Posted by Elizabeth on December 20, 1998, at 20:50:02
In reply to Re: Dual Diagnosis, posted by MHW on December 19, 1998, at 12:02:59
In response to the original question, first of all:
1. What substances to your clients tend to be abusing? It does make a difference.
2. What symptoms are you concerned with addressing? Withdrawals can be a big problem, as can chronic drug cravings.
3. What are your other concerns?
In general I think you need to treat the underlying mood disorder, but you're right that diagnosis can be tricky. Sometimes drug effects or withdrawals can make symptoms of a mood disorder worse, or they can resemble a psychosis. Also, treating the mood disorder may not necessarily make the substance abuse go away - you need to deal with both issues.
I think that it's important not to "punish" a substance-abusing patient by denying them medication they need by virtue of their past. Prescribe cautiously, of course, when dealing with things like benzodiazepines (e.g., no refills, keep track of how much you have prescribed, etc.).
And to "MHW:"
>I was a Mental Health Worker/Counselor for a year w/ dual diagnosis clients in a facility with high turnover, and found that literally 90% of them would get the "schizoaffective" catch-all diagnosis.
I think different health facilities have their own "pet diagnoses" that they use for people they don't know what to do with. (I'm in Boston; "borderline personality" is very popular here.)
>As I got to know the client, I usually found this diagnosis inaccurate, and when this was discussed with whoever their doc-of-the-moment was, they usually agreed. The worst problem was that most low-income clients, because they were bounced around amoung doctors who hardly got to know them, would rack up all sorts of heavy-duty meds, (even clients as young as 19 or 20!), and again, if I talked to the current psychiatrist, they would often agree and reduce the meds. And I'm just a lowly MHW without a degree!!
Well, you seem clueful enough. :-)
> I'm sure this is somewhat true of all low-income mental health clients, but I think dual diagnosis clients are especially victim to misdiagnosis and over-medication because many doctors still don't take into consideration just HOW MANY mentally ill people are chemically dependent and how often they are NOT going to volunteer the info/admit that they are!
Not just low-income.
poster:Elizabeth
thread:1518
URL: http://www.dr-bob.org/babble/19981201/msgs/1668.html