به نام خدا DRUG ABUSE & MENTAL ILLNESS: COMORBIDITY محمد نادی روانپزشک به نام خدا DRUG ABUSE & MENTAL ILLNESS: COMORBIDITY محمد نادی روانپزشک

Addictive Disorders Often Co- Exist with or Predispose to Mental Disorders DSM IV Manual: D evotes ~ 100 pages to describing addiction and dependence disorders DSM IV Manual: D evotes ~ 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 Disorder Mental Disorder Addictive Disorders Often Co-Exist With Mental Disorders

Lifetime Prevalence of Drug Disorders Among Persons With Various Mental Disorders (vs. any Drug Disorder Alone) Lifetime Prevalence of Drug Disorders Among Persons With Various Mental Disorders (vs. any Drug Disorder Alone) Source: Regier,D.A. et al., JAMA 264(19), pp , November 21, Schizo- phrenia Schizo- phrenia APD Anxiety Panic Disorder Panic Disorder OCD Bipolar Disorder Bipolar Disorder Depression Any Drug Disorder (alone) Any Drug Disorder (alone)

What Do Mental and Addictive Disorders Have in Common? What Do Mental and Addictive Disorders Have in Common? Both are Behavioral Dysfunctions With Similar Neurobiological Basis Both 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 for self-administration Significance: rationale for self-administration

serotonin synaptic terminal Synaptic vesicle Postsynaptic target Activate transmitter receptors Causes an effect transporter Prozac & Cocaine block

National Comorbidity Survey (NCS) Nearly half of individuals with a past year substance use disorder also had a mental disorder

National Comorbidity Survey (NCS) Most prevalent Affective disorders Affective disorders Anxiety disorders Anxiety disorders Personality disorders Personality disorders Psychotic disorders Psychotic disorders Most prevalent Affective disorders Affective disorders Anxiety disorders Anxiety disorders Personality disorders Personality disorders Psychotic 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 Cycle Hypothalamus Pituitary Gland Pituitary Gland Adrenal Glands Adrenal Glands Kidneys CRF ACTH CORTISOL Stress Responses

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?

Prolonged DRUG USE AbstinenceAbstinence RELAPSERELAPSECRFCRF AnxietyAnxiety What Happens When A Person Stops Taking A Drug? What Happens When A Person Stops Taking 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 Disorders Have a Brain Disease People With Comorbid Mental and Addictive Disorders Have a Brain Disease Double Mental Disorder Mental Disorder Addictive Disorder Addictive Disorder Comorbid Disorders Comorbid Disorders

Panic disorder Recurrent panic attacks : PalpitationsPalpitations SweatingSweating Trembling or shakingTrembling or shaking Shortness of breathShortness of breath Feeling of chokingFeeling of choking Nausea or abdominal distressNausea or abdominal distress Chest painChest pain

Social phobia Marked fear of social or performance situations for example: Public speakingPublic speaking Writing, eating, or drinking in publicWriting, eating, or drinking in public Initiating or maintaining conversationsInitiating or maintaining conversations

Specific phobia Marked fear that is excessive FlyingFlying Enclosed spacesEnclosed spaces HeightsHeights Animals (e.g., snakes or spiders)Animals (e.g., snakes or spiders) BloodBlood

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 SSRIsSSRIs TCIsTCIs MAOIMAOI PsychotherapyPsychotherapy

Major Depressive Disorder Five 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 Disorder Treatment 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 Lithium AnticonvulsantsAnticonvulsants AntipsychoticsAntipsychotics E C TE C T PsychotherapyPsychotherapy

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 othersViolation of the rights of others Self-centered, inability to maintain relationshipsSelf-centered, inability to maintain relationships Poor sexual adjustment, inability to delay gratificationPoor sexual adjustment, inability to delay gratification Aggressive, impulsive, manipulativeAggressive, impulsive, manipulative Poor work historyPoor work history

Borderline Personality Disorder unstable interpersonal relationshipsunstable interpersonal relationships Impulsive and unpredictable behaviorsImpulsive and unpredictable behaviors Chronic feelings of emptinessChronic feelings of emptiness Extreme shifts in mood and depressionExtreme shifts in mood and depression Self-destructive behaviorsSelf-destructive behaviors

Histrionic Personality disorder Overly dramatic, intensively expressiveOverly dramatic, intensively expressive Enjoys being the center of attentionEnjoys being the center of attention Poor interpersonal relationshipsPoor interpersonal relationships Romantic fantasiesRomantic fantasies uses physical appearance to draw attention to selfuses 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 ejaculationPremature ejaculation SSRIsSSRIs ClomipramineClomipramine

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