![[dr. bob]](/dr-bob-sm.gif)
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 5 of 5. This is the beginning of the thread.
Posted by Carol Palmer on December 8, 1998, at 19:50:27
Any psychopharmalogical tips for the dual diagnosis client? My caseload 80-95% dually diagnosed.
Posted by MHW on December 19, 1998, at 12:02:59
In reply to Dual Diagnosis, posted by Carol Palmer on December 8, 1998, at 19:50:27
> Any psychopharmalogical tips for the dual diagnosis client? My caseload 80-95% dually diagnosed.
Great question (I have no tips). 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. 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!!
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!
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.
Posted by mhw on December 29, 1998, at 18:15:06
In reply to Re: Dual Diagnosis, posted by MHW on December 19, 1998, at 12:02:59
> MHW: Thank you for your reply. There isn't
anything I did not disagree with. And, yes you
don't have to have a degree to see that someone
is mentally ill and over medicated! I see clients
with insurance and with free care; just out of tx
or having some sobriety. Trick to find the right
medication combinations. To date have had no
reactions like some I have read in the letters.
We have a very good, careful and caring pyschiatrist.
Thanks again. Carol
Posted by carol palmer on December 29, 1998, at 18:46:23
In reply to Re: Dual Diagnosis, posted by Elizabeth on December 20, 1998, at 20:50:02
>
>Elizabeth: Thank you for your reply. I work in
Boston also and yes, the diagnosis of the year and
most likely the nineties is "borderline," in addition
to ADHD (I think women are being left out on this one).
Primarily my concerns are finding correct medications
and finding that trauma survivors who are dually dx
are needing two medications aside from one for sleep.
I work closely with a psychiatrist here that I think
does a good job with assessment and medication - have
not experienced with clients side effects as I have
read in some of these letters. Yeah, medications and
preventing decompensation once they are sober a while
and medications aren't preventing a bottoming out.
Treating the underlying mood disorder is correct, and
then wonder about that fine line of retriggering to
another set of disorder as PTSD. I guess the question
was asking for a "magic" answer of which there is none
yet. There is not a lot of DD tx facilities still.
I am thankful that we have a psychiatric unit in
our hospital.
Carol.
This is the end of the thread.
Psycho-Babble Medication | Extras | FAQ
Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.org
Script revised: February 4, 2008
URL: http://www.dr-bob.org/cgi-bin/pb/mget.pl
Copyright 2006-17 Robert Hsiung.
Owned and operated by Dr. Bob LLC and not the University of Chicago.