What if this knowledge leads to more individualised treatments? And are we ready for personalised treatment in the addiction field?
Working with schizophrenia, bipolar & substance misuse september 2015Patrick Doyle
The document provides information about a 2-day training course on working with individuals experiencing schizophrenia, bipolar disorder, and substance misuse. The course objectives are to develop understanding of these conditions, explore best practices for engagement, and promote inclusion. The document outlines the agenda, which includes introductions, learning about symptoms and treatments for schizophrenia in the first part, and a discussion of dual diagnosis and mental health/substance misuse links.
Training innovations dual diagnosis cambian fountains march 16Patrick Doyle
Dual Diagnosis describes the co-occurring problems of mental illness and substance misuse. However, the term 'dual' is something of a misnomer - the needs of this client group are often highly complex and extend beyond the relatively simplistic scenario implied by the term 'dual diagnosis'. This course uses realistic scenarios to enable participants to look at the reasons why mentally ill clients are so prone to drug and alcohol problems, the potential consequences of dual diagnosis, and current assessment and treatment approaches
Duration: half-day. one day, or two day options
Experience: None required
This course is suitable for: all staff currently working within health and social care settings in the United Kingdom. The course is designed to meet the training needs of domiciliary care agencies, care home or hospital settings and all staff. The course is also ideal for carers.
Number of Trainees: 15 maximum
Course Standard: Certificate of attendance
Equipment Needed: Hand-outs will be provided
Candidates will cover:
•Definitions of dual diagnosis and co-morbidity.
•Possible reasons for substance misuse in those with mental health difficulties
•Effects of substance misuse on those with mental health difficulties
By the end of the course Candidates will be able to:
•Discuss the relationship between substance misuse and mental health problems
•Describe the risk factors associated with these behaviours
•Understand the skills that are necessary to effectively work with clients who have dual diagnosis
Psychiatric Disorders in Chemically Dependent Individuals - October 2012Dawn Farm
This program provides an overview of co-occurring addiction and psychiatric illness, including standard diagnostic criteria, individual considerations for determining the appropriate course of treatment, available treatment interventions, and the perspectives of both the addict and the treatment provider on addiction and psychiatric illness. It is presented by Dr. Patrick Gibbons, LMSW, DO; Adjunct Clinical Instructor in Psychiatry at the University of Michigan; Medical Director of the WCHO Community Crisis Response Team; consultant with Pain Management Solutions in Ann Arbor; Medical Director of the Michigan Health Professionals Recovery Program, and Medical Director of Dawn Farm. This program is part of the Dawn Farm Education Series, a FREE, annual workshop series developed to provide accurate, helpful, hopeful, practical, current information about chemical dependency, recovery, family and related issues. The Education Series is organized by Dawn Farm, a non-profit community of programs providing a continuum of chemical dependency services. For information, please see http://www.dawnfarm.org/programs/education-series.
Co-occurring Disorders: The Rule, Not The Exception : Constant MoutoniCAADEvents
A focused introduction to the importance of underpinning that a comprehensive understanding of a person’s behavioural, mental and emotional health issues, requires an understanding of the person, their environment and needs.
This program is part of a comprehensive School Mental Health and High School Curriculum Guide.
Find out more about the guide by visiting:
teenmentalhealth.org
Mental health involves a balanced development of personal and emotional attitudes for harmonious living. Good mental health includes feelings of confidence, adaptability, acceptance of criticism, moral and social values, and good relationships.
Mental illness can be caused by nervous system damage, heredity, social/environmental factors, and prolonged emotional reactions like anxiety or fear. Some types of mental disorders are neurosis, personality disorders, amnesia, anxiety, depression, somnambulism, schizophrenia, manic depression, mood disorders, and attention deficit disorders.
Treatment for mental disorders includes shock therapy, psychotherapy, chemotherapy, and social therapy through attention and care from others.
Mental Health Policy - Defining mental illness, epidemiology, service use, an...Dr. James Swartz
The document discusses the evolution of definitions and classifications of mental disorders from DSM-II to the current DSM-5. It notes that DSM-III represented a radical departure by focusing on defining disorders based on observable symptoms rather than etiology. This symptom-based model allowed for more standardized diagnosis and epidemiological research but was also influenced by various political and economic pressures from pharmaceutical companies, clinicians, and insurers. Subsequent DSM revisions have continued expanding diagnoses and faced criticism for potentially overmedicalizing human suffering.
The document discusses several myths and facts related to mental health. It notes that mental health problems are very common, affecting 1 in 5 American adults and half of children by age 14. However, less than 20% of children with mental health issues receive treatment. Additionally, the vast majority of people with mental illness are not violent. The document aims to dispel several common myths and promote understanding of mental health issues.
Working with schizophrenia, bipolar & substance misuse september 2015Patrick Doyle
The document provides information about a 2-day training course on working with individuals experiencing schizophrenia, bipolar disorder, and substance misuse. The course objectives are to develop understanding of these conditions, explore best practices for engagement, and promote inclusion. The document outlines the agenda, which includes introductions, learning about symptoms and treatments for schizophrenia in the first part, and a discussion of dual diagnosis and mental health/substance misuse links.
Training innovations dual diagnosis cambian fountains march 16Patrick Doyle
Dual Diagnosis describes the co-occurring problems of mental illness and substance misuse. However, the term 'dual' is something of a misnomer - the needs of this client group are often highly complex and extend beyond the relatively simplistic scenario implied by the term 'dual diagnosis'. This course uses realistic scenarios to enable participants to look at the reasons why mentally ill clients are so prone to drug and alcohol problems, the potential consequences of dual diagnosis, and current assessment and treatment approaches
Duration: half-day. one day, or two day options
Experience: None required
This course is suitable for: all staff currently working within health and social care settings in the United Kingdom. The course is designed to meet the training needs of domiciliary care agencies, care home or hospital settings and all staff. The course is also ideal for carers.
Number of Trainees: 15 maximum
Course Standard: Certificate of attendance
Equipment Needed: Hand-outs will be provided
Candidates will cover:
•Definitions of dual diagnosis and co-morbidity.
•Possible reasons for substance misuse in those with mental health difficulties
•Effects of substance misuse on those with mental health difficulties
By the end of the course Candidates will be able to:
•Discuss the relationship between substance misuse and mental health problems
•Describe the risk factors associated with these behaviours
•Understand the skills that are necessary to effectively work with clients who have dual diagnosis
Psychiatric Disorders in Chemically Dependent Individuals - October 2012Dawn Farm
This program provides an overview of co-occurring addiction and psychiatric illness, including standard diagnostic criteria, individual considerations for determining the appropriate course of treatment, available treatment interventions, and the perspectives of both the addict and the treatment provider on addiction and psychiatric illness. It is presented by Dr. Patrick Gibbons, LMSW, DO; Adjunct Clinical Instructor in Psychiatry at the University of Michigan; Medical Director of the WCHO Community Crisis Response Team; consultant with Pain Management Solutions in Ann Arbor; Medical Director of the Michigan Health Professionals Recovery Program, and Medical Director of Dawn Farm. This program is part of the Dawn Farm Education Series, a FREE, annual workshop series developed to provide accurate, helpful, hopeful, practical, current information about chemical dependency, recovery, family and related issues. The Education Series is organized by Dawn Farm, a non-profit community of programs providing a continuum of chemical dependency services. For information, please see http://www.dawnfarm.org/programs/education-series.
Co-occurring Disorders: The Rule, Not The Exception : Constant MoutoniCAADEvents
A focused introduction to the importance of underpinning that a comprehensive understanding of a person’s behavioural, mental and emotional health issues, requires an understanding of the person, their environment and needs.
This program is part of a comprehensive School Mental Health and High School Curriculum Guide.
Find out more about the guide by visiting:
teenmentalhealth.org
Mental health involves a balanced development of personal and emotional attitudes for harmonious living. Good mental health includes feelings of confidence, adaptability, acceptance of criticism, moral and social values, and good relationships.
Mental illness can be caused by nervous system damage, heredity, social/environmental factors, and prolonged emotional reactions like anxiety or fear. Some types of mental disorders are neurosis, personality disorders, amnesia, anxiety, depression, somnambulism, schizophrenia, manic depression, mood disorders, and attention deficit disorders.
Treatment for mental disorders includes shock therapy, psychotherapy, chemotherapy, and social therapy through attention and care from others.
Mental Health Policy - Defining mental illness, epidemiology, service use, an...Dr. James Swartz
The document discusses the evolution of definitions and classifications of mental disorders from DSM-II to the current DSM-5. It notes that DSM-III represented a radical departure by focusing on defining disorders based on observable symptoms rather than etiology. This symptom-based model allowed for more standardized diagnosis and epidemiological research but was also influenced by various political and economic pressures from pharmaceutical companies, clinicians, and insurers. Subsequent DSM revisions have continued expanding diagnoses and faced criticism for potentially overmedicalizing human suffering.
The document discusses several myths and facts related to mental health. It notes that mental health problems are very common, affecting 1 in 5 American adults and half of children by age 14. However, less than 20% of children with mental health issues receive treatment. Additionally, the vast majority of people with mental illness are not violent. The document aims to dispel several common myths and promote understanding of mental health issues.
This document discusses mental health and illness from several perspectives. It defines mental health and illness, compares physical and mental illness, and outlines the prevalence of mental disorders in India according to WHO classifications. It describes the burden of disease from mental illness and common disorders seen in India. The document also discusses models of mental illness, risk factors, signs and symptoms, and approaches to prevention and treatment including through community-based programs like the District Mental Health Program.
This document discusses dual diagnostic disorders, which involve co-occurring substance abuse and mental health disorders. It notes that dual diagnoses are common and treatment requires addressing both conditions simultaneously. Integrated treatment from the same clinician or team is most effective, treating the substance abuse and mental illness at the same time through counseling, education, and other services. For those with dual diagnoses, participating in integrated treatment can help reduce risks and support recovery from both conditions.
Demography and epidemiology of psychiatric disorders in elderlyRavi Soni
This document discusses the demography and epidemiology of psychiatric disorders in elderly populations. It begins with an introduction to geriatric psychiatry and outlines some key statistics on aging populations globally and in India. Specifically:
- The proportion of those aged 60 and older is projected to increase dramatically in India, from 8% currently to over 20% by 2050.
- Psychiatric morbidity is high in elderly populations, with estimates ranging from 17-43% suffering from mental health problems in various Indian studies.
- Common disorders discussed include dementia, depression, anxiety, bipolar disorder, and others. Dementia prevalence is estimated to be around 3.5 million people currently in India, and this number is expected to rise dramatically with
How GPs and mental health practitioners should work togetherKris Van den Broeck
In this slideshow, we first present a literature study, showing that guidelines on the treatment of major depressive disorder (MDD) only provide little information about how to organise collaborative care. An additional Pubmed search, however, may be inspirational for who would like to improve collaboration amongst caregivers regarding the care for severely depressed patients. A second (qualitative) study presented in this presentation outlines how collaborative care amongst general practitioners (GPs) and mental health care practitioners is organised today in Belgium and what can be improved according to practitioners in favour of severely depressed patients.
The document discusses dual diagnosis, which refers to the co-occurrence of mental health and substance use disorders. It notes that substance use is common among those with mental illness, with rates as high as 30-70% among those in treatment settings. Reasons for substance use among those with mental illness include self-medicating symptoms, countering medication side effects, and social factors. Integrated, holistic treatment is recommended that focuses on engagement and harm reduction rather than abstinence. Mainstreaming services within mental health systems while collaborating with addiction services is advocated.
This document discusses integrating mental health services into primary care. It notes that hundreds of millions suffer from mental disorders that create enormous suffering if left untreated. Integrating mental health into primary care is the most viable way to close the treatment gap and ensure people receive needed care. The document outlines strategies for primary care mental health services, including early identification and management of common disorders like depression and psychosis. It provides assessment and treatment guidelines for various mental health conditions suitable for primary care management. The goal is to enable stable psychiatric patients to receive optimal treatment in primary care to prevent relapse.
This document discusses mental health and mental illness. It provides statistics on the global burden of mental disorders, including that 450 million people worldwide have a mental disorder at any time, and over 800,000 die by suicide each year. The text defines mental health and mental illness, and notes that mental disorders are influenced by biological, psychological and social factors. It emphasizes that mental health is closely tied to physical health, and discusses the impact of mental illness on individuals and communities.
The term “psychosomatic disorder” is mainly used to mean “a physical disease that is thought to be caused, or made worse, by mental factors.” ... For example, chest pain may be caused by stress and no physical disease can be found.
This document discusses mental illness and the stigma surrounding it in society. It notes that 1 in 5 Canadians will experience a mental illness in their lifetime. Mental illnesses include anxiety disorders, mood disorders like depression, personality disorders, schizophrenia, and others. While treatable with support and medication, mental illness remains a taboo topic shrouded in misunderstanding. The document argues for educating the public to reduce stigma and encourage those in need to seek help.
Mental illness refers to health problems that significantly affect how a person feels, thinks, behaves and interacts. About 1 in 5 Australians will experience a mental illness in their lifetime. Common types include depression, anxiety, schizophrenia and bipolar disorder. While mental illnesses can cause great suffering, most are treatable, especially when treatment begins early. There are many myths and misunderstandings surrounding mental illness that contribute to stigma, but in reality people with mental illness are seldom dangerous and recovery is possible with appropriate treatment and support.
-Definition of mental health
-Definition of mental illness
-When do you need to see a psychiatrist?
-Causes of mental illness
-Consequences of mental illness
-Treatment team
-Medications used in mental illness
-Myths and facts about mental illness (misconceptions)
This document discusses a web conference on treating co-occurring disorders. It defines co-occurring disorders as the simultaneous existence of substance use disorders and mental health disorders. Approximately 50-75% of those with substance use disorders also have a mental health disorder. The document contrasts traditional treatment models with integrated treatment and argues that integrated treatment, which addresses both disorders simultaneously with one treatment team, has benefits over other models. It provides information on screening and assessment tools, levels of care, and evidence-based therapies for treating co-occurring disorders.
Mental Health Improvement Master Presentationcdosullivan
The document discusses various perspectives on defining and understanding mental health and well-being. It covers how mental health relates to both the individual and community levels. It also examines how inequality, stigma, discrimination, and social exclusion can influence mental health and discusses bringing a holistic understanding of mental health to the local level.
The document discusses co-existing mental health and substance use problems. It notes that co-existing problems are common, with high rates of substance use disorders occurring alongside mood and anxiety disorders. Having co-existing problems leads to more severe and treatment-resistant issues. Screening and assessment tools are recommended to help identify and classify co-existing problems. An integrated treatment approach is needed that addresses both the substance use and mental health issues. Cultural factors are also important to consider in assessment and treatment of co-existing problems.
The document discusses psychological disorders from multiple perspectives. It begins by outlining what topics will be covered, including defining and classifying disorders, specific disorders like anxiety disorders, mood disorders, and schizophrenia. It then discusses reasons for learning about psychological disorders and different perspectives on defining and understanding disorders. Key concepts covered include the medical model of disorders, biopsychosocial approaches, diagnosing and classifying disorders using the DSM, and critiques of diagnosis and labeling. Specific anxiety disorders like generalized anxiety disorder, panic disorder, phobias, and obsessive-compulsive disorder are explained. The nature of mood disorders like major depressive disorder and bipolar disorder are also outlined.
Douglas Ziedonis M.D. -
Member, RiverMend Health Scientific Advisory Board for Addiction & Psychiatry
Department of Psychiatry, University of Massachusetts Medical School & UMass Memorial Health Care
Dr. Ziedonis addresses the RiverMend Health Scientific Advisory Board on co-occurring addictions and processes to help treat them.
To watch lecture visit :http://vimeo.com/100314352
For more information visit: http://www.rivermendhealth.com/scientific-advisory-board-addiction.html
The document discusses mental health services in the UK for depression. It provides statistics on depression prevalence and details primary and secondary care systems for mental health. Primary care focuses on diagnosis, management and prevention, while secondary care handles more severe cases, like those involving psychosis or hospitalization. The document critiques gaps in primary care for mental health and outlines guidelines and pathways to improve treatment, such as increasing accessibility and using evidence-based therapies like CBT.
Milen xx philippines mental health promotion and practice strategiesMilen Ramos
PROMOTION OF MENTAL HEALTH AMONG WOMEN IN PHILIPPINES
CELEBRATION OF INTERNATIONAL WOMEN S DAY
STAGING MENTAL HEALTH PROMOTION AND SERVICES
INDIVIDUAL, COMMUNITY AND NATIONAL INTERVENTION
Team Based Care for Hypertension Management a biopsychosocial approachMichael Changaris
This presentation is an overview of the collaborative care model of hypertension management for behavioral health providers, primary care doctors and health care teams. It explored social determinants of health, complex interaction of adverse childhood experiences and treatment and provides a map for integrated care.
This document discusses elderly depression, suicide risk, and treatment options. It notes that depression is a leading cause of disability worldwide. Late life depression prevalence is estimated at 1-3% of those aged 65 and older. Risk factors for late life depression include chronic illness, cognitive impairment, and lack of social support. Screening tools like the PHQ-9 and GDS can help assess depression severity. Treatment may include psychotherapy, pharmacotherapy, partial hospitalization, or inpatient care depending on symptom severity and suicide risk. Managing elderly depression requires considering medical comorbidities and choosing appropriate treatment.
Constant Mouton. Troira. Power Point Presentation iCAAD Amsterdam 2018iCAADEvents
This document discusses co-occurring disorders, or the presence of both a substance use disorder and mental health disorder. It notes that co-occurring disorders are the rule rather than the exception, with high rates of comorbidity between substance use and mental health conditions. Untreated co-occurring disorders can lead to worse outcomes for both disorders and increased health, social, and legal problems. The document advocates for integrated treatment that addresses both disorders simultaneously rather than sequential or parallel treatment.
This document discusses mental health and illness from several perspectives. It defines mental health and illness, compares physical and mental illness, and outlines the prevalence of mental disorders in India according to WHO classifications. It describes the burden of disease from mental illness and common disorders seen in India. The document also discusses models of mental illness, risk factors, signs and symptoms, and approaches to prevention and treatment including through community-based programs like the District Mental Health Program.
This document discusses dual diagnostic disorders, which involve co-occurring substance abuse and mental health disorders. It notes that dual diagnoses are common and treatment requires addressing both conditions simultaneously. Integrated treatment from the same clinician or team is most effective, treating the substance abuse and mental illness at the same time through counseling, education, and other services. For those with dual diagnoses, participating in integrated treatment can help reduce risks and support recovery from both conditions.
Demography and epidemiology of psychiatric disorders in elderlyRavi Soni
This document discusses the demography and epidemiology of psychiatric disorders in elderly populations. It begins with an introduction to geriatric psychiatry and outlines some key statistics on aging populations globally and in India. Specifically:
- The proportion of those aged 60 and older is projected to increase dramatically in India, from 8% currently to over 20% by 2050.
- Psychiatric morbidity is high in elderly populations, with estimates ranging from 17-43% suffering from mental health problems in various Indian studies.
- Common disorders discussed include dementia, depression, anxiety, bipolar disorder, and others. Dementia prevalence is estimated to be around 3.5 million people currently in India, and this number is expected to rise dramatically with
How GPs and mental health practitioners should work togetherKris Van den Broeck
In this slideshow, we first present a literature study, showing that guidelines on the treatment of major depressive disorder (MDD) only provide little information about how to organise collaborative care. An additional Pubmed search, however, may be inspirational for who would like to improve collaboration amongst caregivers regarding the care for severely depressed patients. A second (qualitative) study presented in this presentation outlines how collaborative care amongst general practitioners (GPs) and mental health care practitioners is organised today in Belgium and what can be improved according to practitioners in favour of severely depressed patients.
The document discusses dual diagnosis, which refers to the co-occurrence of mental health and substance use disorders. It notes that substance use is common among those with mental illness, with rates as high as 30-70% among those in treatment settings. Reasons for substance use among those with mental illness include self-medicating symptoms, countering medication side effects, and social factors. Integrated, holistic treatment is recommended that focuses on engagement and harm reduction rather than abstinence. Mainstreaming services within mental health systems while collaborating with addiction services is advocated.
This document discusses integrating mental health services into primary care. It notes that hundreds of millions suffer from mental disorders that create enormous suffering if left untreated. Integrating mental health into primary care is the most viable way to close the treatment gap and ensure people receive needed care. The document outlines strategies for primary care mental health services, including early identification and management of common disorders like depression and psychosis. It provides assessment and treatment guidelines for various mental health conditions suitable for primary care management. The goal is to enable stable psychiatric patients to receive optimal treatment in primary care to prevent relapse.
This document discusses mental health and mental illness. It provides statistics on the global burden of mental disorders, including that 450 million people worldwide have a mental disorder at any time, and over 800,000 die by suicide each year. The text defines mental health and mental illness, and notes that mental disorders are influenced by biological, psychological and social factors. It emphasizes that mental health is closely tied to physical health, and discusses the impact of mental illness on individuals and communities.
The term “psychosomatic disorder” is mainly used to mean “a physical disease that is thought to be caused, or made worse, by mental factors.” ... For example, chest pain may be caused by stress and no physical disease can be found.
This document discusses mental illness and the stigma surrounding it in society. It notes that 1 in 5 Canadians will experience a mental illness in their lifetime. Mental illnesses include anxiety disorders, mood disorders like depression, personality disorders, schizophrenia, and others. While treatable with support and medication, mental illness remains a taboo topic shrouded in misunderstanding. The document argues for educating the public to reduce stigma and encourage those in need to seek help.
Mental illness refers to health problems that significantly affect how a person feels, thinks, behaves and interacts. About 1 in 5 Australians will experience a mental illness in their lifetime. Common types include depression, anxiety, schizophrenia and bipolar disorder. While mental illnesses can cause great suffering, most are treatable, especially when treatment begins early. There are many myths and misunderstandings surrounding mental illness that contribute to stigma, but in reality people with mental illness are seldom dangerous and recovery is possible with appropriate treatment and support.
-Definition of mental health
-Definition of mental illness
-When do you need to see a psychiatrist?
-Causes of mental illness
-Consequences of mental illness
-Treatment team
-Medications used in mental illness
-Myths and facts about mental illness (misconceptions)
This document discusses a web conference on treating co-occurring disorders. It defines co-occurring disorders as the simultaneous existence of substance use disorders and mental health disorders. Approximately 50-75% of those with substance use disorders also have a mental health disorder. The document contrasts traditional treatment models with integrated treatment and argues that integrated treatment, which addresses both disorders simultaneously with one treatment team, has benefits over other models. It provides information on screening and assessment tools, levels of care, and evidence-based therapies for treating co-occurring disorders.
Mental Health Improvement Master Presentationcdosullivan
The document discusses various perspectives on defining and understanding mental health and well-being. It covers how mental health relates to both the individual and community levels. It also examines how inequality, stigma, discrimination, and social exclusion can influence mental health and discusses bringing a holistic understanding of mental health to the local level.
The document discusses co-existing mental health and substance use problems. It notes that co-existing problems are common, with high rates of substance use disorders occurring alongside mood and anxiety disorders. Having co-existing problems leads to more severe and treatment-resistant issues. Screening and assessment tools are recommended to help identify and classify co-existing problems. An integrated treatment approach is needed that addresses both the substance use and mental health issues. Cultural factors are also important to consider in assessment and treatment of co-existing problems.
The document discusses psychological disorders from multiple perspectives. It begins by outlining what topics will be covered, including defining and classifying disorders, specific disorders like anxiety disorders, mood disorders, and schizophrenia. It then discusses reasons for learning about psychological disorders and different perspectives on defining and understanding disorders. Key concepts covered include the medical model of disorders, biopsychosocial approaches, diagnosing and classifying disorders using the DSM, and critiques of diagnosis and labeling. Specific anxiety disorders like generalized anxiety disorder, panic disorder, phobias, and obsessive-compulsive disorder are explained. The nature of mood disorders like major depressive disorder and bipolar disorder are also outlined.
Douglas Ziedonis M.D. -
Member, RiverMend Health Scientific Advisory Board for Addiction & Psychiatry
Department of Psychiatry, University of Massachusetts Medical School & UMass Memorial Health Care
Dr. Ziedonis addresses the RiverMend Health Scientific Advisory Board on co-occurring addictions and processes to help treat them.
To watch lecture visit :http://vimeo.com/100314352
For more information visit: http://www.rivermendhealth.com/scientific-advisory-board-addiction.html
The document discusses mental health services in the UK for depression. It provides statistics on depression prevalence and details primary and secondary care systems for mental health. Primary care focuses on diagnosis, management and prevention, while secondary care handles more severe cases, like those involving psychosis or hospitalization. The document critiques gaps in primary care for mental health and outlines guidelines and pathways to improve treatment, such as increasing accessibility and using evidence-based therapies like CBT.
Milen xx philippines mental health promotion and practice strategiesMilen Ramos
PROMOTION OF MENTAL HEALTH AMONG WOMEN IN PHILIPPINES
CELEBRATION OF INTERNATIONAL WOMEN S DAY
STAGING MENTAL HEALTH PROMOTION AND SERVICES
INDIVIDUAL, COMMUNITY AND NATIONAL INTERVENTION
Team Based Care for Hypertension Management a biopsychosocial approachMichael Changaris
This presentation is an overview of the collaborative care model of hypertension management for behavioral health providers, primary care doctors and health care teams. It explored social determinants of health, complex interaction of adverse childhood experiences and treatment and provides a map for integrated care.
This document discusses elderly depression, suicide risk, and treatment options. It notes that depression is a leading cause of disability worldwide. Late life depression prevalence is estimated at 1-3% of those aged 65 and older. Risk factors for late life depression include chronic illness, cognitive impairment, and lack of social support. Screening tools like the PHQ-9 and GDS can help assess depression severity. Treatment may include psychotherapy, pharmacotherapy, partial hospitalization, or inpatient care depending on symptom severity and suicide risk. Managing elderly depression requires considering medical comorbidities and choosing appropriate treatment.
Constant Mouton. Troira. Power Point Presentation iCAAD Amsterdam 2018iCAADEvents
This document discusses co-occurring disorders, or the presence of both a substance use disorder and mental health disorder. It notes that co-occurring disorders are the rule rather than the exception, with high rates of comorbidity between substance use and mental health conditions. Untreated co-occurring disorders can lead to worse outcomes for both disorders and increased health, social, and legal problems. The document advocates for integrated treatment that addresses both disorders simultaneously rather than sequential or parallel treatment.
Schizophrenia is a chronic mental disorder defined by periods of psychosis and disturbed thoughts and behavior lasting over 6 months. It involves an inability to distinguish between reality and delusions. Diagnosis requires 2 or more symptoms such as hallucinations, disorganized behavior, or negative symptoms. Schizophrenia has no single cause but is thought to involve genetic and environmental factors. It affects over 2 million Americans and has enormous societal costs due to disability and healthcare expenses. Treatment involves antipsychotic medication to control symptoms, though medication may have dangerous side effects.
This document discusses co-occurring disorders, which are when an individual has both a mental illness and a substance abuse disorder. Approximately 50% of people with severe mental illness also have a substance abuse problem. Common disorders that co-occur include mood disorders like depression and bipolar disorder, as well as anxiety disorders. People may use substances to self-medicate their psychiatric symptoms. Effective treatment requires an integrated approach that addresses both disorders simultaneously.
Community Mental HealthLecture 1011OverviewKno.docxtemplestewart19
Community Mental Health
Lecture 10
1
1
Overview
Know what is meant by Mental Health, Mental Disorder, Mental Illness, and DSM-V
Understand examples of mental disorders
Emphasis on stress & suicide
Understand mental health challenges
Understand goals of mental disorder treatment
2
2
Introduction
Mental health: Individual’s social and emotional well-being
Mental disorders: Health conditions characterized by alterations in thinking, mood, or behavior associated with distress and/or impaired functioning (or, disruption of social/emotional well-being)
Mental illness: All diagnosable mental disorders
Diagnosis through DSM-V
3
3
Introduction
Mental health: Individual’s social and emotional well-being
Mental disorders: Health conditions characterized by alterations in thinking, mood, or behavior associated with distress and/or impaired functioning (or, disruption of social/emotional well-being)
Mental illness: All diagnosable mental disorders
Diagnosis through DSM-V
4
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (“DSM-V” or “DSM-5”)
Most influential book in mental health
Published by American Psychiatric Association (APA)
Classifies disorders based on behavioral signs and symptoms rather than definitive tests or measurements of brain or another body system
4
Introduction
Causes of disability for all ages combined (U.S., Canada, & Western Europe, 2000)
5
5
Mental Disorders: Overview
May arise from various causes:
Poor prenatal care; postnatal environment; genetics; environmental factors; brain function impairment; substance abuse; maladaptive family functioning; stress
Various types of mental disorders exist
Focus on some well-known disorders in this class
6
Mental Disorders: Overview
May arise from various causes:
Poor prenatal care; postnatal environment; genetics; environmental factors; brain function impairment; substance abuse; maladaptive family functioning; stress
Various types of mental disorders exist
Focus on some well-known disorders in this class
7
Stress is a contemporary problem in mental health
Stress: Individual’s psychological and physiological response to real or perceived stressors
Acute vs. chronic (by amount of time)
Eustress vs. distress (by nature of influence)
Stressor: Any real or perceived physical, social, or psychological event or stimulus that causes our bodies to react or respond (can be internal/external)
Mental Disorders: Overview
May arise from various causes:
Poor prenatal care; postnatal environment; genetics; environmental factors; brain function impairment; substance abuse; maladaptive family functioning; stress
Various types of mental disorders exist
Focus on some well-known disorders in this class
8
Individuals typically go through three stages when responding to stressors, known as general adaptation syndrome
General adaptation syndrome (GAS)
Alarm (initiate “fight or flight” response)
Resistance (sustained high resistance to stress)
Exhaustion (Bod.
Community Mental HealthLecture 1011OverviewKno.docxjanthony65
Community Mental Health
Lecture 10
1
1
Overview
Know what is meant by Mental Health, Mental Disorder, Mental Illness, and DSM-V
Understand examples of mental disorders
Emphasis on stress & suicide
Understand mental health challenges
Understand goals of mental disorder treatment
2
2
Introduction
Mental health: Individual’s social and emotional well-being
Mental disorders: Health conditions characterized by alterations in thinking, mood, or behavior associated with distress and/or impaired functioning (or, disruption of social/emotional well-being)
Mental illness: All diagnosable mental disorders
Diagnosis through DSM-V
3
3
Introduction
Mental health: Individual’s social and emotional well-being
Mental disorders: Health conditions characterized by alterations in thinking, mood, or behavior associated with distress and/or impaired functioning (or, disruption of social/emotional well-being)
Mental illness: All diagnosable mental disorders
Diagnosis through DSM-V
4
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (“DSM-V” or “DSM-5”)
Most influential book in mental health
Published by American Psychiatric Association (APA)
Classifies disorders based on behavioral signs and symptoms rather than definitive tests or measurements of brain or another body system
4
Introduction
Causes of disability for all ages combined (U.S., Canada, & Western Europe, 2000)
5
5
Mental Disorders: Overview
May arise from various causes:
Poor prenatal care; postnatal environment; genetics; environmental factors; brain function impairment; substance abuse; maladaptive family functioning; stress
Various types of mental disorders exist
Focus on some well-known disorders in this class
6
Mental Disorders: Overview
May arise from various causes:
Poor prenatal care; postnatal environment; genetics; environmental factors; brain function impairment; substance abuse; maladaptive family functioning; stress
Various types of mental disorders exist
Focus on some well-known disorders in this class
7
Stress is a contemporary problem in mental health
Stress: Individual’s psychological and physiological response to real or perceived stressors
Acute vs. chronic (by amount of time)
Eustress vs. distress (by nature of influence)
Stressor: Any real or perceived physical, social, or psychological event or stimulus that causes our bodies to react or respond (can be internal/external)
Mental Disorders: Overview
May arise from various causes:
Poor prenatal care; postnatal environment; genetics; environmental factors; brain function impairment; substance abuse; maladaptive family functioning; stress
Various types of mental disorders exist
Focus on some well-known disorders in this class
8
Individuals typically go through three stages when responding to stressors, known as general adaptation syndrome
General adaptation syndrome (GAS)
Alarm (initiate “fight or flight” response)
Resistance (sustained high resistance to stress)
Exhaustion (Bod.
This document discusses dual diagnosis patients who have both a substance abuse disorder and a mental health disorder. It hypothesizes that 12-step programs may be more effective for those whose primary diagnosis is substance abuse, as the meetings provide fellowship. For those whose primary diagnosis is a mental disorder, medication and cognitive behavioral therapy may help reduce urges to use substances by treating the underlying chemical imbalances and teaching coping skills. The document also discusses different models for understanding addiction, including biological, psychological, and social factors. It emphasizes the need to treat both the substance abuse and mental health components of dual diagnosis.
The document discusses mood and behavior management for patients with bipolar disorder in skilled nursing facilities. It notes that those in skilled nursing often face isolation, health issues, and sleep disturbances that can trigger bipolar episodes. Effective management includes maintaining regular routines, treating underlying symptoms, using behavioral chain analysis to address triggers, and helping staff regulate their own emotions to avoid exacerbating patients' conditions.
Bipolar disorder and alcohol abuse commonly co-occur, with around 30-60% of bipolar patients also having issues with substance abuse. This comorbidity makes diagnosis and treatment more difficult as alcohol use can worsen bipolar symptoms. Patients also sometimes use substances like alcohol to self-medicate and cope with bipolar symptoms. Integrated treatment that addresses both the mental health and substance abuse issues simultaneously tends to be the most effective approach for dual diagnosis patients.
This document discusses mental health and mental illness. It begins by defining mental health and describing common and less common mental health problems. It then discusses the significance of mental health, noting that nearly half of people worldwide experience mental illness. The document outlines stigma associated with mental illness and describes experiences of stigma. It discusses etiology and contributing factors of mental illness, classification of mental disorders, signs and symptoms, prevention, and treatment including medication, psychotherapy, electroconvulsive therapy, hospitalization, and community support programs. It provides an overview of mental health services and programs in India.
Major depressive disorder is a common psychological disorder characterized by a depressed mood lasting more than two weeks along with symptoms like loss of interest, sleep, and pleasure. It can be caused by genetic, biological, cognitive, social, and environmental factors. Treatment approaches include biomedical treatments using antidepressant drugs, individual cognitive therapies to change negative thoughts, and group therapies where people with similar issues provide support. The effectiveness of different treatment approaches is evaluated based on how long symptoms are relieved and whether observable behavior changes.
There is a clear link between mental illness and substance abuse, with each condition potentially causing or exacerbating the other. Many people use drugs and alcohol to self-medicate the symptoms of mental illnesses like anxiety, depression and schizophrenia. However, prolonged substance use can worsen underlying mental health conditions. Effective treatment requires addressing both issues simultaneously. The high rates of co-occurrence indicate that those with mental illness are more vulnerable to developing addictions, and vice versa, as both conditions involve similar dysfunctions in the brain's reward and stress response systems.
This document discusses mental health and issues related to mental illness. It begins with definitions of mental health and outlines common mental health indicators and problems. Part 1 discusses concepts of mental health and illness. Part 2 addresses the prevalence of mental disorders globally and approaches to treatment. Part 3 examines the burdens faced by caregivers of those with mental illness, including physical, financial, time, role and emotional burdens. The document emphasizes the importance of treating both physical and mental health needs, as well as the roles of nursing and an integrated approach to care.
This document provides information on various types of mental disorders including neurotic disorders, mood disorders, schizophrenia, chemical abuse, eating disorders, phobias, mental retardation, and obsessive compulsive disorder. It discusses the definition, types, causes, symptoms, and treatments of neurotic disorders and mood disorders such as depression and bipolar disorder. It also discusses what mental illness is, how it is diagnosed, what forms it can take, and emphasizes that recovery is possible.
Bipolar 1 and substance abuse disordersJody Marvin
Bipolar 1 disorder and substance abuse disorders are chronic conditions that severely disrupt personal relationships, self-esteem, and occupational functioning. Both have biological, psychological, and social components. Biologically, they are influenced by genetics and chemicals in the brain. Psychologically, bipolar 1 causes cycles of mania and depression that impair rational thinking, while substance abuse can cause psychological dependence and deterioration of relationships. Treatment aims to reduce symptoms through medication, therapy, and social support systems.
Mental health refers to maintaining successful mental functioning including daily activities and relationships. Mental illness occurs when the brain is not working properly, disrupting thinking, emotions, behavior, or physical functioning. Major causes of mental illness include genetics, environment, and brain disorders. While mental illness can significantly impact individuals and families, many people with mental illness live productive lives with treatment. Prevention strategies include creating supportive environments, community education, early detection, and ongoing care for those diagnosed.
Data Transcription 21. Research question What are barriers to OllieShoresna
Data Transcription 2
1. Research question
What are barriers to mental healthcare access experienced by West and Central African immigrants in the United States?
2. History of the participant
I: Mr. Phineas tell what part of West/Central Africa you are from, Gender, Interaction with other people and Interaction with the healthcare system
R: I am from Zimbabwe; I am a male gender. I used to go to the hospital for my mental health, but I have not been there for some time now due to language barrier. I felt like people did not understand me.
I: What are the lived experience as a person with mental health disorders or knows someone who does?
R: It was very rough at the beginning. As I said before, I felt like people did not understand me and that was frustrating.
I: Any problems one can define as a culturally based stigma?
R: Yes, cultural stigma is huge. People are afraid to even say they have a mental illness. And when the providers start moving you around rom one counselor to another, it affected my pride.
I: How do you define of mental illnesses?
R: People losing their minds or experiencing psychosis.
I: What are examples that qualify to be mental health illnesses
R: Psychotic behaviors, depression
I: How challenging is it to access medical help?
R: The cost and language barrier
I: How has been the experience when seeking help?
R; Language barrier has been a problem. Cultural beliefs
I: Are there any barriers? Which ones
R: Stigma people afraid to open up, cost, language
3. Current feeling
I: What are your feelings regarding past experiences?
R: Back home was even worse. We hardly talk about our mental health. We do not even have mental health setup. Most people with psychotic disorders are seen to be under some form of spell or witchcraft. It was a taboo.
I: If the same experience happened today, what would be your response
R: Education and interacting with other people have helped me gained some awareness and coping skills.
4. Barriers to access to mental health services among African immigrants
I: Why is it challenging to access mental health services?
R: Cost, stigma, language
I: How does cultural stigma occur for African immigrants when seeking help?
R: People do not want family to know they are struggling mentally. They want to look strong. It is a cultural thing to be strong.
I: What are your experiences with mental health providers or hospitals?
R: it has been very difficult to explain myself to them.
I: How has it been living as a West or Central African immigrant?
R: It has been great living here and being able to support my family back home and having the opportunity to get ahead in life.
I: How did you discover you had developed mental illnesses?
R: I was not able to sleep at night and I was very tried and angry.
I: What efforts have you made to ensure you get mental health-related services? Were they successful?
R: Understanding me and not judging me was very challenging and I had to keep changing counselors and sharing my i ...
This document discusses depression in seniors. It provides information on risk factors for depression in seniors like chronic illness, bereavement, and cognitive impairment. Signs and symptoms of depression in seniors are discussed, as well as challenges in diagnosis since seniors may not report feelings of depression. Treatment options covered include antidepressant medication, psychotherapy, and electroconvulsive therapy for more severe cases. The need for careful treatment and monitoring given risks of side effects and interactions is also summarized.
Schizophrenia is a mental disorder characterized by hallucinations and delusions. The exact cause is unknown but there are several hypotheses including a dopamine imbalance in the brain. Symptoms include changes in behavior, speech abnormalities, hallucinations, and delusions. Treatment involves antipsychotic medications which work by blocking dopamine receptors in the brain. While medications can help control symptoms, schizophrenia has no cure and often becomes a chronic condition.
This document discusses co-occurring disorders (COD), which are when a person has both a substance use disorder and a mental health disorder. Some key points:
- Around 50-75% of people receiving treatment for a substance use disorder also have at least one mental health disorder. Around 25-50% of people with a mental health disorder also have a substance use disorder.
- Common mental health disorders that co-occur with substance use disorders include mood disorders like depression and bipolar disorder, anxiety disorders, schizophrenia, and personality disorders.
- Integrated treatment that addresses both disorders simultaneously tends to be more effective than treating them separately. Screening and assessment tools can help identify CODs.
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DR CONSTANT MOUTON - COULD DUAL DIAGNOSIS BE THE KEY TO PERSONALISED TREATMENT IN ADDICTION?
1. Dr C Mouton
MBChB, FCPsychSA, KNMG Psychiatrist
Medical Director Triora
c.mouton@triora.com
Dual Diagnosis: The key to
personalised addiction
treatment?
2. Disclosure
(Potential) conflict of interest None
Relevant relations with industry None
Sponsoring or research money
Honorarium or financial payments
Shareholder
Other
None
None
None
None
3. Outline
Looking back
Dual Disorders
Definitions and Is the concept of Dual Disorders important?
Epidemiology, pathology
Diagnosis and approach
Personalised Addiction Care
What is it? And is it new?
Is it the future, and if so how far are we?
How does Dual Disorder Treatment help in personalising
treatment?
4. Addiction Care a short history
1784 – Rush argues that alcoholism should be treated (USA)
1849 – “Alcoholism” term coined by Magnus Huss (Sweden)
1870’s – Keely “cures” for alcoholism in USA
1880 – Freud suggests Cocaine to cure alcoholism
1910 – Sterilisation laws for addicts, alcoholics and mentally ill (USA)
1935 – AA is formed (USA) (Bill Wilson and Dr Bob),
1939 – Alcoholics Anonymous book published
1948 – Minnesota Model created
1950 – Pleasure Centre discovered (Olds and Milner)
1952 – AMA defines addiction as a a primary, chronic disease
with genetic, psychosocial, and environmental factors influencing the
condition’s prognosis
https://www.recovery.org/topics/history-of-addiction-treatment/
5. Addiction Care a short history
1958 – Halfway House Association opens
1960 – Jellinek (USA) coined “Disease concept of addiction”
1964 – 1975 – Medical Aid associations start funding rehab
1964 – Methadone introduced
1971 – Narcan registered
1978 – Dopamine hypothesis of reward (Wise et al)
1982 – Betty ford Clinic opens
1982 – CA formed
1994 – SMART recovery is started
1994 – Naltrexone for alcohol registered
https://www.recovery.org/topics/history-of-addiction-treatment/
6. Addiction Care the last 20 years
Role of Dopamine and the Nucleus Accumbans confirmed in addiction
Neuroimaging techniques (MRI, PET etc) identified many structures
involved in addiction (Nora Volkow, NIDA president)
1999 – Frontostriatal system involved (Jentsch and Taylor)
2010 – Executive system/cognitive control of processes responsible for
behavioural aspects of addiction (George and Coob)
CBT (and its different forms)
Motivational Interviewing
Combined interventions for addiction
IDDT: Integrated Dual Disorder treatment
Van der Stel J. Precision in Addiction Care: Does It Make a Difference? The Yale Journal of Biology and Medicine. 2015;88(4):415-422.
8. Definition of addiction (1)
Addiction is a primary, chronic disease of brain reward,
motivation, memory and related circuitry. Dysfunction in these
circuits leads to characteristic biological, psychological, social
and spiritual manifestations. This is reflected in an individual
pathologically pursuing reward and/or relief by substance use
and other behaviors.
https://www.asam.org/resources/definition-of-addiction
9. Definition of addiction (2)
Addiction is characterized by inability to consistently abstain,
impairment in behavioral control, craving, diminished
recognition of significant problems with one’s behaviors and
interpersonal relationships, and a dysfunctional emotional
response. Like other chronic diseases, addiction often involves
cycles of relapse and remission. Without treatment or
engagement in recovery activities, addiction is progressive and
can result in disability or premature death.
https://www.asam.org/resources/definition-of-addiction
10. Definitions
Dual diagnosis - Mental illness and substance abuse
occurring together in the same person
Comorbidity - Two (or more) co-occurring
disorders / dysfunctions
Co-occurrence - Two “things” happening at the
same time
13. Case Ms. X
29 y/o, Asian female, university student, residing in The Hague.
Presenting with suicidal thoughts (wanting to die when she was 36)
because she doesn’t want to live long with the life she’s
experiencing.
In addition: a labile mood, not sleeping well, poor concentration and
being distractible, she experiences panic attacks when thinking
about exams.
She uses alcohol daily to calm her nerves and eats coffee to wake up
in the mornings and get to lectures.
She diagnosed herself with borderline personality disorder, panic
disorder and depression
14. How frequently does it occur?
Lifetime prevalence of mood disorders 20,1%
Lifetime prevalence of anxiety disorders 19,6%
Lifetime prevalence of ADHD 9,2%
Lifetime prevalence of any mental illness 42,7%
Lifetime prev.: substance related disorders 19,1%
Lifetime prev: SUD in severe mental illness 40% - 60%
Pts in addiction units with mental illness 60% - 80%
De Graaf et al, NEMESIS-2
15. How frequently does it occur?
Schizophrenia also with SUD 47%
Bipolar also with SUD 52% - 56%
Depression also with SUD 19% - 27%
ADHD also with SUD 20% - 25%
Anxiety disorders also with SUD 24% - 35%
Post Traumatic Stress Disorder also with SUD 22% - 43%
Personality Disorders also with SUD 44%
(Alcohol)
16. How frequently does it occur?
Lifetime prevalence: any other psychiatric disorder 97%
+ alcohol use disorder 75%
+ drug use 40%
Personality disorders > 60%
Mood disorders ~ 50%
Anxiety disorders > 40%
Patholical Gambling Disorder
Kesser RC, (2008) Petry (2005)
17. Case Ms. X continued
In early childhood she had feelings of insecurity, poor attachment to her
parents and often felt depressed.
Later in life she realized that even though she was academically strong
she struggled with completing tasks, always being late and only
performing well under pressure.
After many failures she started to become more and more anxious
resulting in panic attacks, experiencing fear of failing and eventually fear
of fear itself.
It was in University where she realized that she can augment behaviour
using alcohol and coffee to decrease restlessness and increase
alertness.
18.
19. Experimental
To feel good
Why do people start using?
To feel better
To do better
20.
21. What is the interaction in Dual Diagnosis?
Primary mental illness leading to addiction
Self medicating symptoms
Self medicating side effects
Schizophrenia: nicotine use decreased S/E and (-) symptoms
• Mental illness itself can trigger or worsen addiction
Mania: increased impulsivity increase risk of use/relapse
Panic: alcohol impulsivity other addiction
• Prescribing addictive medicine might trigger addiction (rare)
22. Primary addiction with psychiatric sequelae
• Intoxication can cause symptoms of mental illness
• Substance use can unmask underlying mental illness
• No clear evidence if substance use cause mental illness as such
Cannabis – inducing first psychosis
• Substance use can worsen existing mental illness
What is the interaction in Dual Diagnosis?
23. Dual primary diagnosis (Two separate diagnoses, unrelated,
might interact)
Common etiology
• Bio-psycho-social factors lead to both conditions e.g. Family
dysfunction + conduct disorder = addiction
• Shared genetic risk e.g. ADHD and addiction have shared genomes
involved
What is the interaction in Dual Diagnosis?
24. Infancy Childhood Adolescence Early
adulthood
Attachment issues with strict father,
emotionally unavailable mother
Restlessness, inattention,
underachievment, not finishing
tasks, etc
Depression, feelings of
worthlessness, poor self esteem
Alcohol use daily, augmenting
attention and performance with
alcohol and dry coffee
Anxiety and panic attacks when not
using alcohol or coffee
Case Ms X continued
25.
26. Untreated dual diagnosis
Addiction predicts worse outcome for mental illness
Mental illness predicts worse outcome for addiction
Negative effect on treatment
Non-response or poor response to regular treatment
More frequently non-compliant
Increased hospital admission rates
Increased suicidality rate
Increase overall health cost
27. Untreated dual diagnosis
Higher rate of homelessness
Higher unemployment rate
More family problems
Legal problems / arrest more likely / frequent
Negative effect on psychosocial functioning
Medical problems
Higher HIV, Hepatitis and STD rate
Higher mortality rate
28. Untreated dual diagnosis
More stigma within health sector
Less qualified staff to treat both disorders
More problems getting care / treatment
Lower availability of dual disorder facilities
Poor accessibility to health services
30. Assessment – the bare minimum
Biographical assessment incl. family history (Lifespan + genogram)
Complete addiction history
Complete medical and psychiatric history (symptom clusters)
Trauma history (physical / emotional / ACE)
Functioning (QOL, different life domains)
First the big picture, then treatment strategy
Screening tools are not diagnostic
Assess safety
31. Bio-psycho-social model
Biological Psychological Social
•Genetic predisposition
•Physical development
•Intelligence
•Temperament
•Medical comorbidity
•Personality structure
•Self-esteem
•Insight
•Defence mechanisms
•Patterns of cognition
•Responses to stressors
•Trauma history
•ACE (Adverse Childhood
Events)
•Coping strategies
•Peer relationships
•Family constellation
•Transitions within the
family (ARISE)
•Work environment
•Ethnic influences
•Socioeconomic issues
•Culture
•Religion
32. Predisposing factors:
“What made me vulnerable in the
first place?”
Protective factors:
“Which positive things do I have
going for me?”
Precipitating factors:
“What triggered the most recent
episode?”
Perpetuating factors:
Things that keep the problems
going on / keeps me from
recovery
Problems/diagnoses:
The Big Picture (Dynamic approach)
33. Diagnosis – some aspects
Does it matter?
Only diagnose if you are trained to do so
Be careful with sharing provisional / differential diagnoses
Stay clear of lay diagnoses
Questionnaires are never diagnostic
Capture the Big Picture
Psychodynamic diagnosis
DSM-5 / ICD
35. 3D model
Implications for treatment
Addiction
Functional impairment
Psychiatry
Indication for more
specific treatment
Taking into account more
factors
39. Same team
Same location
Same time
More effective than parallel treatment
At least ten studies show integrated treatment is more
effective than traditional sequential treatment
Drake et al, Schiz Bulletin 1998; Drake et al, Psych Services 2001 for summaries
Integrated Dual Disorder Treatment
40. Multidisciplinary Team
Stage-Wise Interventions (stages of change, stages of
treatment)
Access to Comprehensive Services (e.g., residential, etc.)
Time-Unlimited Services Assertive Outreach
Motivational Interventions (And invitational interventions,
ARISE?)
Substance Abuse Counseling
Drake et al, Schiz Bulletin 1998; Drake et al, Psych Services 2001 for summaries
Integrated Dual Disorder Treatment
41. Group Treatment
Family Participation
Participation in Alcohol & Drug Self-Help Groups
Pharmacological Treatment
Interventions to Promote Health
Secondary Interventions for Treatment of Non- Responders
Drake et al, Schiz Bulletin 1998; Drake et al, Psych Services 2001 for summaries
Integrated Dual Disorder Treatment
43. “ When a doctor tells me that he adheres strictly to
this or that method, I have my doubts about his
therapeutic effect. I treat every patient as
individually as possible, because the solution of the
problem is always an individual one.”
- Carl. G. Jung
44. Personalised medicine: is it new?
400 BC Hippocrates (Dx and Rx of individuals according to the 4
humours (blood, phlegm, black bile and yellow bile)
19th century Claude Bernard “ a physician treats an individual in
an individual manner”
1902 Archibald Garrods paper “The incidence of
allcaptonuria: A study in Chemical Individuality”
2015 E Vieta coined term precision psychiatry in the
column (personalised medicine applied to mental health:
precision psychiatry)
Fernandes BS, et al. The new field of “precision psychiatry.” BMC Medicine. 2017;15:80. doi:10.1186/s12916-017-0849-x.
45. Personalised medicine
Personalised medicine implies a targeted focus on the patient’s
individual characteristics and a better selection of treatment
strategies to increase positive outcomes and reduce
misdiagnoses and cost.
Precision medicine implies that technologies and treatments
are not developed for each individual patient, but rather that a
high level of exactness in measurement will be achieved such
that eventually it will be personalized.
Fernandes BS, et al. The new field of “precision psychiatry.” BMC Medicine. 2017;15:80. doi:10.1186/s12916-017-0849-x.
Van der Stel J. Precision in Addiction Care: Does It Make a Difference? The Yale Journal of Biology and Medicine. 2015;88(4):415-422.
46. Precision psychiatry
“an emerging approach for treatment and prevention that takes
into account each persons variability in genes, environment and
lifestyle”
LEXICALLY a modifier:
“ the quality, condition or fact of being accurate”
“ refinement in a measurement, calculation or specification”
IMPLICATION: psychiatry will have foundation in measurement,
thus objectivity instead of subjectivity
Fernandes BS, et al. The new field of “precision psychiatry.” BMC Medicine. 2017;15:80. doi:10.1186/s12916-017-0849-x.
47. GOALS and implication of Precision
in addiction care
More accurate diagnosing
Through individualised assessment
To treat more specifically
In order to improve outcomes
And decrease cost
Van der Stel J. Precision in Addiction Care: Does It Make a Difference? The Yale Journal of Biology and Medicine. 2015;88(4):415-422.
48. NNT (Number Needed for Treatment) = epidemiological measure that
estimates the number of patients needed to be treated in order for one to
benefit from the treatment
Evidence Based Practice = proving one treatment for one group of patients
Evidence Based Guidelines = are limited AND currently they compare groups
of people with the treatment to groups of people without
Meta-analyses = designed to study specific interventions and compare these;
therefore they compare average differences and do very little to predict
outcome for an individual
WHAT IS NEEDED? Evidence based strategies and predictive instruments to
adequately select treatment or prevention strategies
Van der Stel J. Precision in Addiction Care: Does It Make a Difference? The Yale Journal of Biology and Medicine. 2015;88(4):415-422.
Implication of Precision in addiction care
49. Personalised care – key points / summary
Medicine has always had a personalised approach
Psychiatry as the most subjective of all disciplines has the most
to gain from precision medicine
Even though precision psychiatry is still new, we have a lot to
offer when it comes to personalised approaches to care
Precision psychiatry will revolutionise the field – also for
addiction care
Precision psychiatry will add to personalised psychiatry (and
therefore addiction medicine)
Fernandes BS, et al. The new field of “precision psychiatry.” BMC Medicine. 2017;15:80. doi:10.1186/s12916-017-0849-x.
Van der Stel J. Precision in Addiction Care: Does It Make a Difference? The Yale Journal of Biology and Medicine. 2015;88(4):415-422.
50. How will practice be changed?
Diagnosis will be more precise
Genetics will become more important
Treatment selection will be more precise
53. 1. Cultural aspects
“A common heritage or set of beliefs, norms, and values
shared by a group of people”
Dynamic
Has impact on:
Prevention of mental illness and/or addiction
Development of mental illness and/or addiction
Motivation for treatment
Type of treatment best suited
Recovery process
Relapse risk
54. 1. Cultural aspects
Stigma through culture
Society, subgroup, family etc.
Practice should be personalised:
Understand racial, ethnic, religious and cultural background
Understand influence this has on both addiction and comorbidity
Recognize the effect on motivation, treatment, recovery and
relapse risk
Develop programmes and train staff in order to be more
culturally sensitive
Family therapy
55. Case Ms. X continued
Cultural aspects
Parents denied the diagnosis of ADHD (father nor daughter sought
help)
Thus, primary underlying trigger which led to addiction was never
treated
Addiction is stigmatized and the family was ashamed to talk about
this, hindering her to seek help
Therapy was influenced by shame, absence of family involvement and
differences in cultural background of team and patient
Understanding the effects of immigration, marginalisation and lack of
cultural bonding to Dutch Culture were liberating for the patient
56. 2. Family
ARISE
Genograms
Transitional Family therapy
Genetic component
Heritage
Resilience
57. “Brother”
Alcohol
Internet gaming addiction
“Ms X”
Alcohol
Caffeine
DD: ADHD
?Depression
?Panic D/O
Attachment
Self-esteem
Psychosocial problems
“Father”
Alcohol
DD: ?ADHD
?Depression
“Mother”
DD: Depression
?Personality D/O
Immigration, 1980
Death,
2016
Case Ms. X continued
59. 4. Gender specific approach
Gender groups
Stereotypes
Stigma
Sexual preference and identity
60. 5. e-Health
Outreach pre treatment
Prevention
Used in treatment
Outcome monitoring
Tracking processes
Research
Big data
Individual progress / outcome / parameters
61. Ms. X outcomes
After 6 weeks: treated for addiction and ADHD.
Rest and focus, able to do work necessary for her recovery.
Engaged in 12 step meetings as well as ADHD support groups.
At university work on end thesis and her grades improved.
No anxiety or panic attacks and she wanted to live until she was
really old.
Resistance of family to engage in therapy remains
She experience hope for the future and connection with fellows
and this kept her going and working on her recovery.
63. Recovery from the patients perspective
Feeling supported by family and peers and being able to
participate in the community - BEING CONNECTED
Holistic and individualized treatment approach, seeing
the person “behind the symptoms” – INDIVIDUALIZED
TREATMENT/ SHARED DECISION MAKING
De Ruysscher C, et al.. The Concept of Recovery as Experienced by Persons with Dual Diagnosis: A Systematic Review
of Qualitative Research From a First-Person Perspective. J Dual Diagn. 2017 Jul 12:1-16.
64. Recovery from the patients perspective
Having personal beliefs, such as fostering feelings of
hope, building a new sense of identity, gaining
ownership over one's life, and finding support in
spirituality – SPIRITUALITY
Importance of meaningful activities that structure one's
life and give one motivation to carry on -
MEANINGFULLNESS
De Ruysscher C, et al.. The Concept of Recovery as Experienced by Persons with Dual Diagnosis: A Systematic Review
of Qualitative Research From a First-Person Perspective. J Dual Diagn. 2017 Jul 12:1-16.
65. Next Tuesday
Review your current caseload and review for any missed dual
diagnoses
Use timelines, biographies, genograms and dynamic formulations in order
to UNDERSTAND
Consider your own initial assessment of patients
Be sure to:
See the WHOLE patient
Install HOPE
LISTEN
Be KIND
Show COMPASSION
Build TRUST
66. Dr C Mouton
MBChB, FCPsychSA, KNMG Psychiatrist
Medical Director Triora
c.mouton@triora.com
Thank You
67. Fernandes BS, et al. The new field of “precision
psychiatry.” BMC Medicine. 2017;15:80.
doi:10.1186/s12916-017-0849-x.
Editor's Notes
Definition of addiction looks like any other mental health disorder
She thought she was the only one….
1. Kessler RC, Hwang I, LaBrie R, et al. DSM-IV pathological gambling in the National Comorbidity Survey Replication. Psychol Med. 2008;38(9):1351–60.
2. Petry NM, Stinson FS, Grant BF. Comorbidity of DSM-IV pathological gambling and other psychiatric disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2005;66(5):564–74.
Why do people start with addictive substances or behaviours?
During the second consultation we drew a timeline of the symptoms and attempted to cluster symptoms.
In early childhood she had feelings of insecurity, poor attachment to her parents and often felt depressed.
Later in life she realized that even though she was academically strong she struggled with completing tasks, always being late and performing well only when under pressure.
After many failures she became increasingly anxious resulting in panic attacks, experiencing fear of failing and eventually fear of fear itself.
It was in University where she realized that she can augment behaviour using alcohol and coffee to decrease restlessness and increase alertness.
What happens if dual disorders are not treated?
QUESTION: Are these recognisable from your own practice?
1. Do not diagnose if you are not trained for diagnosing.
Parallel VS Integrated model explained
Is this a new phenomena?
Since when is personalised medicine a concept? 2015? 2000? 1980? Earlier?
Personalised medicine:
Patient characteristics TO individualise treatment strategy = better health outcomes / lower cost
Presicion medicine / psychiatry
Development of precise ways of measuring in order to personalise treatment
BOTH have the same goals, but the methodology is somewhat different. In psychiatry we do not yet have precise ways of measuring.
Why is psychiatry / science not individualized when it comes to treatment strategies?
QUESTION: How do people incorporate this into their practice?
QUESTION: Is this common practice yet?
Ms X experienced many failures: academically as well as personally
She realised that in her family her father had similar problems: hyperactivity, restlessness, poor concentration, procrastination leading to many failures. He became a hard, strict man never showing emotion and expecting the same of her.
Her mother was emotionally labile and not really available to her children.
Ms X learned at an early stage how to fend for herself. This would come in handy when she received incorrect diagnoses and medical advice, was marginalized at university and had little no friends and no support from her family.
Millenials
Domains related to ‘precision psychiatry’. Diverse approaches and techniques, such as ‘omics’, neuroimaging, cognition and clinical
characteristics, converge to several domains. These domains can be analysed using systems biology and computational psychiatry tools to
produce a biosignature – a set of biomarkers – that, when applied to individuals and populations, will produce better diagnosis, endophenotypes
(measurable components unseen by the unaided eye along the pathway between disease and distal genotype), classifications and prognosis, as
well as tailored interventions for better outcomes. The bottom-up approach from specific areas (such as metabolomics) to domains (such as
molecular biosignature), to systems biology and computational psychiatry, to a resultant biosignature, can also be reverted to a top-down
approach, with specific biosignatures being analysed to better understand domains and its specific components. Components and domains are
not mutually exclusive, and a subject can belong to more than one component or domain; for instance, ‘large databanks’ can belong to
data from ‘neuroimaging’, ‘mobile devices’ and ‘panomics’, all of which are put as different domains. After the establishment of precision
psychiatry, persons considered to belong to the same group (agglomerate of persons in grey) will be reclassified into different diagnosis
and endophenotypes. Further, after accomplishing precision psychiatry, it will be possible to more accurately predict response or nonresponse
to treatment, as well as better prognosis