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1
Gilmore, Amanda K., Kaitlin E. Bountress, Emma L. Barrett, Sudie E. Back, and Kathleen T. Brady. PTSD and Co-Occurring Substance Use Disorders. Edited by Charles B. Nemeroff and Charles R. Marmar. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190259440.003.0028.
Full textAbstract:
Post-traumatic stress disorder (PTSD) commonly co-occurs with a number of psychiatric disorders including depression, other anxiety disorders, and medical comorbidity. Substance use disorders (SUD) are among the most commonly co-occurring disorders with PTSD and can complicate the course of illness and treatment. This chapter will discuss co-occurring PTSD and SUD (PTSD/SUD) in terms of epidemiology, theoretical underpinnings, and clinical implications. This chapter also describes clinical assessments for PTSD/SUD and provides a list of potential assessments for use in clinical settings. Further, behavioral and pharmacological evidence-based treatments are described that can be effective in reducing both SUD and PTSD symptoms among individuals with PTSD/SUD. Future work that would help move the field forward regarding etiology and treatment of PTSD/SUD are discussed.
2
White, Susan W., Brenna B. Maddox, and Carla A. Mazefsky, eds. The Oxford Handbook of Autism and Co-Occurring Psychiatric Conditions. Oxford University Press, 2020. http://dx.doi.org/10.1093/oxfordhb/9780190910761.001.0001.
Full textAbstract:
People with autism spectrum disorder (ASD) are often diagnosed, and treated for, co-occurring mental health disorders. Co-occurring problems are, in fact, a primary reason for referral and treatment-seeking. Research on comorbidity and its management in youth and adults with ASD has expanded at a rapid rate over the last decade. This is the first comprehensive volume on the topic of co-occurring psychiatric conditions and symptoms in ASD. In this Handbook, internationally recognized clinical scientists synthesize the research on assessment and evidence-based treatment for a broad range of conditions as they present in ASD, from childhood through adulthood. In addition to coverage of formal diagnoses that frequently present in ASD (e.g., mood and anxiety disorders), common behavioural concerns (e.g., psychosexual and sleep problems) are also addressed. Each chapter summarizes the condition or disorder as it presents in ASD, and presents the extant research on its prevalence, developmental course, etiology, and assessment and diagnosis in the context of ASD. Each chapter also includes a summary of evidence-based treatment approaches or current best practices for intervention, as well as a case example to demonstrate application. Chapters are also included to synthesize broader issues related to co-occurring psychiatric conditions in ASD, including a historical overview and conceptual framework for co-occurring conditions in ASD, crisis management, and psychopharmacology. In sum, this handbook is comprehensive compilation of the current evidence-base and recommendations for future research to inform clinical practice related to co-occurring psychiatric conditions and symptoms in ASD.
3
Ziegler, Penelope P. Pain and Addiction in Patients with Co-Occurring Psychiatric Disorders (DRAFT). Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190265366.003.0024.
Full textAbstract:
Addressed equally to psychiatrists and to primary care providers, this chapter is intended to explore non–substance use disorder psychiatric diagnoses as they impact the perception of pain and the treatment of substance use disorders. A screening checklist emphasizing basic principles of psychiatric history-taking is provided to help identify the patient’s requirements. The author reviews the classes of psychiatric diagnoses most likely to be present in the pain/addiction and other comorbidly-ill patients, and reviews suicide risks. Similarly, the classes of medications employed in psychiatry and their capacity for alleviation or aggravation of substance use disorders are reviewed, with notations of drug–drug interactions. A final section addresses the role of emotions and psychiatric symptoms in the perception and management of pain.
4
Skipper, Cathy, and Florian Birkmayer. The Role of Aromatherapy in the Treatment of Substance Use and Co-Occurring Disorders. Edited by Shahla J. Modir and George E. Muñoz. Oxford University Press, 2018. http://dx.doi.org/10.1093/med/9780190275334.003.0024.
Full textAbstract:
Aromatherapy can be an important tool in the treatment of substance abuse and co-occurring disorders. When used by trained specialists, essential oils are safe, simple, and effective both in alleviating symptoms as well as helping increase self-awareness and transform consciousness. Olfaction is a powerful sensory modality, and olfactory receptors have been found in nearly every tissue of the body and parts of the Central Nervous System (CNS) relevant to addiction and motivation. Essential oils are widely used to support and alleviate nervous symptom disorders such as those triggered by addiction (i.e., anxiety, sleep problems, panic attacks, depression, stress etc.). The available scientific literature supports the traditional uses of the most common essential oils in this domain and is encouraging for the continued development of these powerful plants extracts for addiction support.
5
Vázquez, Gustavo H., Alberto Forte, Sebastián Camino, Leonardo Tondo, and Ross J. Baldessarini. Treatment implications for bipolar disorder co-occurring with anxiety syndromes and substance abuse. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198748625.003.0017.
Full textAbstract:
Anxiety symptoms and syndromes affect approximately half of both types I and II bipolar disorder (BD) patients at some time, more in women than men. Reported prevalence has ranked: generalized anxiety ≥ phobias ≥ panic ≥ post-traumatic stress syndrome ≥ obsessive–compulsive syndrome. BD associated with anxiety disorders is less responsive to mood-stabilizing treatments, with greater disability, substance abuse, and possibly suicidal risk. Emerging treatments for anxiety in BD patients include lurasidone, olanzapine, quetiapine, valproate, and psychotherapies, whereas the efficacy and safety of standard anxiolytics and antidepressants are not established. Abuse of alcohol, cannabis, stimulants, and opioids, alone or in combinations, also affects about half of BD patients at some time—more men than women and possibly somewhat more in type I than II. Substance abuse greatly complicates clinical care, contributing to erratic treatment-adherence, adverse outcomes, disability, increased risk of suicide or accidental death, and increased costs of care and from disability.
6
Guerdjikova, Anna I., Paul E. Keck, and Susan L. McElroy. The impact of psychiatric co-morbidity in the treatment of bipolar disorder: focus on co-occurring attention deficit hyperactivity disorder and eating disorders. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198748625.003.0018.
Full textAbstract:
Bipolar disorder (BD) commonly co-occurs with attention deficit hyperactivity disorder (ADHD) and eating disorders (EDs) in adolescents and in adults. The aim of this chapter is to summarize the available data regarding prevalence, clinical presentation, and psychological and pharmacological treatment of such complicated cases. Results of randomized controlled and open-label trials and case reports are reviewed. The main therapeutic goal when treating BD co-morbid with ADHD or ED is selecting a treatment strategy effective in the management of both syndromes, or at the minimum, selecting one that treats one syndrome without exacerbating the other. Controlled data are scarce. Various classes of medications, including stimulants, atomoxetine, bupropion, and wakefulness-provoking agents, might hold promise as adjunctive medication in improving ADHD symptoms in euthymic BD patients. The specificities of the ED, namely the predominance of undereating or overeating, need to be considered when selecting agents in the treatment of BD co-morbid with EDs.
7
Capaldi, Deborah M., and Hyoun K. Kim. Comorbidity of Depression and Conduct Disorder. Edited by C. Steven Richards and Michael W. O'Hara. Oxford University Press, 2014. http://dx.doi.org/10.1093/oxfordhb/9780199797004.013.015.
Full textAbstract:
Both depression and conduct disorders are relatively prevalent and are related to poor long-term outcomes. Despite being characterized by very different symptoms, it is well established that these two disorders co-occur at higher rates than expected by chance, resulting in poorer adjustment for the individual than would result from either problem alone. The termcomorbidityis usually reserved to refer to the association of diagnosed disorders, whereasco-occurrencerefers more broadly to the association of levels of symptoms of conduct problems and depression, which are usually calculated with means or possibly symptoms counts. In the past two decades, researchers have focused particularly on the following issues regarding the comorbidity of depression and conduct disorder: (1) possible causal associations of the two problem behaviors (i.e., do depressive disorders tend to onset after conduct disorders or vice versa); (2) theory regarding causes of the association (i.e., common versus unique risk factors for these two problem behaviors); (3) changes across development (i.e., with age); (4) risks from diagnosed disorders versus symptoms that do not reach diagnostic criteria; (5) outcomes or prognosis (e.g., are outcomes more severe for co-occurring problems than for either problem alone, are there distinct patterns of outcomes associated with co-occurring problems). Within each of these areas there is considerable interest in moderation of effects by gender or gender similarities and differences. This chapter reviews findings pertaining to these issues and presents suggestions for future research. In addition, assessment approaches and clinical implications are discussed.
8
Fertuck, Eric A., Megan S. Chesin, and Brian Johnston. Borderline Personality Disorder and Mood Disorders. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199997510.003.0011.
Full textAbstract:
Borderline personality disorder (BPD) and mood disorder (MD) can be difficult to differentiate from each other due to several overlapping clinical features. Among BPD symptoms, chronic dysphoria can be mistaken for major depression, while affective instability may be confused with the depressed and elevated mood episodes of bipolar disorder (BD). Conversely, in those with BPD, co-occurring MDs can be difficult to rigorously assess and treat. Even though there is moderate to high co-occurrence between these conditions, BPD and MDs have distinct facets of impulsivity, affective instability, and mood symptoms. Furthermore, BPD, MD, and their co-occurrence predict courses of illness, prognosis, treatment outcomes, and suicide risk. Consequently, thorough assessment and differential diagnosis of these conditions should inform treatment planning and clinical management in both BPD and MD.
9
Bateman, Anthony W., and Roy Krawitz. Borderline personality disorder. Oxford University Press, 2015. http://dx.doi.org/10.1093/med:psych/9780199644209.003.0001.
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Chapter 1 outlines borderline personality disorder (BPD), the history of BPD, its epidemiology, diagnosis and a thorough discussion of the elements of the DSM-IV-TR diagnostic criteria for BPD, and explores individual factors to help understand a person’s BPD (biological vulnerability theory, emotional sensitivity, mentalizing vulnerability, Beck’s core schemas, dichotomous (all or nothing) thinking, fluctuating competence, active passivity), and co-occurring conditions (depression, bipolar disorder, psychotic symptoms, dissociation, personality disorders). The chapter also discusses etiology (biological factors, psychological factors, nature and nurture, sociocultural factors), self-harm, prognosis, and psychosocial treatment outcome studies.
10
Back, Sudie E., Edna B. Foa, Therese K. Killeen, Katherine L. Mills, Maree Teesson, Bonnie Dansky Cotton, Kathleen M. Carroll, and Kathleen T. Brady. Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE). Oxford University Press, 2015. http://dx.doi.org/10.1093/med:psych/9780199334513.001.0001.
Full textAbstract:
Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE) is a an integrated treatment cognitive-behavioral psychotherapy program designed for patients who have posttraumatic stress disorder (PTSD) and a co-occurring alcohol or drug use disorder. COPE represents an integration of two evidence-based treatments: Prolonged Exposure (PE) therapy for PTSD and Relapse Prevention for substance use disorders, where both the PTSD and substance use disorder are addressed concurrently in therapy by the same clinician, and patients can experience substantial reductions in both PTSD symptoms and substance use severity. The program includes information about how PTSD symptoms and substance use interact with one another; information about the most common reactions to trauma; techniques to help the patient manage cravings and thoughts about using alcohol or drugs; coping skills to help the patient prevent relapse to substances; a breathing retraining relaxation exercise; and in vivo (real life) and imaginal exposures to target the patient's PTSD symptoms.
11
Back, Sudie E., Edna B. Foa, Therese K. Killeen, Katherine L. Mills, Maree Teesson, Bonnie Dansky Cotton, Kathleen M. Carroll, and Kathleen T. Brady. Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE). Oxford University Press, 2015. http://dx.doi.org/10.1093/med:psych/9780199334537.001.0001.
Full textAbstract:
Concurrent Treatment of PTSD and Substance Use Disorders Using Prolonged Exposure (COPE) is a an integrated treatment cognitive-behavioral psychotherapy program designed for patients who have posttraumatic stress disorder (PTSD) and a co-occurring alcohol or drug use disorder. COPE represents an integration of two evidence-based treatments: Prolonged Exposure (PE) therapy for PTSD and Relapse Prevention for substance use disorders, where both the PTSD and substance use disorder are addressed concurrently in therapy by the same clinician, and patients can experience substantial reductions in both PTSD symptoms and substance use severity. The program includes information about how PTSD symptoms and substance use interact with one another; information about the most common reactions to trauma; techniques to help the patient manage cravings and thoughts about using alcohol or drugs; coping skills to help the patient prevent relapse to substances; a breathing retraining relaxation exercise; and in vivo (real life) and imaginal exposures to target the patient's PTSD symptoms.
12
Burns, Tom, and Mike Firn. Who is assertive outreach for? Referrals and discharges. Edited by Tom Burns and Mike Firn. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780198754237.003.0003.
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This chapter examines the characteristics of patients who need community outreach. It identifies those who most often receive it and those for whom it seems to add little extra. It considers dual diagnosis patients, offender patients, ethnic minority patients, and patients with co-occurring learning disabilities. It also considers the balance between positive and negative symptoms in psychosis and also its suitability for first-onset psychosis. It discusses the value of explicit criteria for both acceptance and discharge and the nature of step-down where that is an option. The processes of acceptance and discharge, with their necessary collaboration, are outlined.
13
Zanarini, Mary. In the Fullness of Time. Oxford University Press, 2018. http://dx.doi.org/10.1093/med-psych/9780195370607.001.0001.
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Borderline personality disorder (BPD) is still seen in many settings as a chronic disorder. This book details the ways that it is symptomatically a “good prognosis” diagnosis. This is particularly seen in the high rate of remissions of BPD and its constituent symptoms. The rate of suicide is also good news, as it is half the expected rate from four follow-back studies conducted in the 1980s. Areas with a more guarded prognosis, particularly for those who have not recovered, are poor physical health and poor vocational adjustment. In addition, rates of other deaths are increasing and have surpassed the rate of deaths by suicide. This book covers the following topics: History of the borderline diagnosis, models of the core features of BPD, earlier studies of the longitudinal course of BPD, the McLean Study of Adult Development (MSAD), the symptoms of BPD assessed in MSAD, the long-term course of the symptoms of BPD, symptomatic remissions and recurrences of the borderline diagnosis, prevalence and predictors of physically self-destructive acts over time, additional symptom areas over time, psychosocial functioning over time, recovery from BPD, predictors of time-to-remission and recovery, co-occurring disorders over time, mental health treatment over time, physical health and medical treatment, adult victimization over time, sexual issues over time, defense mechanisms over time, and new directions.
14
Carney, Colleen E., and Taryn G. Moss. Sleep Disorders and Depression. Edited by C. Steven Richards and Michael W. O'Hara. Oxford University Press, 2014. http://dx.doi.org/10.1093/oxfordhb/9780199797004.013.012.
Full textAbstract:
Major depressive disorder (MDD) commonly occurs with several sleep disorders, including hypersomnia, breathing or limb-related sleep disturbances, and most notably chronic insomnia. A bidirectional relationship exists between sleep and mood problems, and both issues often warrant timely clinical management. However, there are several assessment- and treatment-related complexities that complicate the clinical management of such patients. For example, there are several overlapping symptoms for MDD and both insomnia and hypersomnia, and the two sleep conditions are both listed as possible symptoms in the diagnostic criteria for MDD. This has led to a well-documented problem of underrecognizing and undertreating these significant disorders in the context of MDD. Moreover, certain effective depression treatments can actually worsen the coexisting sleep disorder. Understanding and treating both disorders (i.e., MDD and the co-occurring sleep disorder) is imperative for effective clinical care. Almost all (i.e., up to 90%) of those with depression report sleep problems. This chapter provides an overview of the etiologic, assessment, and treatment issues inherent in this very large, highly prevalent group.
15
Diamond, Pamela M. Traumatic brain injury. Oxford University Press, 2015. http://dx.doi.org/10.1093/med/9780199360574.003.0053.
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During the past decade, traumatic brain injury (TBI) has become a frequent topic in the media. It has been a decade of expanding awareness, increased research, and growing concern about TBI of all severity levels. Consistent with this increased attention, researchers and policymakers have made strides toward greater understanding of the risks of TBI, the scope and complexity of the symptom profiles seen after TBI, and the types of treatments that optimize recovery. Recent studies have confirmed a 50 to 60% prevalence of TBI among prisoners. Most have experienced multiple injuries and experienced their first TBI in their mid-teens. Routine screening for TBI is rarely done in these settings in spite of there being a number of tested instruments available. The cognitive deficits associated with mild to moderate TBI are often indistinguishable from those associated with many mental illnesses and substance abuse. Etiology is difficult to establish; nevertheless, the common symptom patterns often make adjustment to jail or prison difficult. Educational interventions designed to improve staff knowledge of the prevalence of TBI and frequent symptom patterns are important first steps. Training staff how to modify their behavior and facilitate communication with inmates expressing these symptoms may reduce episodes of misunderstanding and potential aggression. Similarly, current programming may be modified to accommodate the cognitive deficits suffered by inmates with TBI as well as other disorders. This chapter reviews the prevalence of TBI in correctional settings, its impact on co-occurring mental illness and substance use, and opportunities to recognize, intervene, and treat patients with TBI.
16
Klein, Daniel N., Sara J. Bufferd, Eunyoe Ro, and Lee Anna Clark. Depression and Comorbidity. Edited by C. Steven Richards and Michael W. O'Hara. Oxford University Press, 2014. http://dx.doi.org/10.1093/oxfordhb/9780199797004.013.025.
Full textAbstract:
This chapter examines the relation between personality disorder (PD) and depression, disorders that are commonly comorbid in clinical and community populations. This comorbidity presents both clinical and conceptual challenges. In anticipation of the upcoming introduction of theDiagnostic and Statistical Manual of Mental Disorders(fifth edition;DSM-5), we review research on the associations of depression with both PD and traits in order to help bridge the current and future literatures. Issues distinguishing PD and depression are reviewed, including conceptual concerns, the nature of the associations between depression and PD and traits, and current evidence on associations between depression and PD and chief personality trait dimensions. Data are presented from an ongoing study examining associations between depressive symptoms, maladaptive-range personality, and psychosocial functioning using proposedDSM-5criteria for depression and PD trait domains and facets. Depressive disorders exhibit large associations with negative affect and more moderate links with positive affect and conscientiousness/disinhibition, though there appear to be even more differentiated patterns of associations at the facet level. However, our understanding of the processes responsible for the associations of PD and depression is still limited. Despite this lack of clarity, the links between depression and PD and traits have important clinical implications for assessment and treatment of both disorders. Assessment approaches and challenges are discussed, as well as the implications of co-occurring PD and traits for the treatment of depressive disorders. Finally, future research directions are summarized.
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Douaihy, Antoine, Meredith Spada, Nicole Bates, Julia Macedo, and Jack M. Gorman. Anxiety Disorders. Edited by Mary Ann Cohen, Jack M. Gorman, Jeffrey M. Jacobson, Paul Volberding, and Scott Letendre. Oxford University Press, 2017. http://dx.doi.org/10.1093/med/9780199392742.003.0018.
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HIV practitioners are increasingly confronted with complex co-occurring medical and psychiatric disorders among their patients. Depressive and anxiety disorders are among the most commonly diagnosed in HIV-infected individuals and can complicate the overall management of HIV illness. Anxiety may be experienced as a symptom, as a manifestation of an anxiety disorder, as a consequence of HIV-associated or other illness, or as a result of one of its treatments. It can occur at any stage, from the realization of being at risk, to the anxiety about a possible symptom, to the time of HIV testing and the experience of HIV-associated stigma and discrimination, diagnosis, disclosure, illness progression, late- and end-stage illness, and dying. This chapter explores the complexities of anxiety as it relates to HIV and AIDS and discusses the prevalence, diagnosis, and assessment of anxiety disorders. The impact of anxiety on medical management of HIV is also addressed, including adherence to antiretroviral regimen, psychotherapeutic and pharmacological interventions, and coexisting medical and psychiatric disorders.