Ries Non Severe
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Transcript of Ries Non Severe
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Co-occurring Addiction andCo-occurring Addiction andLess SevereLess Severe
Mental DisordersMental Disorders
Richard Ries MDRichard Ries MD
[email protected]@u.washington.eduHarborview Medical CenterHarborview Medical Center
University of WashingtonUniversity of Washington
eattle! Waeattle! Wa
mailto:[email protected]:[email protected]:[email protected] -
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DUAL DIAGNOSIS IS:DUAL DIAGNOSIS IS:
TWO DIAGNOSES/ DISORDERSTWO DIAGNOSES/ DISORDERS
TWO SYSTEMSTWO SYSTEMS
DOUBLE TROUBLEDOUBLE TROUBLE
IN THE EYE OF THE BEHOLDERIN THE EYE OF THE BEHOLDER
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Examples of Dual Dso!"e!s:Examples of Dual Dso!"e!s:
MENTAL DISORDERSMENTAL DISORDERS S#$%op$!e&aS#$%op$!e&a B'pola!B'pola!
S#$%oa(e#)*eS#$%oa(e#)*e Ma+o! Dep!esso&Ma+o! Dep!esso& Bo!"e!l&eBo!"e!l&e
,e!so&al)-,e!so&al)-
,os) T!auma)#,os) T!auma)#S)!essS)!ess So#al ,$o.aSo#al ,$o.a o)$e!so)$e!s
ADDITIONADDITIONDISORDERSDISORDERS
Al#o$olAl#o$ol
A.use/Depe&0A.use/Depe&0
o#a&e/ Amp$e)o#a&e/ Amp$e)
Opa)esOpa)es
Ma!+ua&aMa!+ua&a
,ol-su.s)ae,ol-su.s)ae#om.&a)o&s#om.&a)o&s
,!es#!p)o& "!u1s,!es#!p)o& "!u1s
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Dual Dso!"e!s fo!Dual Dso!"e!s fo!
E*e!-o&e2E*e!-o&e2
If apple" )o all #ases3 Te!m $as &o mea&&1If apple" )o all #ases3 Te!m $as &o mea&&1
4e1 Sp"e! p$o.a a&" 5Ru&&&1 A""#)o&674e1 Sp"e! p$o.a a&" 5Ru&&&1 A""#)o&67
Bo)$ Me&)al a&" A""#)o& Dso!"e!s &ee" )o .eBo)$ Me&)al a&" A""#)o& Dso!"e!s &ee" )o .e
o*e! )$!es$ol"o*e! )$!es$ol"
,e!so&al)- Dso!"e!s3 o)$e! )$a& Bo!"e!l&e &o),e!so&al)- Dso!"e!s3 o)$e! )$a& Bo!"e!l&e &o)
usuall- #ou&)e"usuall- #ou&)e"
Su.s)ae I&"u#e" Dso!"e!s #ause "a1&os)#Su.s)ae I&"u#e" Dso!"e!s #ause "a1&os)#
#o&fusoo&fuso&
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HARATERISTIS OF THE DUAL DIAGNOSISHARATERISTIS OF THE DUAL DIAGNOSIS
LIENT IN 8ING OUNTY9LIENT IN 8ING OUNTY9 Res ;
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S-s)ems ,!o.lemsS-s)ems ,!o.lems
D(e!e&) La=s9#omm)me&)/#o&>"0D(e!e&) La=s9#omm)me&)/#o&>"0
D(e!e&) fu&"&100au")s e)#D(e!e&) fu&"&100au")s e)#
D(e!e&) pe!so&&elD(e!e&) pe!so&&el
D(e!e&) )!a&&1D(e!e&) )!a&&1
D(e!e&) #e!)>#a)o&D(e!e&) #e!)>#a)o& D(e!e&) s)esD(e!e&) s)es
D(e!e&) No!msD(e!e&) No!ms
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T$e Fou! ?ua"!a&) F!ame=o!@ fo!T$e Fou! ?ua"!a&) F!ame=o!@ fo!
o'O##u!!&1 Dso!"e!so'O##u!!&1 Dso!"e!s
A fou!'ua"!a&)A fou!'ua"!a&)#oep)ual f!ame=o!@#oep)ual f!ame=o!@)o 1u"e s-s)ems)o 1u"e s-s)ems&)e1!a)o& a&"&)e1!a)o& a&"
!esou!#e allo#a)o& &!esou!#e allo#a)o& &)!ea)&1 &"*"uals)!ea)&1 &"*"uals=)$ #o'o##u!!&1=)$ #o'o##u!!&1"so!"e!s"so!"e!s4NASMH,D3NASADAD34NASMH,D3NASADAD3
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DOUBLE TROUBLEDOUBLE TROUBLE
Hall 77 Poor out-pt attendance, discontinue RxAlterman 85 More mood changes, intensive staffing olomon 8! More noncompliance, arrests afer 87 "ver t#ice hosp$ rate and criminal %ehav &ra'e 8( More hostilit), noncompliance *ar%ee 8( More ps)ch s)mptoms +)ons 8( More noncompliance, R, ail, rehosp$ .hen (/ 0orse treatment course
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Bu) =$a) a.ou)Bu) =$a) a.ou) NONNON' se*e!el-' se*e!el-
me&)all- ll #o'o##u!!&1 p)s2me&)all- ll #o'o##u!!&1 p)s2 L@e & A""#)o& T!ea)me&) se))&1sL@e & A""#)o& T!ea)me&) se))&1s
L@e & !m&al us)#e se))&1sL@e & !m&al us)#e se))&1s
L@e & ,!ma!- a!e Se))&1sL@e & ,!ma!- a!e Se))&1s
L@e & ERs3 espe#all- =)$ su#"al p)sL@e & ERs3 espe#all- =)$ su#"al p)s
The new TIP will bring more focus onThe new TIP will bring more focus onthese populationsthese populations
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L@el$oo" of a Su#"e A))emp)L@el$oo" of a Su#"e A))emp)
Rs@ Fa#)o!Rs@ Fa#)o!
o#a&e useo#a&e use
Ma+o! Dep!esso&Ma+o! Dep!esso&
Al#o$ol useAl#o$ol use Sepa!a)o& o! D*o!#eSepa!a)o& o! D*o!#e
NIMH/NIDANIMH/NIDA
I!ease" O""s OfI!ease" O""s Of
A))emp)&1A))emp)&1
Su#"eSu#"e
J )mes mo!e l@el-J )mes mo!e l@el-
K )mes mo!e l@el-K )mes mo!e l@el-
; )mes mo!e l@el-; )mes mo!e l@el-
)mes mo!e l@el- )mes mo!e l@el-
EA EALUATIONEA EALUATION
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Double "roubleDouble "rouble::
RELATIONSHI, OF ALOHOL DRUG ,ROBLEMSRELATIONSHI, OF ALOHOL DRUG ,ROBLEMS
TO SEERE SUIIDALITY 4&3
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D!u1 I&"u#e" ,s-#$opa)$olo1-D!u1 I&"u#e" ,s-#$opa)$olo1-
D!u1 S)a)esD!u1 S)a)es W)$"!a=alW)$"!a=al
A#u)eA#u)e
,!o)!a#)e",!o)!a#)e"
I&)ox#a)o&I&)ox#a)o&
$!o Use$!o Use
S-mp)om G!oupsS-mp)om G!oups Dep!esso&Dep!esso& A&xe)-A&xe)-
,s-#$oss,s-#$oss
Ma&aMa&a
Rou&sa*lle
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we ve- on reva ence o - n e&en en oo anwe ve- on reva ence o - n e&en en oo anAn'iety Disorders A(ong Res&ondents with DM-$%An'iety Disorders A(ong Res&ondents with DM-$%
ubstance Use Disorders Who ought "reat(ent in the #astubstance Use Disorders Who ought "reat(ent in the #ast
)* Months)* Months
DisorderDisorder Res&ondents! + ,Res&ondents! + ,"hose With Any Alcohol Use Disorder ,/.0)+1"hose With Any Alcohol Use Disorder ,/.0)+1
A&- moo" "so!"e!A&- moo" "so!"e! 23.4523.45 4K074K07
Ma+o! Dep!esso&Ma+o! Dep!esso& 0P0P 4K074K07
D-s)$-maD-s)$-ma 00 40K740K7
Ma&aMa&a 0PJ0PJ 40;740;7H-poma&aH-poma&a 00 407407
A&- a&xe)- "so!"e!A&- a&xe)- "so!"e! 66.6066.60 4K074K07
,a "so!"e!,a "so!"e!
W)$ a1o!ap$o.aW)$ a1o!ap$o.a K0K0 40PK740PK7
W)$ou) a1o!ap$o.aW)$ou) a1o!ap$o.a
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we ve- on reva ence o - n e&en en oo anwe ve- on reva ence o - n e&en en oo anAn'iety Disorders A(ong Res&ondents with DM-$%An'iety Disorders A(ong Res&ondents with DM-$%
ubstance Use Disorders Who ought "reat(ent in the #astubstance Use Disorders Who ought "reat(ent in the #ast
)* Months)* Months
DisorderDisorder Res&ondents! + ,Res&ondents! + ,"hose With Any Drug Use Disorder ,)6.)3+1"hose With Any Drug Use Disorder ,)6.)3+1
A&- moo" "so!"e!A&- moo" "so!"e! 43.6)43.6) 4P0;J74P0;J7
Ma+o! Dep!esso&Ma+o! Dep!esso& KK0JKK0J 4J0;74J0;7
D-s)$-maD-s)$-ma P0
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4! of social
an"iety disorder
patients havepanic disorder##
$%! to &$! of panic disorder
patients have depression'
((! of social
an"iety disorder
patients have )CD##
&*! of )CD
patients have
depression#
*%! of social an"iety
disorder patients havedepression
o(or y oyDe&ression and An'ietyDe&ression and An'iety
DisordersDisorders
Depression
)CD
Social
+n"iety
Disorder
Panic
Disorder
H,-HL.
C)MM)0
H,-HL.
C)M)12,D
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Diagnostic Criteria forDiagnostic Criteria for
#anic Attac7#anic Attac7
Palpitations3 pounding
heart
Sweating rembling or sha5ing
+dapted with permission from +merican Psychiatric +ssociation6 Diagnostic and Statistical
Manual of Mental Disorders, 4th ed6 (46
+ discreet period of intense fear or discomfortin which 4 or more of the following symptoms
developed abruptly and reached a pea5 within
(% minutes7
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Diagnostic Criteria forDiagnostic Criteria for
#anic Attac7 Continued#anic Attac7 Continued Di88iness Chills or hot flushes
9eelings of unreality 9ear of losing
control or goingcra8y
9ear of dying Paresthesias
Cho5ing feeling
Smothering or
shortness of breath Chest pain or
discomfort
+bdominal distress
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9atigue
-astro:intestinal
Symptoms
S)M+,C
S.MP)MS
Headache
Chest Pain
Di88iness
o(atic y(&to(s $no(aticy(&to(s $n
#anic Disorder#anic Disorder
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8uality of 9ife in #anic Disorder8uality of 9ife in #anic Disorder
!
Mar'o#it6 et al$Arch Gen Psychiatry. (8(4!9(84$
Marital Discord
;past < wee5s=
>se )f ?1
;past year=9inancial
Dependence
;welfare ordisability=
i
i
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American Ps)chiatric Association$ &iagnostic and tatistical Manual of Mental &isorders,4th ed$ ((4$
DM-$% DiagnosticDM-$% Diagnostic
Criteria for #"DCriteria for #"D
?"posure to a traumatic event in which?"posure to a traumatic event in which
the person7the person7
e"perienced3 witnessed3 or wase"perienced3 witnessed3 or was
confronted by death or serious in@ury toconfronted by death or serious in@ury toself or othersself or others
+D+D
responded with intense fear3responded with intense fear3helplessness3helplessness3
or horroror horror
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DM-$% DiagnosticDM-$% Diagnostic
Criteria for #"DCriteria for #"D
ContinuedContinued SymptomsSymptoms
appear in A symptom clusters7 re:appear in A symptom clusters7 re:
e"periencing3 avoidance/numbing3e"periencing3 avoidance/numbing3
hyperarousalhyperarousal
last for B ( monthlast for B ( month
cause clinically significant distress orcause clinically significant distress orimpairment in functioningimpairment in functioning
i i i iDM $% Di
i C i i
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DM-$% Diagnostic CriteriaDM-$% Diagnostic Criteria
for #"D Re-e'&eriencingfor #"D Re-e'&eriencing
Persistent re:e"periencing ofPersistent re:e"periencing of ( of the following7( of the following7
recurrent distressing recollections of eventrecurrent distressing recollections of event
recurrent distressing dreams of eventrecurrent distressing dreams of event acting or feeling event was recurringacting or feeling event was recurring
psychological distress at cues resembling eventpsychological distress at cues resembling event
physiological reactivity to cues resemblingphysiological reactivity to cues resemblingeventevent
i i C i i f
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DM-$% Diagnostic Criteria forDM-$% Diagnostic Criteria for
#"D Avoidance:;u(bing#"D Avoidance:;u(bing
+voidance of stimuli and numbing of general+voidance of stimuli and numbing of generalresponsiveness indicated byresponsiveness indicated by A of the following7A of the following7 avoid thoughts3 feelings3 or conversations#avoid thoughts3 feelings3 or conversations# avoid activities3 places3 or people#avoid activities3 places3 or people# inability to recall part of traumainability to recall part of trauma
interest in activitiesinterest in activities
estrangement from othersestrangement from others restricted range of affectrestricted range of affect sense of foreshortened futuresense of foreshortened future
DM $% Di tiDM $% D
i ti
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American Ps)chiatric Association$ &iagnostic and tatistical Manual of Mental &isorders, 4th
ed$ ((4$
DM-$% DiagnosticDM-$% Diagnostic
Criteria for #"DCriteria for #"D
Hy&erarousalHy&erarousal Persistent symptoms of increased arousalPersistent symptoms of increased arousal
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#revalence of "rau(a and#revalence of "rau(a and
#robability of #"D#robability of #"D
0itness Accident :hreat #;
0eapon
Ph)sical
Attac'
Molestation .om%at Rape
(
$
:his pilot stud) suggests that paroxetine is an effective treatment for social anxiet) disorder in
individuals #ith comor%id alcohol pro%lems, and positive treatment effects can %e seen in as
little as 8 #ee's$ Further stud) is #arranted to investigate its utilit) in helping affected
individuals reduce alcohol use$ .op)right /33 0ile)-+iss, Cnc$
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Display&dopt=pubmed_pubmed&from_uid=11754136http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Display&dopt=pubmed_pubmed&from_uid=11754136http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Display&dopt=pubmed_pubmed&from_uid=11754136 -
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W$- a!e&) A&)"ep!essa&)s mo!eW$- a!e&) A&)"ep!essa&)s mo!e
e(e#)*e & a""#)o&s pa)e&)s2e(e#)*e & a""#)o&s pa)e&)s2
,s-#$a)!# ou)#omes:,s-#$a)!# ou)#omes: A&)"ep!essa&)s o&l- .ea) pla#e.o .- a&-=a- &A&)"ep!essa&)s o&l- .ea) pla#e.o .- a&-=a- &
NON a""#)sNON a""#)s
S)u"- pa)e&)s also 1e) 5a""#)o& !x6S)u"- pa)e&)s also 1e) 5a""#)o& !x6 Ma-.e a""#)o& !x s mo!e a&)'"ep3 a&) a&x )$a& =eMa-.e a""#)o& !x s mo!e a&)'"ep3 a&) a&x )$a& =e
)$&@9*% S#$u#@) ; ' )$&@9*% S#$u#@) ; ' T$s s poo!l- s)u"e"9ma-.e .e))e! =)$ s)epT$s s poo!l- s)u"e"9ma-.e .e))e! =)$ s)ep Su. I&"u#e" #!)e!a a!e =!o&1Su. I&"u#e" #!)e!a a!e =!o&1
A""#)o&s ou)#omesA""#)o&s ou)#omes Me"s )a@e fo#us o( so.!e)-Me"s )a@e fo#us o( so.!e)- Me"s !e&fo!#e so.!e)-Me"s !e&fo!#e so.!e)- us) "o&) =o!@ fo! )$sus) "o&) =o!@ fo! )$s
Al#o$ol l& Exp Res0 Fe.CP47:'Al#o$ol l& Exp Res0 Fe.CP47:'
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#o o p es e.C P4 7 p C 4 7
00
Concurrent alcoholism and social an"iety disorder7 a first step toward
developing effective treatments6
1andall CL3 homas S3 hevos +K6
:he present stud) investigated #hether simultaneous treatment of social pho%ia and alcoholism, compared
#ith treatment of alcoholism alone, improved alcohol use and social anxiet) for clients #ith dual diagnoses
of social anxiet) disorder and alcohol dependence$
M:H"&9 :he design #as a t#o-group, randomi6ed clinical trial that used / #ee's of individual
cognitive %ehavioral therap) for alcoholism onl) =n B 44> or concurrent treatment for %oth alcohol and social
anxiet) pro%lems =n B 4(>$ "utcome data #ere collected at the end of / #ee's of treatment and at 9((-35$Related Articles,+in's
+ cognitive:behavioral treatment for incarcerated women with
substance abuse disorder and posttraumatic stress disorder7 findings
from a pilot study6
lotnic5 C3 a@avits LM3 1ohsenow DI3 Iohnson DM6
:his preliminar) stud) evaluates the initial efficac) of a cognitive-%ehavioral treatment,
ee'ing afet), as an adunct to treatment-as-usual in an uncontrolled pilot stud) of
incarcerated #omen #ith current J& and comor%id P:&$
"f the 7 incarcerated #omen #ith P:& and J& #ho received ee'ing afet) treatmentand had outcome data,
results sho# that nine ;$A!= no longer met criteria for PSD at the end of
treatmentN at a followup A months later3 seven ;4&!= still no longer met criteria
for PSD
Additionall), there #as a significant decrease in P:& s)mptoms from inta'e to posttreatment,#hich #as maintained at the
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a& eou!a1&1 su.s)ae a.use pa)e&)s )oa& eou!a1&1 su.s)ae a.use pa)e&)s )o
pa!)#pa)e & self'$elp 1!oups !e"u#e "ema&" fo!pa!)#pa)e & self'$elp 1!oups !e"u#e "ema&" fo!
$eal)$ #a!e2$eal)$ #a!e2
A uas'expe!me&)al s)u"-A uas'expe!me&)al s)u"-
&K3 -ea! follo='up&K3 -ea! follo='up Hump$!e-s e) al 00Hump$!e-s e) al 00
Ou)p) I&p) "a-s A.s)&eeOu)p) I&p) "a-s A.s)&ee
s)ss)s Ra)es Ra)es
S)ep 0 0P KP0 S)ep 0 0P KP0
o1 Be$ J0o1 Be$ J0
Q all p 0 QQ JK $1$e! #os) fo! BTQ all p 0 QQ JK $1$e! #os) fo! BT
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Dual S#!ee&&1:Dual S#!ee&&1:
)$e 5Dual a1e6999990eas-3 .u) &o "a)a)$e 5Dual a1e6999990eas-3 .u) &o "a)a
ASAM p) pla#eme&)99900&ee"s expe!ee3 l))le o! &oASAM p) pla#eme&)99900&ee"s expe!ee3 l))le o! &o
"a)a"a)a
ASI ps-#$999999990s$o!)3 a*ala.le3 1oo" s#!ee&&13ASI ps-#$999999990s$o!)3 a*ala.le3 1oo" s#!ee&&131oo" "a)a1oo" "a)a
Be#@3 u&13 Ham D e)#900eas-3 1oo" "a)a3 ma- .e lm)e"Be#@3 u&13 Ham D e)#900eas-3 1oo" "a)a3 ma- .e lm)e"
B!ef S-mp)om I&*e&)o!-9eas-3 .!oa" s-mp)om mxB!ef S-mp)om I&*e&)o!-9eas-3 .!oa" s-mp)om mx
O)$e!s99999999999see &e= o'o##u!!&1 TI, & 'O)$e!s99999999999see &e= o'o##u!!&1 TI, & '
KK
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55Dual AGE6 ?UESTIONSDual AGE6 ?UESTIONS
u) Do=& 4o! s)oppe"7u) Do=& 4o! s)oppe"7 Be#ause me&)al s-mp)oms =o!se&e"Be#ause me&)al s-mp)oms =o!se&e"
Be#ause MH "o#)o! o! )$e!aps) su11es)e"Be#ause MH "o#)o! o! )$e!aps) su11es)e"
A&&o-e" =$e& "!u1/al#0 use "s#usse"A&&o-e" =$e& "!u1/al#0 use "s#usse" A&&o-e"3 a&xous o! a&1!-39 >1$)s =$e& us&1A&&o-e"3 a&xous o! a&1!-39 >1$)s =$e& us&1
A"m))e" )o ER o! $osp)al fo! ps-#$ =$e& us&1 o! &o)A"m))e" )o ER o! $osp)al fo! ps-#$ =$e& us&1 o! &o)
ADHD =$e& #$l"ADHD =$e& #$l"
Gul)- a.ou) useGul)- a.ou) use Gul)-3 "ep!esse"3 su#"al =$e& us&1 o! &o)Gul)-3 "ep!esse"3 su#"al =$e& us&1 o! &o)
E*e! ma"e a su#"e a))emp) =$e& us&1 o! &o)E*e! ma"e a su#"e a))emp) =$e& us&1 o! &o)
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AGE ?ues)o&sAGE ?ues)o&s
E-e ope&e!: )a@e& "!&@ o! "!u1 & AM )o feelE-e ope&e!: )a@e& "!&@ o! "!u1 & AM )o feel.e))e!.e))e!Ta@e& a "!&@ o! "!u1 )o .lo) ou) s-mp)omsTa@e& a "!&@ o! "!u1 )o .lo) ou) s-mp)omsTa@e& "!&@ o! "!u1 =)$ ps-#$ me"Ta@e& "!&@ o! "!u1 =)$ ps-#$ me" No) )a@e& me"s .e#ause of us&1 "!u1/al#No) )a@e& me"s .e#ause of us&1 "!u1/al#
4fo!1o)3 a*o" mx&13 e)#074fo!1o)3 a*o" mx&13 e)#07
W$a) a!e o! !easo&s -ou use al#/"!u1s2W$a) a!e o! !easo&s -ou use al#/"!u1s2 W$a) a!e o! !easo&s -ou m1$) =a&) )oW$a) a!e o! !easo&s -ou m1$) =a&) )o
s)op o! #u) "o=&2s)op o! #u) "o=&2
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Me"#a)o&sMe"#a)o&s
Esse&)al )o T!ea)me&) of Se*e!el-Esse&)al )o T!ea)me&) of Se*e!el-
Me&)all- IllMe&)all- Ill
Su.s)ae Use a&" No)'Ta@&1 Me"s a!e )$e Su.s)ae Use a&" No)'Ta@&1 Me"s a!e )$e )op !easo&s fo! De'omp)op !easo&s fo! De'omp
S$oul" .e pa!) of #ou!) o!"e!sS$oul" .e pa!) of #ou!) o!"e!s
Mo&)o!e" .- ase ma&a1e!s3 &u!ses3 "o#)o!sMo&)o!e" .- ase ma&a1e!s3 &u!ses3 "o#)o!s
Fo! Dep/A&x3 less #lea!Fo! Dep/A&x3 less #lea! ,e!so&al expe!ee s$o=s maxm%&1 s)ep,e!so&al expe!ee s$o=s maxm%&1 s)ep
AND use of me"s s .es) !xAND use of me"s s .es) !x
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I) ma-I) ma- &o)&o).e )$a) )$e me"4s7.e )$a) )$e me"4s7
s)oppe" =o!@&13 .u)99s)oppe" =o!@&13 .u)99
T$e pa)e&) s)oppe" )$e me"T$e pa)e&) s)oppe" )$e me"
T$e pa)e&) s)oppe" )$e me" AND use"T$e pa)e&) s)oppe" )$e me" AND use"
"!u1s a&"/o! al#o$ol9000"!u1s a&"/o! al#o$ol9000 OR lo=e!e" )$e me" a&" use"9OR lo=e!e" )$e me" a&" use"9
OR use" o& )op of )$e me"90OR use" o& )op of )$e me"90
OR use" )=#e )$e "ose o& o&e "a- a&"OR use" )=#e )$e "ose o& o&e "a- a&"&o)$&1 )$e &ex)90&o)$&1 )$e &ex)90
S)mula&)s 4 #o#a&e/amp$e)s7 a!e mos)S)mula&)s 4 #o#a&e/amp$e)s7 a!e mos)
MSE "es)!u#)*e0MSE "es)!u#)*e0
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Ho= )o use AA as a )!ea)me&)Ho= )o use AA as a )!ea)me&)
pa!)&e!pa!)&e!
0 8&o= some)$&1 a.ou) AA3 )s $s)o!-30 8&o= some)$&1 a.ou) AA3 )s $s)o!-3p!esee & -ou! #ommu&)-3 s)!u#)u!e a&"p!esee & -ou! #ommu&)-3 s)!u#)u!e a&"#o&)e&)#o&)e&)
0 Helpful Rea"&1s:0 Helpful Rea"&1s: B!o=&: A ps-#$olo1#al *e= of )$e s)epsB!o=&: A ps-#$olo1#al *e= of )$e s)eps AA:AA: AA fo! )$e me"#al p!a#))o&e!AA fo! )$e me"#al p!a#))o&e!C a&"C a&"
T$e AA mem.e! a&" me"#a)o&sT$e AA mem.e! a&" me"#a)o&s T=el*e S)ep Fa#l)a)o& T$e!ap- Ma&ual'T=el*e S)ep Fa#l)a)o& T$e!ap- Ma&ual'
,!o+e#) Ma)#$3 NIAAA =e. s)e,!o+e#) Ma)#$3 NIAAA =e. s)e Fo!ma&: 5O&e AA Me)&1 "oes&) >) all6Fo!ma&: 5O&e AA Me)&1 "oes&) >) all6
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)ne year +2S,?C? was predicted by9
AA involvement ="RB/$(>, = nB
not having pro-drin'ing influences in oneLs net#or' ="RB3$7
having support for reducing consumption from people met
in AA =versus no support "RB$
,n contrast3 having support from non:++ members was
not a significant predictor of abstinence6
?as'utas9 Addiction /33/
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Dou.le T!ou.le Re#o*e!- 4DTR7Dou.le T!ou.le Re#o*e!- 4DTR7
Ou)#omesOu)#omes
Mem.e!s of K DTR 1!oups 4&K7 Ne= Yo!@ )-3Mem.e!s of K DTR 1!oups 4&K7 Ne= Yo!@ )-3 -ea! ou)#omes -ea! ou)#omes
D!u1/al#o$ol a.s)&ee PK a) .asel&e3D!u1/al#o$ol a.s)&ee PK a) .asel&e3!ease" )o a) follo='up0!ease" )o a) follo='up0
Mo!e a))e&"ae .e))e! Me"#a)o& a"$e!ee3Mo!e a))e&"ae .e))e! Me"#a)o& a"$e!ee3
Be))e! Me"#a)o& a"$e!ee less $osp)al%a)o&Be))e! Me"#a)o& a"$e!ee less $osp)al%a)o&
Ma1u!a A"" Be$ 3 ,s-#$ Se!* Ma1u!a A"" Be$ 3 ,s-#$ Se!*
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Dual Dep/A&x RV pla&Dual Dep/A&x RV pla&
D(e!e&)al DxD(e!e&)al Dx s)ep fa#l)a)o& s)ep fa#l)a)o&
Me"s f &"#a)e" 4 a&" I of)e& use )$em7Me"s f &"#a)e" 4 a&" I of)e& use )$em7 s)s:s)s:
Res /=ee@ 4 s)ep fa#l a&" me"s7Res /=ee@ 4 s)ep fa#l a&" me"s7 AA x =ee@ o!
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Lo= me&)al ll&ess/H1$ a""#)o&s ou)p)Lo= me&)al ll&ess/H1$ a""#)o&s ou)p)
1e)s1e)s
Cn most MH.s9Cn most MH.s9 M& visit I < monthsM& visit I < months .M visit I / #'sfocus on A&+s.M visit I / #'sfocus on A&+s Ma)%e dual dx group -/ hrs;#'Ma)%e dual dx group -/ hrs;#' +imited expectations of recover)+imited expectations of recover) Pschotherap) time N 3-/ hrs #ee'Pschotherap) time N 3-/ hrs #ee'
Cn the most Addictions C"PsCn the most Addictions C"Ps M& visit ; < months, often careM& visit ; < months, often care .M 9 I / #'s$focus on u% use, J toxs.M 9 I / #'s$focus on u% use, J toxs C"P group < hrs-
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Report Questions Ability of National Treatment Infrastructure to Deliver Quality Care
301-405-9770 (voice) 301-403-8342 (fax) [email protected]!.e!u """.cesar.u!.e!u
CESAR #A$ is su%%or&e! ' *+, 199-1002 a"ar!e! ' &/e .S. e%ar&e& of us&ice &/rou/ &/e overor6s *ffice of Crie Co&ro a! reve&io. CESAR
Percentage
of Programs
Closed or Stopped
Services
Reorganized Director in
Position Less Than
One ear
!o "nformation
Services# $%mail#
or &oicemail
09
209
409
-09
809
1009
1'(
2'(
'4(
2)(
S*RCE: A!a%&e! ' CESAR fro &/e ;c
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Ne= Issues & Me"#a)o&s fo!Ne= Issues & Me"#a)o&s fo!
o'o##u!!&1 A""#)o& a&"o'o##u!!&1 A""#)o& a&"
Me&)al Dso!"e!sMe&)al Dso!"e!s
R#$a!" Res MDR#$a!" Res MD
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Me"#a)o& mo&)o!&1 a&"Me"#a)o& mo&)o!&1 a&"
mo)*a)&1mo)*a)&1
?no# #ho is on #hat and #hat for?no# #ho is on #hat and #hat for
?no# the prescri%er if possi%le?no# the prescri%er if possi%le
it in on med sessions onsiteit in on med sessions onsite :al' to off-site doctor or nurse:al' to off-site doctor or nurse P1? problemOOOP1? problemOOO
?no# something a%out meds?no# something a%out meds
A::. :ech transfer centers summar)A::. :ech transfer centers summar) @e# ."& :CP = &ec 34>@e# ."& :CP = &ec 34> @CMH #e% site, @AMC #e% site@CMH #e% site, @AMC #e% site
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Me"#a)o&s: #ou&selo!sMe"#a)o&s: #ou&selo!s
!ole!ole As' the pt a%out 9As' the pt a%out 9
.ompliance.ompliance OOsometimes people forget their medicationsho# often does thissometimes people forget their medicationsho# often does this
happen to )ouQ ie D not ta'inghappen to )ouQ ie D not ta'ing
ffectivenessffectiveness OOho# #ell do )ou thin' the meds are #or'ingho# #ell do )ou thin' the meds are #or'ing #hat do )ou notice#hat do )ou notice here is #hat C noticehere is #hat C notice
ide ffects$ide ffects$ OO are )ou having an) side effects to the medicationare )ou having an) side effects to the medication #hat are the)#hat are the) have )ou told the prescri%erhave )ou told the prescri%er do )ou need help #ith tal'ing to the presci%erdo )ou need help #ith tal'ing to the presci%er
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Me"#a)o&s90po)e&)alMe"#a)o&s90po)e&)al
p!o.lemsp!o.lems
a& !e&fo!#e a""#)o& "e&al f !e#o*e!- s &o)a& !e&fo!#e a""#)o& "e&al f !e#o*e!- s &o)&)e1!a)e" a&" suppo!)e"9esp .- )$e&)e1!a)e" a&" suppo!)e"9esp .- )$ep!es#!.e!004 so =o!@ =)$ )$em7p!es#!.e!004 so =o!@ =)$ )$em7
a& .e expe&s*e3 #ause s"e e(e#)s3 #oul" .ea& .e expe&s*e3 #ause s"e e(e#)s3 #oul" .euse" & o*e!"ose0use" & o*e!"ose0 Eum.e! )$e p) =)$ see&1 MD3 o! me&)alEum.e! )$e p) =)$ see&1 MD3 o! me&)al
$eal)$ s-s)em3 #os)3 #o&*e&ee e)#90e ma@e$eal)$ s-s)em3 #os)3 #o&*e&ee e)#90e ma@esu!e )$e- a!e !eall- &e#essa!-0su!e )$e- a!e !eall- &e#essa!-0
A#)*e pa!)#pa)o& & !e#o*e!- #a& .e .o)$A#)*e pa!)#pa)o& & !e#o*e!- #a& .e .o)$a&)"ep a&" a&)a&x9.u) f )$ese p!o.lemsa&)"ep a&" a&)a&x9.u) f )$ese p!o.lems#o&)&ue3 o! "s!up) !e#o*e!-3 me"s s$oul" .e#o&)&ue3 o! "s!up) !e#o*e!-3 me"s s$oul" .e#o&s"e!e"#o&s"e!e"
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A&)ps-#$o)#sA&)ps-#$o)#s
Al#o$ol l& Exp Res KAl#o$ol l& Exp Res K
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Al#o$ol l& Exp Res0 KAl#o$ol l& Exp Res0 KMa-C;4P7:J'KP0Ma-C;4P7:J'KP0
+ double:blind3 placebo:controlled study of olan8apine in the
treatment of alcohol:dependence disorder6
-uardia I3 Segura L3 -on8alvo 23 ,glesias L3 1oncero C3 Cardus M3 Casas M6
M:H"&9 A total of !3 alcohol-dependent patients #ere assigned to / #ee'sL treatment
#ith either olan6apine or place%o$ :he primar) varia%le relapse to heav) drin'ing rate #as
evaluated %) means of intention-to-treat anal)ses$ Alcohol consumption, craving, adverse
events, and changes in the %iochemical mar'ers of heav) drin'ing and possi%le toxicit) #erealso evaluated$
RJ+:9 0e did not find significant differences in the survival anal)sis %et#een place%o and
olan6apine-treated patients =?aplan-Meier log ran' B 3$4!, df B , p B 3$53>$ leven =
patients treated #ith olan6apine relapsed compared #ith ( =/(D> of those receiving place%o
=chi B 3$5$ Although some adverse events =#eight gain, increased appetite,
dro#siness, constipation, and dr) mouth> #ere found more freIuentl) in the olan6apine group,differences did not reach statistical significance in comparison #ith the place%o group$
."@.+JC"@9 Ge found no differences in relapse rate or other drin5ing variables
when comparing olan8apine with placebo:treated patients6
l& ,s-#$op$a!ma#ol0 l& ,s-#$op$a!ma#ol0
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- pFe.C47: and su%stance use disorder$ "f these 58 patients, 4< #ere
%eing treated #ith clo6apine at the time of the surve) the remaining 5 patients had
discontinued clo6apine %efore the surve)$
More than J$! of the patients who were active substance users at the time of
initiation of treatment with clo8apine decreased their substance use over the
course of clo8apine administration$For patients #ho continued treatment #ith
clo6apine up to the present, the decrease in su%stance use #as strongl) correlated
#ith a decrease in glo%al clinical s)mptoms$
S#$%op$! Res0 K Fe. CJJ4'7:P'P0S#$%op$! Res0 K Fe. CJJ4'7:P'P0
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9irst episode schi8ophrenia:related psychosis and substance use disorders7
acute response to olan8apine and haloperidol6
-reen +,3 ohen M93 Hamer 1M3 Stra5ows5i SM3 Lieberman I+3 -lic5 ,3 Clar5 GSN H-DH 1esearch -roup6
M:H"&9 :he stud) involved /!/ patients$ Patients #ith a histor) of su%stance
dependence #ithin month prior to entr) #ere excluded$
RJ+:9 "f this sample, (7 = had a lifetime diagnosis of su%stance use disorder
=J&> of these 74 =/8D of the total> had a lifetime canna%is use disorder =.J&> and 54 =/D> had
a lifetime diagnosis of alcohol use disorder =AJ&>$
hose with C>D had a lower age of onset than those without6Patients with S>D were more li5ely to be men6Patients with S>D had more positive symptoms and fewer negative symptoms than
those without S>D3 and they had a longer duration of untreated psychosis6he (D6Patients with +>D were less li5ely to respond to olan8apine than those without +>D6
&C.JC"@9 :hese data suggest that first-episode patients are Iuite li'el) to have comor%id
su%stance use disorders, and that the presence of these disorders ma) negativel) influence
response to antips)chotic medications, %oth t)pical and at)pical antips)chotics, over the first /
#ee's of treatment$
p 4 7p
*ipolar &isord$ /33/&ec4=!>943!-
Related Articles,+in's
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Display&dopt=pubmed_pubmed&from_uid=12519101http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Display&dopt=pubmed_pubmed&from_uid=12519101 -
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&ec4=!>943!-$
uetiapine in bipolar disorder and cocaine dependence6
2rown ?S3 e@te5 +3 Perantie DC3 2obadilla L6
M:H"&9 "pen-la%el, add-on, Iuetiapine therap) #as examined for / #ee's in 7
outpatients #ith %ipolar disorder and cocaine dependence$ u%ects #ere evaluated #ith a
structured clinical intervie# Hamilton &epression Rating =H&R>, Eoung Mania Rating
=EMR>, *rief Ps)chiatric Rating =*PR> scales and .ocaine .raving uestionnaire =..>$
Jrine samples and self-reported drug use #ere also o%tained$ &ata #ere anal)6ed using a last
o%servation carried for#ard method on all su%ects given medication at %aseline$
RJ+:9
Significant improvement from baseline to e"it was observed in HD1S3 .M1S3 2P1S and
CC scores ;p or %6%$=6
Dollars spent on cocaine and days/wee5 of cocaine use decreased non:significantly3
and urine drug screens did not change significantly from baseline to e"it6
uetiapine #as #ell tolerated, #ith no su%ects to our 'no#ledge discontinuing %ecause of
side-effects$ ."@.+JC"@9 :he use of Iuetiapine #as associated #ith su%stantial
improvement in ps)chiatric s)mptoms and cocaine cravings$ :he findings are promising and
suggest larger controlled trials of Iuetiapine are needed in this population$
S#$%op$! Res0 Ma!S#$%op$! Res0 Ma!
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CJ47:;'P0CJ47:;'P0
+lcohol and cannabis use in schi8ophrenia7 effects of clo8apine vs6risperidone6
-reen +,3 2urgess ?S3 Dawson 13 immet S3 Strous 1D6
M:H"&9 :his stud) involved retrospective assessment of a%stinence
=cessation of alcohol and canna%is use> in 4 patients treated #ith either
risperidone =nB8> or clo6apine =nB
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Eu! ,$a!ma#ol0Eu! ,$a!ma#ol0
Ma- Ma-, %ut long-lasting #hen the dose #as increased to $3
mg;'g that also %loc's dopamine &=/> receptors$
.an 2 Ps)chiatr)$ /33/ep47=7>9!7 5
Related Articles,+in's
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ep47=7>9!7-5$
1isperidone decreases craving and relapses in individuals withschi8ophrenia and cocaine dependence6
Smelson D+3 Losonc8y M93 Davis CG3 Kaune M3 Gilliams I3 iedonis D6
"*2.:CK9 :o examine the efficac) of at)pical neuroleptics for decreasing craving and drug relapses
during protracted #ithdra#al in individuals duall) diagnosed #ith schi6ophrenia and cocaine dependence$
M:H"&9 0e conducted a !-#ee', open-la%el pilot stud) comparing risperidone #ith t)pical neuroleptics
in a sample of #ithdra#n cocaine-dependent schi6ophrenia patients$
RJ+:9 Preliminary results suggest that individuals treated with risperidone had significantly
less cue:elicited craving and substance abuse relapses at study completion6 9urther3 they showed a
trend toward a greater reduction in negative and global symptoms of schi8ophrenia$
."@.+JC"@9 At)pical neuroleptics ma) help reduce craving and relapses in this population$ Futureresearch should include more rigorous dou%le-%lind place%o-controlled studies #ith this class of
medications$
C bid b t Ab A i t dCo(orbid ubstance Abuse Associated
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Co(orbid ubstance Abuse AssociatedCo(orbid ubstance Abuse Associated
With ;onco(&liance in chi>o&hreniaWith ;onco(&liance in chi>o&hrenia
Nea!l- $alf of all pa)e&)s &Nea!l- $alf of all pa)e&)s &
a p!ospe#)*e K'-ea! s)u"-a p!ospe#)*e K'-ea! s)u"-
4N
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I) ma- &o) .e )$a) )$eI) ma- &o) .e )$a) )$e
me"4s7 s)oppe" =o!@&13me"4s7 s)oppe" =o!@&13
.u)99.u)99T$e pa)e&) s)oppe" )$e me"T$e pa)e&) s)oppe" )$e me"T$e pa)e&) s)oppe" )$e me" AND use"T$e pa)e&) s)oppe" )$e me" AND use"
"!u1s a&"/o! al#o$ol9000"!u1s a&"/o! al#o$ol9000
OR lo=e!e" )$e me" a&" use"9OR lo=e!e" )$e me" a&" use"9 OR use" o& )op of )$e me"90OR use" o& )op of )$e me"90
OR use" )=#e )$e "ose o& o&e "a- a&"OR use" )=#e )$e "ose o& o&e "a- a&"
&o)$&1 )$e &ex)90&o)$&1 )$e &ex)90 S)mula&)s 4 #o#a&e/amp$e)s7 a!e mos)S)mula&)s 4 #o#a&e/amp$e)s7 a!e mos)
MSE "es)!u#)*e0MSE "es)!u#)*e0
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RIS,ERDALRIS,ERDALONSTAONSTAXX
I&+e#)o& 8) ompo&e&)sI&+e#)o& 8) ompo&e&)seedle Proeedle ProQQDeviceDevice
Safety eedleSafety eedleSmartSiteSmartSiteSS
+ccess+ccess
DeviceDevice
1isperidone1isperidone
MicrospheresMicrospheres
+Rueous+Rueous
DiluentDiluent
+ssembled+ssembled
1,SP?1D+L1,SP?1D+LQQC)S+C)S+
PR. approved #ith
changes9 ;3;3
PR. approved #ith
changes9 ;3;3$ "nthe %asis of this list, a consecutive series of !8 patients #ith 74 episodes of acute mania #ho
had %een referred for routine treatment #ere retrospectivel) assessed to determine their
eligi%ilit) for a h)pothetical %ut representative randomised controlled trial$
RJ+:9 )nly (&! of the manic episodes would Rualify for the hypothetical trial ;male
episodes
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Sp!&1C47:K'PSp!&1C47:K P
he differential effects of medication on mood3 sleep disturbance3 and
wor5 ability in outpatient alcohol deto"ification6
Malcolm 13 Myric5 H3 1oberts I3 Gang G3 +nton 196
A dou%le-%lind, randomi6ed controlled trial of patients =n B meeting &M-CK
criteria for alcohol #ithdra#al and stratified %ased on detoxification histor) #ere
treated #ith carbama8epine or lora8epamfor 5 da)s on a fixed dose taperingschedule$ Mood s)mptoms improved for all su%ects regardless of medication or
detoxification histor)$
main effect favoring carbama8epine in reducing an"iety ;p %6%%%*=6
main effect of medication on sleep that again favored carbama8epine ;p
%6%(J&=6
Cn this stud) of outpatients #ith mild to moderate alcohol #ithdra#al,
car%ama6epine #as superior to lora6epam in reducing anxiet) and improving sleep$
Al#o$ol l& Exp Res Al#o$ol l& Exp Res
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Al#o$ol l& Exp Res Al#o$ol l& Exp Res
SepCP4
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Changes in use of valproate and other mood stabili8ers for patients
with schi8ophrenia from (4 to (J6
Citrome L3 Levine I3 +llingham 26
M:H"&9 For each calendar )ear from ((4 through ((8, data #ere dra#n from
a data%ase containing clinical and drug prescription information for ever) inpatient in
the adult civil facilities of the @e# Eor' tate "ffice of Mental Health$
RJ+:9 Cn ((4 a total of /!$/ percent of inpatients diagnosed as having
schi6ophrenia received a mood sta%ili6er, compared #ith 4
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+d@unctive divalproe" and hostility among patients with
schi8ophrenia receiving olan8apine or risperidone6Citrome L3 Casey D?3 Daniel D-3 Go8nia5 P3 Kochan LD3 racy K+6
M:H"&9 A total of /4( inpatients #ith schi6ophrenia #ere randoml) assigned,
RJ+:9 .om%ination treatment #ith risperidone or olan6apine plus divalproex
#as associated #ith different scores on the hostilit) item of the PA@ compared
#ith antips)chotic monotherap)$
his result was not seen beyond the first wee5 of treatment3 but there was a
trend toward a difference in effect for the entire treatment period6Combination therapy had a significantly greater antihostility effect at days A
and * than monotherapy6he effect on hostility appears to be statistically independent of
antipsychotic effect on other P+SS items reflecting delusional thin5ing3a formal thought disorder3 or hallucinations6
."@.+JC"@9 &ivalproex sodium ma) %e useful as an adunctive agent in
specificall) reducing hostilit) in the first #ee' of treatment #ith risperidone or
olan6apine among patients #ith schi6ophrenia experiencing an acute ps)chotic
episode$
l& ,s-#$op$a!ma#ol0 l& ,s-#$op$a!ma#ol0 Fe.C47:'J0Fe.C47:'J0
Rela)e" A!)#les3Rela)e" A!)#les3L&@sL&@s
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Display&dopt=pubmed_pubmed&from_uid=11199943http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Display&dopt=pubmed_pubmed&from_uid=11199943http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=pubmed&cmd=Display&dopt=pubmed_pubmed&from_uid=11199943 -
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Divalproe" sodium augmentation of haloperidol in hospitali8ed
patients with schi8ophrenia7 clinical and economic implications6Gassef ++3 Hafi8 -3 Hampton D3 Molloy M6
&ivalproex sodium has %een approved for use in treating %ipolar disorder$ Cts
usefulness in schi6ophrenia has )et to %e adeIuatel) assessed$
Compared with those who received no or delayed augmentation3 the early:augmentation group reRuired 446J! fewer inpatient days from the initiation of
haloperidol treatment6Patient response to treatment #as particularl) noted in
suspiciousness, hallucinations, unusual thought content, and emotional #ithdra#al$
?arly augmentation with valproate may reduce the length of inpatient stays
and provide substantially better therapeutic outcomes$ Ct is, ho#ever,premature to recommend changes in the standard clinical management of
schi6ophrenia on the %asis of the data provided herein, in vie# of the small sample
and open-la%el nature of the report$
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&epa'ote #ith At)pical Antips)chotic9 lipids
Patients treated #ith a com%ination of &epa'ote and U)prexa experienced a
minimal increase in total cholesterol compared to the greater increase inpatients treated #ith U)prexa #hen used as monotherap)9
T
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)ral topiramate for treatment of alcohol dependence7 a
randomised controlled trial6 2ohnson *A et al
M:H"&9 dou%le-%lind randomised controlled /-#ee' clinical trialcomparing oral topiramate and place%o for treatment of 53 individuals #ith
alcohol dependence$$
FC@&C@19 At stud) end, participants on topiramate, compared #ith
those on place%o, had
those of place%o, of similar magnitude to the self-reported drin'ing changes,
and highl) correlated #ith them$
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opiramate for +lcohol Githdrawal7
9 Med Arh$ /33/5!=4>9/-/$
A pilot stud) of :opiramate =:opamax> in the treatment of tonic-clonic sei6ures
of alcohol #ithdra#al s)ndromes$ Rustem%egovic A, ofic , ?ro)er 1$ Anton
Pro'sch Cnstitute, Kienna, Austria$
/ patients #ith median age of 4($5 )ears and median %od) #eight of
7!$< 'g #ere treated #ith topiramate t#ice dail) for up
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?ffects on weight and outcome of long:term olan8apine:
topiramate combination treatment in bipolar disorder$
:#ent)-six &iagnostic and tatistical Manual of Mental &isorders, Fourth
dition %ipolar spectrum patients received olan6apine plus topiramate cotherap) for
treatment of their manic =n B 4>, h)pomanic =n B !>, depressive =n B />, and mixed =n B
> s)mptoms for )ear$ :hree rapid c)cling patients #ere also enrolled despite %eing
euth)mic$ :hirteen =53D> patients completed the -)ear follo#-up$
*) intent-to-treat, patients significantl) improved from %aseline in
.oung Mania 1ating Scale scores ;P %6%%%(=3 Hamilton Depression 1ating Scale ;P %6%$=3 and
Modified Clinical -lobal ,mpressions for 2ip ;mania P %6%%%(3 Depression ; Ham= P %6%$3 000overall P %6%%%(=6
Most patients gained weight during the first month of combined treatment ;mean
weight gain %6* T/: %6& 5g=3 but at the (
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-abapentin for the treatment of ethanol withdrawal6
oris I3 Smith L3 1ao SM3 horne DL3 9lowers I6
0e retrospectivel) report on the use of ga%apentin for ethanol #ithdra#al in 4(
patients$ :hirt)-one patients #ere treated in the outpatient program and 8 in the
general inpatient ps)chiatric unit$
Positive outcomes as evidenced by completion of gabapentin therapy were
achieved in
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)pen pilot study of gabapentin versus tra8odone to treat insomnia in
alcoholic outpatients6
Karam:Hage M3 2rower KI6
Alcohol-dependent outpatients #ith persisting insomnia #ere treated #ith either ga%apentin ortra6odone$ Patients #ere assessed at %aseline and after 4-! #ee's on medication using the
leep Pro%lems uestionnaire =P>$ "f 55 cases initiall) treated, (D dropped out due to
morning dro#siness$ "f the remaining 53 cases, at %edtime and ! #ere treated #ith tra6odone =35 X;- 57 mg> at
%edtime$
2oth groups improved significantly on the SP but the gabapentin group improvedsignificantly more than the tra8odone group6 Controlled studies are warranted to
replicate these findings6
Me" A!$0 KCP;47:P'J0Me" A!$0 KCP;47:P'J0
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C 4 74 7
+ study of gabapentin in the treatment of tonic:clonicsei8ures of alcohol withdrawal syndrome6
1ustembegovic +3 Sofic ?3 ahirovic ,3 Kundurovic 6
Cn this stud) for thirt) = patients #ith alcohol #ithdra#al s)ndrome, the
response to anticolvusant ga%apentin #as assessed$ :hirt) = patients#ith median age of 57$3 )ears and median %od) #eight of 7($ 'g #ere
treated #ith ga%apentin < x
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Lamotrigine in patients with bipolar disorder and cocaine dependence6
2rown ?S3 e@te5 +3 Perantie DC3 )rsula5 PI3 2obadilla L6
M:H"&9 +amotrigine #as started at a dose of /5 mg;da) =/$5 mg;da) in those ta'ing
valproic acid> and titrated to a maximum dose of , %ipolar CC
disorder =@ B 7>, or %ipolar disorder not other#ise specified =@ B >, #ith a mean X;- & age ofLS9 Significant improvement was observed in H+M:D3 .M1S3 and 2P1S scores
;p or 6%
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A&)'opa)e A""#)o& Me"sA&)'opa)e A""#)o& Me"s Harm reduction766opiatesHarm reduction766opiates
MethadoneMethadone )nly through Methadone agencies for +ddiction)nly through Methadone agencies for +ddiction Confusion when in@ury/pain/addiction co:occurrConfusion when in@ury/pain/addiction co:occurr
L++M6L++M6 Due to liver prolems ; minor= is being phased outDue to liver prolems ; minor= is being phased out
2uprenorphine2uprenorphine ot given orallyot given orally
Subo"oneSubo"one Combination of 2up plus alo"one subligualCombination of 2up plus alo"one subligual +bsorb the 2up3 not the alo"one+bsorb the 2up3 not the alo"one ,f used , then immediate Githdrawal from nalo"one,f used , then immediate Githdrawal from nalo"one
Practitioners need special D?+ W and trainingPractitioners need special D?+ W and training
Githdrawal treatmentGithdrawal treatment MethadoneMethadone 2uprenorphine2uprenorphine Clonidine TTClonidine TT
,ntrinsic +ctivity7 9ull +gonist ;Methadone=3 Partial
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:(% : :J :* :& :$ :4
%
(%
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Patient dependent on short:acting opioidsF
Githdrawal symptomspresent (C,) D+. # a"s
If us&1 B,s3 oxa%epam a&" l.!umIf us&1 B,s3 oxa%epam a&" l.!um
A&)#o&*ulsa&)sA&)#o&*ulsa&)s
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A&)#o&*ulsa&)sA&)#o&*ulsa&)s Role & al# =)$"!a=al a#u)e a&"/o! p!o)!a#)e"Role & al# =)$"!a=al a#u)e a&"/o! p!o)!a#)e"
Role & .pola!3 esp !ap" #-#leRole & .pola!3 esp !ap" #-#le
Role & ea!l- a&)ps-#$o)# au1me&)a)o&Role & ea!l- a&)ps-#$o)# au1me&)a)o&
G!ea) fo! o&1o&1 sleep p!o.lems000 Is )$s p!o)!a#)e"G!ea) fo! o&1o&1 sleep p!o.lems000 Is )$s p!o)!a#)e"=)$"!a=al2=)$"!a=al2
Is )$e!e a !ole & #!a*&1/!elapse p!e*e&)o&2Is )$e!e a !ole & #!a*&1/!elapse p!e*e&)o&2
Is )$e!e a !ole fo! ,RN use & a1)a)e" Dual p)s3 su#$ as P m1Is )$e!e a !ole fo! ,RN use & a1)a)e" Dual p)s3 su#$ as P m1*alp!oa)e3 J m1 1a.ape&)& e)#22*alp!oa)e3 J m1 1a.ape&)& e)#22
A&)#o&*ulsa&)s & al#o$olA&)#o&*ulsa&)s & al#o$ol
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A&)#o&*ulsa&)s & al#o$olA&)#o&*ulsa&)s & al#o$ol
=)$"!a=al=)$"!a=al
Goo" e*"ee fo! #a!.ama%ep&e3 *alp!oa)e a&"Goo" e*"ee fo! #a!.ama%ep&e3 *alp!oa)e a&"
1!o=&1 fo! 1a.ape&)& a&" )op!ama)e1!o=&1 fo! 1a.ape&)& a&" )op!ama)e
Ma- e*e& .e supe!o! & )e!ms of safe)-3 a.l)-Ma- e*e& .e supe!o! & )e!ms of safe)-3 a.l)-fo! )a@e $ome "oses a&" & some s)u"es3 e*e&fo! )a@e $ome "oses a&" & some s)u"es3 e*e&
a&xe)-/a1)a)o&a&xe)-/a1)a)o&
Ha*e .ee& s$o=& e(e#)*e & $1$ "ose B,Ha*e .ee& s$o=& e(e#)*e & $1$ "ose B,"epe&"ee"epe&"ee
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S)a- ool a&"S)a- ool a&"8eep alm8eep alm
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