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P01: olicognography

P02: addictions

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OLICOGNOGRAPHY on ADDICTIONS

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Addictions Psychiatric Comorbitities

Basic Olicognograph: Pathologic Behaviors

Co-Occurring Problems: individuals with substances use disorders have high rates of additional health and social burdens that increase the difficulty of treatment: psychiatric problems, HIV risk behaviors, violence, illegal activity and involvement in the criminal justice system, service utilization, homelessness, and a wide range of vocational problems. This grounds social and complementary services support and by side of individual a series of related clinical and psychological approaches considering: co-morbidity, multiple consumption complications, psychiatric co-morbidity, personality disorder sensibility as well as sort of psychiatric register problem that happen to be essential in the management of addiction as anxiety, depression, suicidal intent and so on.

Prevalences in drugs addicts show that personality disorders (50-90 %) represent the most common comorbidity, followed by mood disorders (20-60 %) and psychotic disorders (15-20 %). Psychopathologic - sociopathic personalities represent up to 25% of clinical sample and recent psychopathological studies showthat they are often previous to drug consumption. Pronostic of psychiatric problems is worse in case of drug consumption and long term use. Mentionned syndromes interact and mean that the same person withsome of these disorders together add to his/her drug problems.

Main problems with comorbidity are 1) They suffer more from psychiatric disorders and care providers have more problems for detecting their comorbidity. 2) In comorbidity no psychosocial method is known to be well effective one over the other for caring drug addiction. 3) Patient presenting a comorbidity are often send to psychiatric institution or service without proper diagnosis or treatment. 4) Staff is not trained for treating co-morbidity because of their specific training (medicine, psychology, social care, etc.). 5) Actually comorbidity treatment is often wringly organized, inefficient meanwhile staff turn over is often hight 6) Patient with comorbidity treatment is for long term.

Alcohol and other drug (AOD) use disorders (i.e., AOD abuse and dependence) commonly co-occur. This co-morbidity has important social, psychiatric, and medical consequences. Although making an accurate diagnosis can be challenging, especially in the context of multiple disorders and also when related to substances associated with social stigma. Several factors may help therapists to improve diagnostic accuracy: adopting an empathic, accepting and non judgmental stance to encourage patients to be accurate and forthcoming in their reports of AOD use; being sensitive to the prevalence of substance use disorders in all patient populations and settings; and being alert to nuances of DSM–IV–TR diagnostic criteria.

Polydrug use is a (too) wide concept that includes many kinds of drug uses, especially if taking into account cannabis, alcohol and tobacco associations. Most of the clinical issues come from the different legal status of the substances used, either illegal (heroin and cocaine) or legal (alcohol, psychotropic medications) and from the division between institutions in this field. The aim is first to minimize the risk of psychotropic drug abuse, but also to create the bases of a therapeutic alliance with patients who, initially, have no other demand than the supply of medication.

The use of substances is a major concern with adolescents with psychotic disorders, as it can have detrimental effects on psychotic symptoms and other aspects of functioning. There is evidence that cannabis use may precipitate the development of psychosis in biologically vulnerable individuals. Substance misuse is an important area to address among adolescents with psychosis and that treating substance misuse in these adolescents may be complex. Not only do these adolescents have psychosis, which already complicates substance misuse treatment, but they may also have depression and anxiety symptoms associated with their illness and possibly with their substance use, as well as potentially engaging in deviant behaviours. Thus, the results point to the need of integrating substance misuse treatment into the treatment programs that the adolescents are already receiving for their psychosis. Indeed, many early psychosis first-episode detection programs are attempting to integrate substance misuse treatment into their programs.

The odds of having an alcohol disorder if a person also has any mental disorder are 2.3 times higher than if there is no mental disorder. Among people with substance (except alcohol) use disorders, 53% also suffer from at least one other mental disorder, with an odds ratio of 4.5 when compared to people without substance. Higher percentages of people with mental illness, particularly those with schizophrenia, smoke tobacco than in the general population and among people without mental illness. Depending on the particular mental illness, it has been reported that 26–88% of psychiatric patients smoke compared to 20–30% of the general population. Substance use disorders (SUDs) are extremely common in bipolar I and II disorders. The lifetime prevalence of SUDs is at least 40% in bipolar I patients. To recognize to that the effects of many psychoactive substances can produce psychiatric-like syndromes. For example: amphetamines and cocaine can induce psychotic like symptoms, and many drugs produce hallucinations, which are an aspect of some psychoses. Furthermore, psychoactive substances alter mood states, producing either euphoria and feelings of well-being, or inducing depression, especially during substance withdrawal.

Personality disorders are defined as enduring patterns of inner experience and behaviour causing distress and leading to maladaptive functioning in the areas of emotion, cognition, interpersonal relationships and impulse control. Individuals with personality disorders not only use health services because of the inherent symptoms of this disorder, but they have an increased risk of suffering from further psychiatric disorders, particularly mood, anxiety and psychotropic abuse disorders. In addition, personality disorders play a role in the course of (chronic) somatic illnesses (including compliance problems and deficient development of coping mechanisms).They have high prevalence rates of approximately 10% in the general population and up to 40% among psychiatric patients, and although patients with these conditions are frequent users of psychiatric services, there is limited knowledge on evidence-based psychopharmacological treatments for these conditions. While specific recommendations can be provided for patients meeting the diagnostic criteria of borderline personality (BPD), schizotypal (STPD) and anxious/avoidant (AVPD) personality disorders, there are hardly any trials of pharmacological interventions in any other type of personality disorder. There is a high degree of comorbidity between schizophrenia and psychostimulant use in countries with high high rates of cocaine and amphetamine use. Psychostimulant use is 2–5 times higher among patients with schizophrenia compared with the general population.

Depression is a common and debilitating condition, with considerable impact for depressed individuals and a heavy burden for society.The comorbidity with substance use is 32% with an odds ratio of 2.6 compared to general population. In spite of its prevalence, depression is underrecognized and under- or inappropriately treated. In spite of the large number of antidepressants available at the present time, they are far from ideal and all show a similar slow, and frequently, incomplete response. Anxiety is a essential in the management of drugs use disorders. For a simple classification of anxiety states: 1) Phobic: Afraid of specific situations, stimuli leading to avoidance of these; 2) Panic: Recurrent attacks of severe anxiety in an unpredictable way; 3) Generalised Relatively: free-floating anxiety not confined to specific situations or discrete attacks; 4) Adjustment or PTSD: Shorter or longer term reactions to a specific stressor. PTSD characterised by characteristic reliving experiences with avoidance, mood and concentration problems; 5) Somatoform: Includes persistent physical symptoms (somatisation) and persistent worry about illness (hypochondriasis).

The frequency of suicidal behaviour escalates steeply from childhood through middle to late adolescence and into adulthood, with suicide rates peaking in the 19 to 23 years-old population. Substance abuse is a significant risk factor for completed suicide. A high prevalence of comorbidity with mood, anxiety, and substance abuse disorders has been found in adolescent suicide victims.Signs a person may be suicidal:1) Threatening to hurt or kill themselves 2) Looking for ways to kill themselves: seeking access to pills, weapons, or other means 3)Talking or writing about death, dying or suicide 9) Anxiety, agitation, unable to sleep or sleeping all the time 10) Dramatic changes in mood 11) No reason for living, no sense of purpose in life. Rage, anger, seeking revenge 6) Acting recklessly or engaging in risky activities, seemingly without thinking 7) Feeling trapped, like there’s no way out 8) Increasing alcohol or drug use 8) Withdrawing from friends, family or society 9) Anxiety, agitation, unable to sleep or sleeping all the time 10) Dramatic changes in mood 11) No reason for living, no sense of purpose in life.

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