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The illnesses may affect each other, and each disorder predisposes to relapse in the other disease. At times the symptoms can overlap and even mask as each other, making treatment and diagnosis difficult. To fully recover, a person needs to treat/address both disorders.
experienced mental health problems. 44% of mental health service users reported drug use.
UK Dept. of Health
Psychiatric Comorbidity Among Community-based, Treatment Seeking Opioid Dependents in Klang Valley
(Komorbiditi Penyakit Psikiatri dalam Kalangan Penagih yang Bergantung pada Opioid di Lembah Kelang)
AzLin Baharudin*, Lotfi Anuar, Suriati Saini, Osman Che Bakar, Rosdinom Razali & Nik Ruzyanei NiK Jaafar
204 penagih 43.6% - penagih opioid ini mempunyai komorbiditi psikiatri. Kemurungan 32.6%, disthiamia 23.6% Panik 14.6%.
Psychiatric Comorbidity Among Community-based, Treatment Seeking Opioid Dependents in Klang Valley
Addiction and mental health services separate AA/rehab centres: bias against medication
Service models used aligned to organisations rather than complex needs of people with dual diagnosis
Mental health & addiction services and the management of dual diagnosis in Ireland National Advisory Committee on Drugs 2004.
Diagnosis #1:
MENTAL ILLNESS
feeling, mood,
ability to relate to others, and daily functioning.
Just as diabetes is a disorder of the pancreas, mental illnesses are medical conditions that often result in a diminished capacity for coping with the ordinary demands of life.
DSM-5
diagnostic criteria and codes 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. 11. 12. 13. 14. 15. Neurodevelopmental disorders Schizophrenia spectrum and other psychotic disorders Bipolar and related disorders Depressive disorders Anxiety disorders Obsessive-compulsive and related disorders Trauma- and stressor-related disorders Dissociative disorders Somatic symptom and related disorders Feeding and eating disordersdisorders Sexual dysfunctionsGender dysphoria Disruptive, impulse-control, and conduct disorders Substance-related and addictive disorde rNeurocognitive disorders Paraphilic disorders
Major Depression
Dysphoric mood
At least 4 of the following Changes in appetite and sleep patterns, agitation, loss of interest in pleasurable activities, fatigue, worthlessness, guilt, inability to concentrate, ruminating negative thoughts, feeling helpless and hopeless, recurrent thoughts of death
Feeling hopeless
Feeling like life is not worth living Ruminating on negative thoughts Emotional numbness
Bipolar Disorder
Bipolar disorder, also known as manic depression, is a brain disorder that causes unusual shifts in a person's mood, energy, and ability to function. Different from the normal ups and downs that everyone goes through, the symptoms of bipolar disorder are severe. They can result in damaged relationships, poor job or school performance and even suicide.
Increase in activity, hyper verbal or pressured speech, flights of ideas, grandiosity, decreased need for help, distractibility, buying sprees, sexual indiscretions, foolish business investments, reckless driving
Personality Disorders
Each of us has a personality or group of characteristics (traits) which influence the way we think, feel & behave and makes us a unique individual. Someone may be described as having a 'personality disorder' if their personal characteristics cause regular and long term problems in the way they cope with life and interact with other people. Some people with these disorders never come into contact with the mental health services.
APA: when personality traits are inflexible and maladaptive and cause either significant impairment in social or occupational functioning or subjective distress.
Personality Disorders
Approximately 10-13% of the population have a personality disorder. Personality disorders are more common in younger age groups (25-44 year age group) and are equally distributed between males and females.
Personality Disorders
Prominent characteristics
Tx of problematic relationships Blames difficulties on others or bad fortune
Distorted thinking
A pattern of continuous antisocial behavior in which the rights of others are violated
Mental illnesses are not the result of personal weakness, lack of character, or poor upbringing.
Most people diagnosed with a serious mental illness can experience relief from their symptoms by actively participating in an individual treatment plan.
Diagnosis #2:
SUBSTANCE ABUSE
It bugs you until it gets what you want. It never forgets when/where it is used to getting its bone.
It thinks its going to get a bone anytime I do anything that reminds it of the bone.
Stigmas
Alcohol and drug abuse have many negative connotations in our society.
For many, drug abuse is perceived to result from lack of willpower, laziness, or selfishness.
Sadly, these erroneous perceptions also extend to a group extremely vulnerable to drug abuse people with mental disorders.
Theories of Dual-Diagnosis
Self-medication theory: Substances are selectively used in service of alleviating symptoms of mental illness (i.e. stimulant abuse employed to counter the sedative effects of anti-psychotic medications) Alleviation of dysphoria: mental illness creates dysphoria (feeling bad) and this dysphoria leads to drug use to mitigate the experience of these unpleasant feelings Multiple risk: In addition to the alleviation of bad-feelings, there are additional risks such as: social isolation, poverty, lack of daily structure, residing in areas with drug availability, history of traumatic events
Ciri-ciri Relapse
Rasmussen (2000) ada menggariskan ciri-ciri relapse ialah
perubahan dalaman individu seperi peningkatan stress, perubahan pemikiran,perasaan dan tingkah laku;menafikan tentang rasa kebimbangan yang dialami; menghindari dan mempertahan diri sendiri bahawa tidak relapse sebaliknya memfokuskan kepada orang lain, bersifat defensive, bersifat kompulsif,berkelakuan impulsive
Ciri-ciri Relapse
kemurungan (depression)
tabiat makan yang luar biasa (tidak lalu atau terlalu banyak makan), kurang bersemangat untuk mengambil sesuatu tindakan, sukar untuk tidur, terjejas aktiviti harian mengalamisuatu tempoh tekanan yang agak lama.
Individu yang relapse juga akan kehilangan kawalan kerana memendam perasaan,
berasa tidak mampu dan tidak berguna, menolak pertolongan, melanggari program pemulihan,melanggar nilai nilai diri, hilang keyakinan diri,marah tanpa sebab,suka bersendirian,kecewa
mengalami tekanan.
Ciri-ciri terakhir ialah individu mula relapse dengan mengambil dadah akibatnya berperasaan kecewa,hilang kawalan diri dan kehidupan serta kemerosotan tahap kesihatan.
Treatment Continued
Parallel: These intervention approaches focus on both substance abuse and mental illness treatment at the same time Integrated: Treatments are delivered at the same time (like the parallel approach) but are coordinated by the same staff team members in the same treatment setting Specific approaches with in these 3 philosophies include: Biological: This is the psychotropic medication arm of treatment and can be effective toward managing symptoms of mental illness which in turn can facilitate treatment of substance misuse
Treatment Continued
Social and Psychological: This is a broad spectrum term used to describe therapeutic techniques such as: Motivational Interviewing: Engaging in supportive and directed conversation about individuals behaviors and patterns that are designed to increase intrinsic motivation to change Cognitive Behavioral: weakening connections between life stressors and reactive/habitual responses that are negative and destructive. Self-Help Groups: This includes many 12-step groups that can instill peer support and self-discipline
AOS Programs
Programs that offer Addiction-Only Services
Some addiction treatment programs cannot accommodate patients with psychiatric illnesses that require ongoing treatment, however stable the illness and however well functioning the individual. Such programs are said to provide Addiction-Only Services
DDC Programs
Dual Diagnosis Capable (DDC) Programs
Dual Diagnosis Capable (DDC) programs routinely accept individuals who have co-occurring mental and substancerelated disorders. DDC programs can meet such patients needs so long as their psychiatric disorders are sufficiently stabilized and the individuals are capable of independent functioning to such a degree that their mental disorders do not interfere with participation in addiction treatment.
DDE Programs
Dual Diagnosis Enhanced (DDE) Programs
DDE programs can accommodate individuals with dual diagnoses who may be unstable or disabled to such an extent that specific psychiatric and mental health support. monitoring and accommodation are necessary in order for the individual to participate in addiction treatment. Such patients are not so acute or impaired as to present a severe danger to self or others, nor do they require 24-hour, intensive psychiatric supervision.
The ideal Client & professionals can see and access holistic service
The reality
SAFETY
Acute medical detoxification should follow same established protocols as for individuals with addiction only. Maintain reasonable non-addictive psychotropics during detoxification For acute behavioral stabilization, use whatever medications are necessary (including benzodiazepines) to prevent harm.
APAKAH PRINSIP ASAS RAWATAN PENAGIHAN DADAH YANG BERKESAN? Prinsip asas rawatan penagihan dadah yang berkesan adalah: 1. Tiada rawatan tunggal sesuai untuk semua individu klien. 2. Rawatan dan pemulihan perlulah mengikut keperluan klien yang unik. 3. Kemudahan rawatan perlu sentiasa ada (tersedia). 4. Rancangan pemulihan perlu dinilai dan dikaji semula dari masa ke masa. 5. Klien hendaklah berada dalam tempoh rawatan yang mencukupi. 6. Kaunseling dan terapi tingkahlaku merupakan komponen yang kritikal dan berkesan dalam rawatan. 7. Ubat-ubatan boleh membantu rawatan penagih dadah.