خدا نام به
& 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
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
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
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