Mental Health & Substance Use Disorders

Transcription

1 Mental Health & Substance Use Disorders

2 Thank you to Daniella Kanareck Dr. Arielle Taylor

3 Overview 1. Overview of Mental Health 2. Stigma and attitudes associated with this population 3. Mental Disorders and Substance Use: Co-morbidity 4. Prevalence 5. Psychiatric Illnesses Anxiety Disorders, Affective Disorders, Psychosis, 6. Physical Health 7. Social issues 8. Summary

4 What comes first Dilemma?

5 Stigma Mental illness is also associated with stigma in Australian society, which often leads to isolation and discrimination Many people who have mental health problems have other problems such as physical health problems, alcohol and substance use. ABS Year book

6 Stigma is doubled Stigma cont. lack knowledge and understanding of Mental Illness, are fearful, judgemental and mistrusting, leading to isolation, and labelling (e.g. being a drunk, an addict a pothead ) for people with a co morbidity diagnosis of mental illness and substance use Discrimination is common because of major health and social issues, family breakdown, poor history of engagement with services and heightened risk of relapse and potential of forensic issues

7 Mental Disorders and Substance Use- Alcohol Approximately one-third of respondents with an alcohol use disorder (abuse or dependence) met criteria for at least one comorbid mental disorder in the previous 12 months. They were 10 x more likely to have a drug use disorder, 4 x more likely to have an affective disorder and 3 x more likely to have an anxiety disorder. Respondents with an alcohol use disorder and a comorbid mental disorder were significantly more disabled and higher users of health services than respondents with an alcohol disorder and no comorbid mental disorders. (National Survey of Mental Health and Well Being, 1997)

8 Overview of Mental Health Mental illness is widely recognized as a major health concern in Australia. 1:5 Australian adults will experience a mental disorder at some time in their life. Females are more likely than males to report long-term mental or behavioural problems. Mental health problems/illness affect ones perceptions, cognition, emotions, behaviour, social wellbeing, and capacity to negotiate daily life. A diverse range of social, environmental, biological and psychological factors can impact on an individual's mental health. Numerous types and symptoms with varying degrees of severity.

9 Overview of Mental Health cont. Among the broad categories of disease, cancer is the leading cause of disease burden (19% of Australia s total), closely followed by cardiovascular disease (18%), then mental disorders (13%). Almost 1 in 9 GP encounters involves mental health-related problems mostly depression, anxiety and sleep disturbance Mental disorders were the leading contributors to YLD, accounting for 24% of the non-fatal burden of disease in Australia in 2003 YLDs = Years Lived with Disability (National Survey of Mental Health and Wellbeing, 2007)

10 Proportion of people with a mental disorder in the previous 12 months

11 PREVALENCE

12 Mental Health Illnesses Anxiety disorders Mood (affective) disorders Schizophrenia/ Psychosis onset of psychotic symptoms such as delusions, hallucinations, and perceptual disturbances, and the severe disruption of ordinary behaviour. Psychological distress : Based on questions about negative emotional states in the last four weeks by Kessler Psychological Distress Scale (K10) Alcohol and Drug use disorders (includes harmful use and dependence) National Survey of Mental Health and Wellbeing, 2007

13 What is Anxiety? Normal reaction or feeling of fear that anyone may experience in the face of any situation we can feel anxious. as a response to social situations a perceived threat/danger As performance anxiety When stressed and managing everyday life problems Leaning new skills Experienced during the Flight and Fight response this can feel overwhelming. Just thinking about a situation Feeling anxious is appropriate in these situations and lasts only a short time. Even the most confident feel anxious at times. The symptoms of anxiety are sometimes not all that obvious as they often develop gradually and, given that we all experience some anxiety at some points in time, it can be hard to know how much is too much

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15 When Anxiety Becomes A Problem Anxiety disorders are the most common mental disorders, affecting 14% of Australians in a one year period. Women are more likely to develop anxiety than men. National Survey of Mental Health and Wellbeing, 2007 There are many forms of anxiety disorders, but the one thing they have in common is their impact on day-to-day activities. Anxiety can affect your ability to concentrate, sleep and carry out ordinary tasks at work, home or school. Anxious people tend to overestimate the probability (how likely it is that something bad will happen) and cost (how bad it is) of a threat

16 Anxiety Disorders Generalised anxiety disorder (GAD), Panic Disorder, Agoraphobia, Social Phobia, Obsessive-Compulsive Disorder (OCD) and Post-Traumatic Stress Disorder (PTSD))

17 Generalised Anxiety Disorder Symptoms For 6 months or more, on more days than not, very worried, found it hard to stop worrying found that anxiety made it difficult to do everyday activities (e.g. work, study, seeing friends and family)? experienced 3 or more of the following: felt restless or on edge felt easily tired had difficulty concentrating felt irritable had muscle pain (e.g. sore jaw or back) had trouble sleeping (e.g. difficulty falling or staying asleep or restless sleep)?

18 Substance Use in Anxiety Disorders Alcohol and other substances are sometimes used to give a feeling of wellbeing, confidence and relaxation when people suffer anxiety (safety behaviour) Changes in usual behaviour social withdrawal, may doctor shop Heavy or long-term use of substances such as alcohol, cannabis, amphetamines or sedatives can cause people to develop anxiety, particularly as the effects of the substance wear off. People with anxiety may find themselves using more of the substance to cope with withdrawal-related anxiety, which can lead to them feeling worse.

19 Common Interactions : Anti-Anxiety Drugs with substance use Benzodiazepines, Hypnotics Drowsiness, dizziness Slow breathing or difficulty breathing Impaired motor control Unusual behaviour Problems with memory Impairs decision making

20 Affective Disorders Depression Bipolar Affective Disorder Mania, Hypomania Dysthymia

21 Affective Disorders- Depression 5 or more symptoms Continuously for 2 week period or more Effects normal function of daily life Feelings of sadness and mood is depressed most of the day Feelings of worthlessness and guilt Difficulties with negative thoughts and inability to concentrate Noticeably slower or experience of psychomotor agitation Unable to feel/experience pleasure from previous enjoyable activities (anhedonia) Effects on weight and appetite (gain or loss) Invasive thoughts of death/suicide with or without plans /attempts DSM1V Major Depressive Disorder

22 Common Interactions : Antidepressant Medications and with Substance Use Symptoms Drowsiness, dizziness Loss of effectiveness of antidepressant Hopelessness Increased depression Increased risk of suicide or suicidal ideation in adolescents and young adults Increased risk of overdose Disturbance in heart rhythm Seizures Cognitive Impairment Postural Hypotension Insomnia Food related adverse event Antidepressant Medications SSRI, SNRI, Tricyclic, MAOIs SSRI, SNRI, Tricyclic SSRI, SNRI SSRI, SNRI, Tricyclic SSRI, SNRI SSRI, SNRI Tricyclic Tricyclic Tricyclic Tricyclic, MAOIs MAOIs MAOIs (Taylor, Paton, & Kerwin, 2003)

23 Depression and Substance Use- Cumulative Effects of ETOH Alcohol and other substances are sometimes used to alleviate symptoms Alcohol increases the risk of having a Major Depressive Episode Increased risk of: Suicidal behaviour Aggression/violence Tolerance/liver damage Dependence- Lifetime prevalence of people diagnosed with Major Depressive Disorders seeking treatment approx. 40% Cognitive impairment with increased risk of Dementia (NHMRC, 2009)

24 Bipolar Disorder Episodes of mania together with depressive episodes. These mood swing periods can last for days, weeks or even months. Manic symptoms Labile mood Disorders of thought form (racing thoughts) Delusions of grandeur Pressured and excessive speech Disinhibited and lack insight Psychomotor activity is increased Risk taking behaviours may include increased substance use Less need for sleep Flamboyant

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26 Mood Stabilisers Lithium Sodium Valproate Tegretol Drug Interactions Psychotropic medications interact with illicit drugs and ETOH negatively E.G. ETOH increases peak Lithium concentration Sometimes increasing symptoms not alleviating them Interfere with efficacy of other prescribed medications (i.e. antipsychotics) increasing the side effect profile ETOH in general effects the efficacy of mood stabilizers and antidepressant medication Causes over sedation/drowsiness and risk of misadventure and injury (Loxley et al., 2004)

27 Psychosis in Mental Illness Schizophrenia Bipolar Disorder Schizoaffective Disorder Psychotic Depression Psychosis as a result of illicit drug taking

28 Symptoms of Psychotic Disorders Loose contact with reality, especially in SMI Delusions and hallucinations can have a paranoid themes Disordered thought form Concentration is affected/preoccupied Blunted affect Withdrawn, amotivated, loose interest and drive in previous activities Decrease in emotional regulation, potential aggressive behaviour Relationships breakdown as interpersonal skill deteriorate

29 Anti psychotic Medication Atypical Respiridone Olanzapine Quetiapine Amisulpride Clozapine Ziprasidone Aripiprazole Butyrophenones Serenace

30 Anti Psychotic Medication and Substance Use Sedation and drowsiness Increase EPSE Increased potential for relapse of symptoms and/or substance dependence Increase in: + symptoms - symptoms Delusions Hallucinations Thought Disorder Decline in self care Loss of drive Blunted affect/ emotions Withdrawn Postural hypertension Neuroleptic Malignant Syndrome, especially in Alcohol Use increased agitation and body temperature deregulation

31 Physical Health Risks for People with Multiple risk factors Mental Illness Multiple unhealthy behaviours diet, lack physical exercise, injury and trauma Increase in co-morbid physical health problems related to substance use itself Impaired control of use of drug- problematic pattern of use and difficulties Long term effects of psychiatric medications, tardive dyskinesia More medications into the mix the potential for adverse drug interactions Overdose Death

32 Health Risks They have higher rates of CVA risk factors and physical illnesses that are often undiagnosed and reported low rates of accessing medical care (AIHW, 2010, 2005a) Smoking, poor diet, physical inactivity and alcohol misuse are the main behavioural risk factors for CVD. (AIHW, 2010) Greater risk of developing metabolic syndrome leading to type II NIDDM CVD is the largest single cause of death in people with severe mental illness such as Schizophrenia and Bipolar Disorder. Death rates 2.5 x higher than that of the general population (Lawrence, et al.,2001)

33 Social Issues for Mental Health and Substance Use Clients Relationships with health services Accommodation/Housing Relationships and family support limited Isolation/loneliness/withdrawal Financial disadvantage/low income Amotivation and poor engagement Medication side-effects Social relationships, limited networks as only friends associated with substance use Dependence behaviours Potential for criminal history

34 Management and Support Pathways Health services Mental Health and Drug and Alcohol services both community and inpatient working together Management (e.g. non-pharmalogical interventions and drug therapy)can be problematic because of the complexity associated with the clinical management of this patient group one size does not fit all high rates of treatment drop-out Co-morbid underlying personality traits/disorders Treatment- a holistic and combined treatment approach to dual diagnosis has a better outcome (Jackson-Koku, 2001) Partnerships with: Emergency Dept. GP NGOs Pharmacies Aged and disability services Families, friends

35 Summary The relationship between substance use and psychotic disorders remains controversial little research conducted into dual diagnosis and models of care for this complex problem and at times difficult client group. It is an important clinical challenge for psychiatry and D&A services to work together, especially if effective treatment and management modalities for the person with mental illness and substance use are to be achieved. Thank you address: