Transcript Depressive Disorders and Substance Use Disorders

Depressive Disorders
and
Substance Use
Disorders
Dysthymic Disorder
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Depressed mood for
most of the day, for
more days than not, as
indicated either by
subjective account or
observation by others,
for at least 2 years, but
without a major
depressive episode
occurring.
Dysthymic Disorder
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Dysthymic depression has 2 or
more of the following:
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Poor appetite, or overeating
Insomnia or hypersomnia
Low energy or fatigue
Low self-esteem
Poor concentration or difficulty making
decisions
Feelings of hopelessness
Major Depressive Disorder
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Presence of one (Single
Episode) or more
(Recurrent) Major
Depressive Episodes
Not better accounted for
by a Schizoaffective or
other type of disorder
Not accompanied by any
episodes of mania
Depressive Episode
A.
Five or more of the
following are present
during the same 2week period, and
represent a change
from previous
functioning, and at
least one of the
symptoms is either (1)
depressed mood, or
(2) loss of interest . . .
Depressive Episode
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Depressed mood most of the day, every day
Loss of interest or pleasure in most all activities,
every day
Significant weight loss w/o dieting
Insomnia / hypersomnia every day
Psychomotor agitation / retardation every day
Fatigue or energy loss every day
Worthlessness or inappropriate guilt feelings nearly
every day
Decreased ability to think, concentrate or make
decisions nearly every day
Recurrent thoughts of death, or suicidal ideation,
with or without plan &/or attempt
Depressive Episode
B.
Symptoms cause
clinically significant
distress or
impairment in
social,
occupational, or
other important
areas of
functioning
Depressive Episode
C.
Symptoms are NOT
due to the effects of a
substance (e.g., drug
of abuse, or
medication) or a
general medical
condition (e.g.,
hyperthyroidism)
Depressive Episode
D.
Symptoms are not better
accounted for by
Bereavement (i.e. lasting
longer than 2 months after a
significant loss, or
characterized by severe degree
of functional impairment,
preoccupation with
worthlessness, suicidal
ideation, psychotic symptoms,
or psychomotor retardation)
Dual Diagnosis Issues
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Certain intoxication syndromes
(usually with depressant
substances) &/or withdrawal
syndromes (usually from
stimulants) can mimic some of the
symptoms of a depressive episode,
thus making accurate diagnosis and
effective treatment more
complicated.
Exs. Sedative intoxication, Cocaine
withdrawal
Sedative Intoxication
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Inappropriate sexual or
aggressive behavior
Slurred speech
Stupor
Impaired attention or
memory
Mood lability
Impaired judgment
Psychomotor retardation or agitation
Impaired social, occupational, or other
functioning
Cocaine Withdrawal
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Depressed mood
Fatigue
Vivid, unpleasant dreams
Insomnia or hypersomnia
Increased appetite
Psychomotor retardation or
agitation
Symptoms cause clinically
significant distress or impairment
in social, occupational, or other
important areas of functioning
Principles of Treatment
Principles of Dual Recovery
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Treatment of both
mental illness and
substance abuse at
the same time
Individualized dual
recovery plan
Collaboration and
coordination
Keeping hope alive
Principles of Dual Recovery
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Medication adherence
Dual diagnosis &/or
other treatment groups
Self-help groups (DRA,
DBSA, AA, NA), other
support networks
Family support and
problem solving
Individual therapy
Motivational strategies
Principles of Dual Recovery
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Managing stressors,
triggers, relapse risk
factors
Skill-building in areas
of need
Increased overall
structure and balance
(including proper diet,
exercise, sleep
habits)
Any Questions or
comments?
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