Transcript Comorbid Illness is Important In

Comorbidity General Lecture
Marc A. Schuckit, M.D.
Department of Psychiatry
University of California, San Diego
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1
Some Explanations for Comorbidity
1. Substance induced temporary disorders
2. Substances intensify prior psychiatric
conditions
3. A few psychiatric disorders increase the
risk for substance use disorders
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2
Rationale
• Drugs can cause psychiatric symptoms
• These last days to weeks
• They clear spontaneously
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3
Hamilton Depression Score > 20*
40%
* Mood swings last longer
Source: Brown S, Schuckit M. (1988) J Stud Alcohol;49:412-417.
30%
20%
10%
0%
1
2
3
4
Weeks Abstinent
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16
4
Anxiety In 171 Primary Alcoholics
•
•
•
•
Symptom
Withdrawal palpitations and/or
shortness of breath
80%
Panic while drinking
4%
Panic while sober
2%
Generalized anxiety while sober 4%
Source: Brown S, Schuckit M. J Stud Alcohol. 1990;51:34-41.
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5
When 2+ Disorders Are Observed:
• Which one(s) should be treated?
• What is best therapy?
• Will disorders and/or treatments interact?
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6
Comorbidity is Common in SUD
• 2 / 3 have 2nd diagnosis
BUT
• Most are ASPD and other SUD
• Many others are organic
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7
Studies of Children Of Alcoholics
Don't reveal increased psychiatric disorders
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8
Diagnosis Can Indicate:
• When to intervene
• Treatment with best asset to risk ratio
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9
DSM IV Major Depressive Episode
• A. 5/9 symptoms for two weeks with either
(1) depressed mood or (2) loss of interest
or pleasure
• B-E. Exclusion criteria
• MDD is diagnosed by symptoms and
history
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10
Alcoholism Course
• Fluctuating:
– controlled use
– problems
– abstinence
• 20% spontaneous remission
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11
Anxiety Disorders
• Panic Disorder with or without Agoraphobia
• Agoraphobia
• Social Phobia
• Specific Phobia
• Obsessive-Compulsive Disorder
• Posttraumatic Stress Disorder
• Generalized Anxiety Disorder
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12
Depressive Symptoms in Alcoholics
• 80% Sadness
• 30% - 40% Depressive Episodes
• Question: What is the best treatment?
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13