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& DRUG ABUSE:MENTAL ILLNESS

COMORBIDITY

روانپزشک نادی محمد

خدا نام به

DRUG ABUSE &MENTAL ILLNESS:

COMORBIDITY

روانپزشک نادی محمد

Addictive Disorders Often Co-Exist with or Predispose to Mental

Disorders

DSM IV Manual: Devotes ~ 100 pages to describing addiction and dependence disorders

DSM IV Manual: Devotes ~ 100 pages to describing addiction and dependence disorders

Discusses substance abuse as a confound to diagnosis and Tx Discusses substance abuse as a confound to diagnosis and Tx

Addictive DisorderAddictive Disorder

Mental DisorderMental Disorder

Addictive DisordersOften Co-Exist With

Mental Disorders

Addictive DisordersOften Co-Exist With

Mental Disorders

Lifetime Prevalence of Drug Disorders AmongPersons With Various Mental Disorders

(vs. any Drug Disorder Alone)

Lifetime Prevalence of Drug Disorders AmongPersons With Various Mental Disorders

(vs. any Drug Disorder Alone)

Source: Regier,D.A. et al., JAMA 264(19), pp. 2511-2518, November 21, 1990.Source: Regier,D.A. et al., JAMA 264(19), pp. 2511-2518, November 21, 1990.

0

5

10

15

20

25

30

35

40

45

Schizo-phreniaSchizo-phrenia APDAPD

AnxietyAnxiety

PanicDisorder

PanicDisorder

OCDOCD

BipolarDisorderBipolar

Disorder

DepressionDepressionAny DrugDisorder(alone)

Any DrugDisorder(alone)

What Do Mental and AddictiveDisorders Have in Common?

What Do Mental and AddictiveDisorders Have in Common?

Both are Behavioral DysfunctionsWith Similar Neurobiological BasisBoth are Behavioral Dysfunctions

With Similar Neurobiological Basis

Because of this overlap, drugs of abuse

can cause symptoms that mimic

most forms of mental illness

Because of this overlap, drugs of abuse

can cause symptoms that mimic

most forms of mental illness

Some drugs of abuse have a mechanism of action similar

to that of drugs used as psychotherapeutic agents

Some drugs of abuse have a mechanism of action similar

to that of drugs used as psychotherapeutic agents

Significance: rationale forself-administration

Significance: rationale forself-administration

serotonin synapticterminal

Synaptic vesicle

Postsynaptictarget

Activate transmitter receptors

Causes an effectCauses an effect

transporterProzac &Cocaineblock

National ComorbiditySurvey (NCS)

Nearly half of individuals with a past year substance use disorder also had a mental disorder

Nearly half of individuals with a past year substance use disorder also had a mental disorder

National ComorbiditySurvey (NCS)

Most prevalent

• Affective disorders

• Anxiety disorders

• Personality disorders

• Psychotic disorders

Most prevalent

• Affective disorders

• Anxiety disorders

• Personality disorders

• Psychotic disorders

And One of the Most Powerful

Triggers for Relapse In Recovering Addicts

And One of the Most Powerful

Triggers for Relapse In Recovering Addicts

Research Tells Us That STRESS Can Be A Major Factor In the

Initiation of Drug Use…

Research Tells Us That STRESS Can Be A Major Factor In the

Initiation of Drug Use…

The Stress Hormone CycleThe Stress Hormone Cycle

HypothalamusHypothalamus

PituitaryGland

PituitaryGland

AdrenalGlands

AdrenalGlands

KidneysKidneys

CRFCRF

ACTHACTHCORTISOLCORTISOL

Stress ResponsesStress Responses

DRUG USE(Self-Medication)DRUG USE

(Self-Medication)

STRESSSTRESS

CRFCRF

AnxietyAnxiety

CRFCRF

AnxietyAnxiety

What Role Does Stress Play In

Initiating Drug Use?

What Role Does Stress Play In

Initiating Drug Use?

ProlongedDRUGUSE

ProlongedDRUG

USE

AbstinenceAbstinence

RELAPSERELAPSE

CRFCRF

AnxietyAnxiety

What Happens WhenA Person StopsTaking A Drug?

What Happens WhenA Person StopsTaking A Drug?

Chronic use of some of the drugs may alter the way the brain

functions, making persons particularly susceptible to mental

illness

Chronic use of some of the drugs may alter the way the brain

functions, making persons particularly susceptible to mental

illness

Double

People With Comorbid Mental and Addictive DisordersHave a Brain Disease

People With Comorbid Mental and Addictive DisordersHave a Brain DiseaseDoubleDouble

MentalDisorder

MentalDisorder

AddictiveDisorder

AddictiveDisorder

ComorbidDisordersComorbidDisorders

Panic disorderRecurrent panic attacks :• Palpitations• Sweating• Trembling or shaking• Shortness of breath• Feeling of choking • Nausea or abdominal distress• Chest pain

Social phobia

Marked fear of social or performance situations for example:

• Public speaking• Writing, eating, or drinking in public• Initiating or maintaining

conversations

Specific phobia

Marked fear that is excessive

• Flying• Enclosed spaces• Heights• Animals (e.g., snakes or spiders)• Blood

Obsessive-compulsive disorder

Has obsessions or compulsions

• Obsessions are defined as recurrent and persistent thoughts, impulses, or images that are experienced as intrusive and inappropriate

Generalized Anxiety disorder

• Excessive anxiety and worry about a number of events or activities (future oriented), occurring more days than not for at least 6 months

Posttraumatic Stress Disorder • The person has been exposed to a traumatic

event:

• The traumatic event is persistently reexperienced

• Persistent avoidance of stimuli associated with the trauma

• Persistent symptoms of increased arousal

Anxiety disorder Treatment

• SSRIs• TCIs• MAOI• Psychotherapy

Major Depressive DisorderFive of the following ,during 2-week:

• Depressed mood• Diminished interest or pleasure • Decrease or increase in appetite • Insomnia or hypersomnia • Psychomotor agitation or retardation • Fatigue• Feelings of worthlessness or guilt • Diminished ability to think• Recurrent thoughts of death

MDD & Anxiety DisorderTreatment

• SSRIs• TCIs• MAOI• Psychotherapy• ECT

Manic Episode A period of elevated or irritable mood, 1 week:

• Inflated self-esteem or grandiosity • Decreased need for sleep• More talkative than usual• Flight of ideas • Distractibility • Hyperactivity • Excessive involvement in pleasurable activities

Bipolar Mood Disorder Treatment

• Lithium• Anticonvulsants• Antipsychotics• E C T• Psychotherapy

Psychotic Disorder

Delusion Hallucination

• Schizophrenia• Delusional disorder• Schizoaffective disorder

Personality Disorder • A pattern of inner experience and behavior that

deviates from the individual's culture • cognition • affectivity • interpersonal functioning • impulse control

The enduring pattern

The pattern is stable and of long duration

Antisocial Personality Disorder

• Violation of the rights of others• Self-centered, inability to maintain

relationships• Poor sexual adjustment, inability to delay

gratification• Aggressive, impulsive, manipulative• Poor work history

Borderline Personality Disorder

• unstable interpersonal relationships• Impulsive and unpredictable

behaviors• Chronic feelings of emptiness• Extreme shifts in mood and

depression• Self-destructive behaviors

Histrionic Personality disorder

• Overly dramatic, intensively expressive

• Enjoys being the center of attention• Poor interpersonal relationships• Romantic fantasies• uses physical appearance to draw

attention to self

Personality Disorder Treatments Psychotherapy

Pharmacotherapy• Mood stabilizer• Antipsychotics• SSRIs or Other Antidepressants• Beta blockers• NO BZDs Or TCIs

Sexual disorder

• Premature ejaculation

• SSRIs• Clomipramine

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