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Managing patients with dual diagnosis in psychiatric practice

Baigent, Michaela,b,c,d

Current Opinion in Psychiatry: May 2012 - Volume 25 - Issue 3 - p 201–205
doi: 10.1097/YCO.0b013e3283523d3d
ADDICTIVE DISORDERS: Edited by John B Saunders and Linda B Cottler

Purpose of review: To focus on recent research that may influence clinical practice in relation to patients with dual diagnosis disorders.

Recent findings: Harmful substance use is a heightened risk with bipolar disorder. Self-medication with substances of abuse for anxiety is linked with greater risk of developing anxiety disorders, particularly social anxiety disorder. Antisocial and schizotypal personality disorders were particularly linked with chronicity in substance use disorders. There are sex differences in responses to psychological approaches for dual disorders involving alcohol. Integrated dual diagnosis treatment for youth is not conclusive but shows promise. Online therapy is viable for adult patients with dual diagnosis. Structured interventions reduce the risk of opioid misuse amongst those with chronic pain, who are identified as at high risk.

Summary: We have confirmation that clinicians should be particularly vigilant in monitoring for substance use problems early in anxiety disorders and mood disorders and that certain personality disorders are linked with substance use chronicity. Practitioners can incorporate specific therapy approaches for dual disorders that appear to have advantages over treatment as usual.

aDepartment of Psychiatry, Flinders University

bDepartment of Psychiatry, Flinders Medical Centre, Bedford Park

cDrug and Alcohol Services South Australia, Norwood

dBeyondblue, the National Depression Initiative, Hawthorn, Victoria, South Australia, Australia

Correspondence to Michael Baigent, Department of Psychiatry, Flinders Medical Centre, Flinders Drive, Bedford Park, 5042, South Australia, Australia. Tel: +61 8 8204 5237; fax: +61 8 8204 6963; e-mail: Michael.baigent@flinders.edu.au

© 2012 Lippincott Williams & Wilkins, Inc.