Co-Occurring Disorders and Treatment - Research Paper Example

Co-Occurring Disorders and Treatment Abstract This paper presents a clinical assessment of Barbara’s dual diagnosis which is achieved through a thorough history taking process within the interviewing of the client in psychiatric sessions. The assessment process is described in line with the relationship between the current symptoms of the patient and the psychosocial developmental stages as a basis for diagnosis of her co-occurring conditions. A conclusive diagnosis of anxiety attacks which co-occurs with alcohol abuse is described in the paper as Barbara’s condition. The application of Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV) is described as the most appropriate and applicable model for her diagnosis. The treatment process which is guided by the designed treatment plan follows the diagnosis of Barbara’s condition. Detoxification process for the alcohol problem and the application of a dual treatment approach for psychotherapy and activities of a rehabilitative process are described within the treatment plan for her dual diagnosis condition. More importantly, the epidemiological considerations, social cultural, legal and ethical factors are illustrated as mandatory factors to consider by clinicians in charge of care for the patient’s dual diagnosis disorder. Introduction Co-occurring disorders or dual diagnosis is a condition in psychology and psychiatry which describes a state where psychiatric disorder and a problem of substance abuse occur concurrently or at the same time (Sonneborn, Christina and Marc 42). Because dealing with both a psychiatric disorder and abuse and addiction to drugs is a challenge and troubling to patients, immediate diagnosis and treatment is necessary. The treatment of patients with a co-morbid condition is achieved by a critical and accurate assessment of the condition by a psychiatrist to allow for the use of the correct model of diagnosis and treating the patient. This paper presents a case of Barbara, a psychiatric patient who is faced by co-occurring disorders. According to the symptoms of the patient as provided within the case, a differential of a drug problem and psychiatric disorder that occurs concurrently is reflective. However an accurate diagnosis will be reached through a procedural process of assessment which will be followed by the treatment of the co-morbid condition. Therefore the paper includes an assessment process for Barbara, diagnosis and assessment of her level of risk in addition to her treatment plan. Furthermore the paper describes the epidemiological implications which are associated with treating the patient and the social cultural and ethical considerations which the psychiatrist must put into consideration in her assessment, diagnosis and treatment. Assessment of the Patient The assessment of the patent will involve a psychiatric evaluation by a psychiatrist. The goal of the assessment is to obtain a comprehensive history of the patient that will be used to diagnose the two conditions which characterize her co-morbid condition or dual diagnosis. In this regard, the psychiatrist will arrange for session with the patient for the purpose of critically assessing her condition. Barbara has psychiatric conditions which have lasted for a long time. Therefore the history of the client will trace her condition to childhood and the experiences that she went through at home, school and college and at the work place. In the assessment of the client, her symptoms will be a point of focus. The assessment process will be carried out in a relaxed environment within the office of the psychiatrist. This will allow the patient to feel free to talk about her condition and experiences. The psychiatrist will encourage the patient to talk about her feelings and experiences since her childhood through an assurance that what she says will be confidential. More importantly the psychologist will assure the patient that the information that she gives will be used only to make her feel better. In this sense she could be encouraged to talk about her feelings. Assessment of patients with co-morbid conditions involves an evaluation of experiences that the client has undergone through her life in relation to the theories of development (Liang, Tanya and Simon 1126). In this case, the psychiatrist will look into the relevant information which could be explained theoretically to achieve an accurate diagnosis. Erik Erikson’s theory of psychosocial development will be employed in understanding the condition of the patient in line with her development. The assessment of patients with co-occurring conditions involves linking the symptoms to the causative factors which are developmental stages. This includes a developmental theory based evaluation and assessment (Timko, Anne and Rudolf 613). Barbara’s psychiatric assessment will basically depend on the medical history that will be gathered during the session of client with the psychiatrist. It is important to note that patient history in psychological or psychiatric evaluation must be conducted in conjunction to the provisions, standards and ethics of mental care and practice (Norman 1028). In an attempt to reach a comprehensive and accurate understanding of the drug abuse problem and the psychiatric condition an interviewing process will be carried out. The interviewing process will therefore aim at separately assessing the probable causes of the psychiatric disorder and the drug problem with an aim of establishing the relationship or correlation between these two conditions. The first time that Barbara used alcohol will be determined in the interviewing process and will be used to determine the stage in which the problem of drug use began. The patient assessment will also seek to ascertain the time when the symptoms of the psychiatric disorder began to show. By determining the time of onset of psychiatric symptoms of patients, psychiatrists are allowed to assess the duration within which these symptoms have exhibited in the client so that a developmental theory approach will be applied effectively in reaching the diagnosis and a proper treatment plan (Sonneborn, Christina and Marc 47). In this regard, the relationship that Barbara has had with her parents, peers and workmates will be evaluated on the basis of her answers in the psychiatric interviewing process. It is through a separate assessment of psychiatric condition and drug problem that the interaction of symptoms into a co-occurring or co-morbid condition can be ascertained (DeHaas, John and John 335). Therefore the goal of the assessment stage of the client will be achieved when the psychiatrist is able to determine how the symptoms of the two conditions interact into her co-morbid condition. The assessment will act as a basis of the patient diagnosis which is described in the following section. Diagnosis The etiology of drug use among psychiatric patients is described to emanate from the need of these patients to feel better. This is demonstrated in Barbara’s case where her mother gives her a glass of wine to help her relax from her anxiety. Barbara goes further to take several glasses of wine because they help her to prevent the symptoms of anxiety. This is justified by her mother who inaccurately points out that a glass of wine is what a doctor would prescribe for her condition. It is notable from Barbara’s case that her symptoms of anxiety have lasted for a long time and as a result translates to mean that she has been taking wine for a long time which described her drug problem and possible addiction. Because alcohol is used by psychiatric patients with an aim of helping to overcome bad feelings, it is evident that there is a psychiatric disorder which underlies the drug problem (Norman 1030). The use of drugs is a form of self-medication in which patients with psychiatric or psychological disorders engage in so that they would heal their symptoms even though temporarily. Research and experience data as presented by psychologists and psychiatrists reveal that the self-medication in drug use among patients is as a result of the emotional suffering and pain which they experience because of the symptoms of personality disorders such as anxiety, low-self-esteem, depression and agitation (Sonneborn, Christina and Marc 48). Self-medication, when prolonged, leads to addiction of drugs which causes these patients to have an addiction to substance or alcohol abuse in addition to their psychiatric problem (Timko, Anne and Rudolf 616). This is what leads to a diagnosis of a co-occurring disorder which is also referred to as dual-diagnosis disorder or co-morbid disorder (Liang, Tanya and Simon 1128). The Diagnosis of Barbara’s co-occurring disorders will be achieved through separately diagnosing the drug problem and psychiatric disorder with an emphasis on the link between their symptoms and etiology. The diagnosis of Barbara’s psychiatric disorder will be achieved through the application of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV). This is an effective model in dual diagnosis of two conditions which occur at the same time within a patient. DSM-IV allows clinicians, psychologists and psychiatrists to apply standardized criteria to diagnose a mental disorder. This model of diagnosis is effective in clinical practice because it helps clinicians to distinguish between the causal factors of a psychiatric disorder especially when it co-exists with a drug problem (Greg 47). Therefore the symptoms which are exhibited by Barbara will be evaluated in relation to the DSM-IV model to reach a conclusive diagnosis of the co-morbid condition that she has. Barbara has been nervous most of her life a situation which was aggravated by the major life changes which she experienced in her life such as the movement of her family to California from New York. Nervousness is associated with anxiety attacks (Timko, Anne and Rudolf 620). It is notable that the nervousness that Barbara experiences come in terms of episodes. This illustrates that she is not suffering from generalized anxiety disorder which is among the differentials in the diagnostic process. Barbara is suffering from anxiety attacks as the conclusive diagnosis for one of the co-morbid condition. This diagnosis is also explained by the chest pain and shortness in breath which comprise of her symptoms. These are typical characteristics of anxiety attacks. With the support of her mother, Barbara takes one to several glasses of wine to relief her symptoms and make her to feel relaxed. This demonstrates that she is suffering from alcohol abuse problem as a differential diagnosis for her drug problem. However a conclusive diagnosis of addiction to alcohol is reached based on the fact that she has been dependent on alcohol as a relief for her symptoms for a long time. Therefore Barbara’s co-occurring conditions are conclusively diagnosed as anxiety attacks with addiction to alcohol. Level of Risk A level of risk describes the extent of the inherent danger which a patient is predisposed to as a result of a medical condition and the symptoms related to the condition or problem (Sonneborn, Christina and Marc 50). A patient with more than one condition or problem is predisposed to a relatively higher level of risk as compared to patients with a single condition (Liang, Tanya and Simon 1129). The level of risk that the Barbara is exposed to is defined in line with the symptoms and preservations of anxiety attacks and addiction to alcohol. The shortness in breath which characterizes Barbara’s symptoms puts her at a risk of suffocation. In addition, her nervousness exposes her to a nervous breakdown especially when the anxiety is prolonged. Barbara’s level of risk is also described in line with her social life. For example she is likely to fail to actively interact with the people who surround her. This risk is demonstrated by the fact that she is single which a factor of insufficiency involvement in socialization activities is likely. Her alcohol use predisposes her to the risk of total dependence in addition to the use of other more powerful substance and drugs of abuse. In this sense, Barbara is at the risk of acquiring alcohol abuse induced conditions such as liver cirrhosis. More notably is the fact that since Barbara has co-occurring conditions, her level of risk is said to be higher than that of patients with a single condition whether it is psychiatric or drug related. Treatment Plan The treatment plan for Barbara’s co-occurring conditions will be based on a dual treatment approach. This approach to treatment is described as the most effective approach in which patients with dual-diagnosis can be treated (DeHaas, John and John 338). Dual treatment approach involves a simultaneous treatment plan for both of the co-occurring conditions. Therefore the treatment plan for Barbara will involve a concurrent treatment of her anxiety attacks and addiction to alcohol. This is therefore the underlying goal for the treatment of Barbara’s co-morbid condition. It is however necessary to consider that the severity of Barbara’s two co-occurring conditions as defined by the psychiatrist will define the application of dual treatment approach as the best approach of treating her symptoms. For example the duration of her anxiety attacks and the impact that they have inflicted on her social psychological state will described by the psychiatrist as a guideline for the application of the dual treatment approach to heal her condition. In addition, the level of drug use and addiction as determined by the psychiatrist during the assessment and diagnosis process will define the application of the dual treatment approach in the treatment process. The treatment plan for dual diagnosis involves either an inpatient program or an outpatient program depending on the severity of the conditions or problems (Timko, Anne and Rudolf 613). In Barbara’s case, an outpatient treatment program will be appropriate considering that her condition is episodic. However, the psychiatrist may recommend an inpatient program for the treatment of the problem of addiction to alcohol. The initial step or treatment stage for Barbara is detoxification. Detoxification is an effective approach to the treatment of patients with alcohol addiction as one of the co-occurring conditions in a dual diagnosis case (Liang, Tanya and Simon 1132). The process detoxification will be appropriate for Barbara’s drug addiction problem because it will allow her body to be cleansed of alcohol. This process will be achieved within a specified period of time as prescribed by the psychiatrist in charge of her case. Therefore this process will take place within a span of a few days and even a few weeks as defined by the severity of her alcohol addiction problem. After the psychiatrist or lead clinician defines Barbara’s body to be free of alcohol as a result of the detoxification process, then a dual treatment program will be initiated. The goal of the dual treatment and its initiation will be to achieve a successful rehabilitation of the patient. In the rehabilitative stage of the patient treatment, Barbara will be helped to overcome all the symptoms which are exhibited by the anxiety attacks and addiction to alcohol. The psychiatrist will therefore prescribe psychotherapy sessions ether on individual or group level which will be used to achieve a successful rehabilitation of the patient. Group and individual sessions of psychotherapy as forms of behavioral therapy are effective in the treatment of patients with co-morbid condition (DeHaas, John and John 348). In addition to the psychotherapy sessions, Barbara will be involved in various rehabilitative activities such as programs on anti-drug use education, lessons and discussions on the effects of drug use and abuse, the need for proper lifestyle and nutrition in addition to involvement in exercising activities. Epidemiological Implications of the Treatment The epidemiological correlation of anxiety with gender revel that women, when compared to men, have a more likelihood of developing anxiety disorder and anxiety attacks (Greg 54). This means that the treatment that is prescribed for Barbara is in line with the epidemiological basis in the diagnosis of her condition. There number of women who are treated for anxiety disorders are as twice as many when compared to their male counterparts. This means that the treatment that Barbara will receive for her anxiety is based on the statistical findings and evidence based practice of the disorder. Epidemiological studies reveal that with the application of effective treatment approaches, more than 67% of patients with anxiety disorders achieve a successful treatment with less than 24% experiencing a recurrence of the condition. Within western countries, alcohol dependence has been found to have a prevalence of approximately 10.6% in the lifetime of users. This means that it is a serious problem which requires the attention of psychiatric treatment. The co-occurrence of anxiety attacks and addiction to alcohol is said to be one of the commonest dual diagnosis conditions in the western countries. The treatment of the co-occurrence of anxiety and addiction to alcohol is aimed at reducing the prevalence of both these conditions and the complications which result from them. Legal, socio-cultural and ethical considerations The ethical framework which guides medical practice and particularly the treatment of mental illnesses must be adhered to by all clinicians (Sonneborn, Christina and Marc 51). These ethics involve confidentiality and privacy of client information as provided during the interviews and therapy sessions. Therefore the psychologists, psychiatrists and clinicians in charge of treating Barbara must uphold the ethics of practice which includes their moral right to ensure that she is provided with high quality care. In addition, clinicians should not in any way harm patients. The guidelines for the diagnosis of mental disorders should also be applied in the treatment of dual diagnosis disorder. The legal provisions for care must also be upheld by the clinicians in charge of the diagnosis and treatment of Barbara’s dual diagnosis conditions. For example, the fundamental rights and freedoms of persons with mental health conditions must be upheld by the practitioners in charge of caring for the patient (Liang, Tanya and Simon 1134). Adherence to the legal provisions on the care for persons with mental health problems is aimed at helping clinicians to avoid legal consequences of negligence or unlawful practice such as suit and loss of license to practice. More importantly the social cultural and ethnic beliefs of patients with dual diagnosis must be respected by caregivers. Various communities, societies and ethnicities have different views on mental illnesses and drug abuse. These beliefs may play a significant role in determining the consent of patients for care and the interventions that care givers use in caring for such patients. It is in this sense that clinicians are obliged to respect the values and beliefs of patients in addition to their preference for care. This is important because it defines the level into which quality of mental health care and the management of drug abuse related conditions are achieved. Conclusion The clinical assessment of Barbara’s dual diagnosis is achieved through a thorough history taking of the patient within the interviewing process in the client psychiatrist sessions. The history of the patient and interlink of current symptoms with psychosocial developmental stages is used in the patient assessment stage as a basis for diagnosis of her co-occurring conditions. In the process of diagnosis, a conclusive diagnosis of anxiety attacks which co-occurs with alcohol abuse is defined as Barbara’s problem. The diagnosis is reached through the application of Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-IV) standards for diagnosis of mental ill patients. The diagnosis is followed by a treatment process which is guided by the designed treatment plan. The treatment plan begins with a detoxification process for the alcohol problem and the application of a dual treatment approach for psychotherapy and activities of a rehabilitative process. The epidemiological considerations, social cultural, legal and ethical factors must be employed by clinicians in charge of care for the patient’s dual diagnosis disorder. This is aimed at ensuring the highest standards of care, safety and satisfaction is achieved in the whole process of assessment, diagnosis and treatment of the patient. Works Cited DeHaas, Ryan, John, Calamari, and John, Bair. "Anxiety Sensitivity and the Situational Antecedents to Drug and Alcohol Use: An Evaluation of Anxiety Patients with Substance Use Disorders." Cognitive Therapy & Research 26.3 (2002): 335-353. Greg, Young. "Improving Services for Individuals with a Dual Diagnosis: A Qualitative Study Reporting On the Views of Service Users." Addiction Research & Theory 19.1 (2011): 47-55 Liang, Wenbin, Tanya, Chikritzhs, and Simon Lenton. "Affective Disorders And Anxiety Disorders Predict The Risk Of Drug Harmful Use And Dependence." Addiction 106.6 (2011): 1126-1134 Norman, Schmidt. "Implications of Comorbid Alcohol Dependence among Individuals with Social Anxiety Disorder." Depression & Anxiety (1091-4269) 25.12 (2008): 1028-1037 Sonneborn, Christina K.M.E., and Marc W.M. Bosma. "Comorbidity and Outcome in Dual Diagnosis Patients – Characteristics of 228 Inpatients." Mental Health & Substance Use: Dual Diagnosis 5.1 (2012): 42-51 Timko, Christine, Anne Sutkowi, and Rudolf Moos. "Patients with Dual Diagnoses or Substance Use Disorders Only: 12-Step Group Participation and 1-Year Outcomes." Substance Use & Misuse 45.4 (2010): 613-627 Read More