PSYCH 275 FINAL: comorbidity

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4 potential explanatory models

(1) secondary alcoholism model, (2) secondary psychiatric disorder model, (3) common factor model, (4) bi directional model

why do these disorders often co-occur (cont...)

Involvement of similar brain regions. Brain systems that respond to reward and stress, for example, are affected by drugs of abuse and may show abnormalities in patients with certain mental disorders.

comorbidity:

Refers to the presence of two or more illnesses - medical or psychiatric conditions, including alcohol and other drug use disorders - in the same person

the common factor model

a third variable explains the co-occurrence of anxiety and AUDs

the self medication model

people consume alcohol to cope with anxiety disorders, leading to co-occurring AUDs

interpretational difficulties

Determining significance Diagnostic Issues Sampling Strategy

Treatment and Public Policy Implications

Need to implement and test integrated treatment Need to address policy barriers to increasing integrated treatment and evidence-based approaches

policy implications

Need to remove barriers to improved treatment access for comorbid individuals "Therapeutic Catch-22's" Integrated services through the use of multidisciplinary treatment teams that provide outreach, comprehensive, and stage-wise treatments

why do these disorders often co-occur (cont...)

Overlapping environmental triggers. Stress, trauma (such as physical or sexual abuse), and early exposure to drugs are common environmental factors that can lead to addiction and other mental illnesses.

why do these disorders often co-occur?

Overlapping genetic vulnerabilities. Predisposing genetic factors may make a person susceptible to both addiction and other mental disorders or to having a greater risk of a second disorder once the first appears.

consideration of comorbidity is important because

Understanding etiology of alcohol and other psychiatric disorders Understanding course of alcohol use disorders Developing and testing integrated treatment approaches for AUD's co-occurring with other psychiatric disorders Developing optimal policies for best serving affected individuals and reducing costs to society

treatment implications

Use and evaluation of integrated treatment approaches is increasing but still rare Pharmacological Treatment Approaches Psychosocial Treatment Approaches

AUD and Anxiety three primary pathways

the common factor model, the self medication model, the substance induced anxiety model

Effects of AUD on Course and Outcome of Schizophrenia

AUD associated w/ more severe course and poorer prognosis although comparisons are methodologically complex

the substance induced anxiety model

AUDs lead to increased anxiety and vulnerability for co-occurring anxiety disorders

AUD and schizophrenia

Contributing Factors: Biological Factors Psychological and Social Factors

why do these disorders often co-occur (cont...)

Drug use disorders and other mental illnesses are developmental disorders. That means they often begin in the teen years or even younger—periods when the brain experiences dramatic developmental changes. Early exposure to drugs of abuse may change the brain in ways that increase the risk for mental disorders. Also, early symptoms of a mental disorder may indicate an increased risk for later drug use.


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