...Co-Morbidity and Homelessness Co-Morbidity and Homelessness Tim Ervin Ivy Tech People who are dually diagnosed with mental illness and substance abuse disorders constitute 10%-20% of homeless persons. They are heterogeneous and extremely vulnerable subgroup with complex, poorly understood needs. (Breakey, 1987; Fischer, 1990) Addressing comorbidity in the homeless population makes us look head on at the clinical, service, legal, and housing issues. My goal is to improve our understanding of this problem and what might be done to help resolve this growing problem. To help explain this comorbidity, we need to know that drug addiction is a mental illness. It is a brain disease characterized by compulsive, at times uncontrollable drug craving, seeking and using despite the terrible consequences. Despite devastating consequences behaviors that stem from drug-induced changes in brain structure and function. These changes occur in some of the same brain areas that are disrupted in other mental disorders, such as depression, anxiety, or schizophrenia. It is not surprising that population surveys show a high rate of co-occurrence, or comorbidity, between drug addiction and other mental illnesses. As awareness of the problem of duel diagnosis has grown models for integrating mental health and substance abuse treatments have begun to emerge but have not been applied to the homeless population. (Argeriou & McCarty, 1990) Approximately one third of homeless persons suffer...
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...and haloperidol. These drugs, work on the assumption that schizophrenia is caused by too much of the neurotransmitter (a chemical messenger within the brain) dopamine. The way in which they act is by binding too, but not stimulating the dopamine receptors (notably the D2 receptors on the receiving end of the synapse). This means that the dopamine itself cannot bind to the receptor, as it is already occupied and so a lower level of dopamine enters the synapse. This lowers the overall levels of dopamine in the brain, combatting the positive symptoms associated with it such as hallucinations. Support for the effectiveness of these drugs has come from studying the relapse rates of people who take them alongside those who are taking a placebo, a fake drug. Davis et al (1980) looked at the results of 28 studies regarding relapse rates between typical antipsychotics and placebos, and found that people on a placebo were 55% more likely...
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... psychoeducation in enhancing mental health outcomes for people with mental disorders The current therapeutic model for the treatment of mental health disorders embraces a combination of pharmacological and psychological interventions. Psychoeducational methods are employed in clinical procedures for all mental health disorders and are critical to integrated health care (Bedell, Hunter & Corrigan, 2009). Creamer and O'Donnell (2008) refer to psychoeducation as education, which is specially targeted to psychological health and aims to produce changes in an individual’s knowledge, attitudes, and skills to improve health outcomes. This study is aimed at discussing what psychoeducation is, its role in clinical settings, its efficacy and how nurses figure in employing techniques attributed to psychoeducation. The study draws from evidence-based literature, including meta-analyses and research papers in the field. It is common practice to inform patients with any chronic disorder to be informed about their illness, prognosis and treatment. For instance, patients with diabetes will be educated on their treatment and how they can help manage the situation and not aggravate their condition. This concept is psychoeducation and is similarly rendered to patients dealing with mental health problems, albeit in different modes or techniques. Any type of intervention that educates patients and their families with the hope of improving their long-term outcome is classified as...
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...Global Leprosy In 1978, NIAID awarded two contracts for the purpose of fractionating Mycobacterium leprae-infected armadillo organs to derive sizable quantities of M. leprae for use by the leprosy research community. Dr. Brennan's program at National Jewish Hospital was awarded one of the two contracts. Upon Dr. Brennan's transfer to Colorado State University in 1980, the work moved there. Thus, we have had this contract since 1979 through five subsequent recompetitions. Since the closing of the WHO/IMMLEP M. leprae Bank in 1990, this Contract is now the sole source of appreciable quantities of M. leprae and its various products. Prior to 1995, two contracts existed, "Isolation, Purification and Characterization of Antigens from Purified Mycobacterium leprae Obtained from Armadillo Tissue" at CSU and "Establishment and Maintenance of an Armadillo Colony Infected with M. leprae" at Florida Institute of Technology, Melbourne, FL, under Dr. Eleanor E. Storrs and, later, Dr. A. Dhople. In 1995, one contract in two parts was announced, and the Gillis W. Long Hansen's Disease Center, Carville/Louisiana State University (Dr. Richard Truman, PI) was the successful bidder for part II. Part II is now responsible for producing and shipping to us about 6 kg per year of combined livers and spleens from infected armadillos with up to 1010AFB/g tissue resulting in a yield of about 10 g of pure M. leprae per year. This contract has been subsequently awarded in 2002. In addition, in August...
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...Geyer (2009) provided a case study of Sandy Lee was sentence to prison for trafficking cocaine, as a result she was mandated at to a residential treatment program transitioning to a lower level of care outpatient treatment. While attending both programs she participates in group and individual sessions addressing her domestic violence which she experienced by her past boyfriends. Additionally, Ms. Lee sought treatment to address her mental health diagnosis of Generalized Anxiety Disorder (GAD) which she was prescribed antidepressants. Ms Lee also resided in transitional housing which she would present to her probation officer for random urine drug screens. Over the month Ms. Lee was able to obtain gainful employment, stable housing and regain custody of her children. However, Ms. Lee violated her probation after testing positive on a random urine drug screen (Geyer, 2009). The purpose of this paper is to discuss treatment outcomes models: recidivism model, relapse model, and harm-reduction model. The recidivism, relapse, and harm-reduction model have in common are they are used in forensic treatment literature (Geyer,...
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...Many individuals at some point in their lives may report feelings of extreme sadness or simply “feeling depressed”. However, such feelings are only one of seven symptoms recognized by the Diagnostic and Statistical Manual (DSM-IV). Major Depressive Disorder (MDD) is one of three primary clinical forms of depression recognized by the DSM-IV. The DSM-IV recognizes the following seven symptoms as indicative of Major Depressive Disorder: (1) significant weight loss (while not trying to lose weight), significant weight gain, or change in appetite; (2) insomnia or hypersomnia; (3) psychomotor agitation or retardation; (4) fatigue or loss of energy; (5) feelings of worthlessness or excessive or inappropriate guilt; (6) decreased concentration or indecisiveness; and (7) recurrent thoughts of death or suicidal ideation, plan, or attempt (Craighead, Ritschel, Arnarson, & Gillespie, 2008, chap. 8). According to the DSM-IV, an individual must experience “marked distress or a decrease in level of functioning” for at least 2 weeks (Craighead et al., 2008, p. 281). The individual must also experience on an almost daily basis, an occurrence of a dysphoric mood or loss of interest/pleasure in almost all activities two weeks prior to the diagnosis of MDD (Craighead et al., 2008, chap. 8). The patient must experience at least four of the seven previously mentioned symptoms (only three if both loss of interest/pleasure and dysphoric mood are present) (Craighead et al., 2008, chap. 8). It...
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...self-talk. Other strategies include initiation or withdrawal from social contact, relation techniques, such as breathing exercises.73% of the sample reported that these strategies were effective in managing their symptoms. Coping strategy enhancement was developed which aims to teach individuals to develop and apply effective coping strategies. These reduce the frequency, intensity and duration of psychotic symptoms. A weakness of this is that schizophrenic patients have irrational thought processes which makes it difficult to identify the accuracy of their statements regarding the onset of symptoms and it is retrospective therefore it is hard to judge the accuracy of the theory. A weakness of this study is that the main technique used is interviews, so participants may have faced demand characteristics, therefore decreasing the validity of the findings. Another weakness is that the cognitive behavioural therapy does not offer a cure for schizophrenia, therefore is not entirely useful as it doesn’t look at the cause of the disorder which makes it simplistic. A strength of this study is that CBT seems to offer an effective means of alleviating the distress associated with the florid symptoms of schizophrenia and therefore is effective in a real life situation. A weakness of this study is that it is reductionist as it does not take into account the biological explanation of schizophrenia. An ethical issue is that the...
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...monoamine-oxidase inhibitors (MAOIs) and trycyclics (TCAs) are effective in reducing depressive symptoms. Antidepressants have been tested in trials with placebos and have found to be effective in reducing symptoms of severe depression in around 65% to 75% compared with around 33% for placebos – Gitlin 2002. Gitlin carried out a clinical trial testing selective serotonin re-uptake inhibitors (SSRIs) and placebos. He found that SSRIs were effective in reducing symptoms of depression in around 75% of patients compared with 33% for placebos. However the 33% of patients that felt better after taking the placebo drug suggests that the cause of depression is not all down to biological reasons but possibly cognitive too and that it may be about the way we think. There were factors that caused limitations to this study, the study was correlational, and this means that the cause and effect was not established between depression and the supposed cause. Hollon did a follow up study to see whether or not SSRIs are effective in treating the actual cause of depression or not. He found that those who were withdrawn from cognitive therapy had a relapse rate of 31% and those withdrawn from drug therapy had a relapse rate of 76%. This shows that drugs only treat the symptoms of depression rather than the actual underlying cause of depression. Therefore it is palliative. It is clear that drugs do not necessarily offer a long term cure as in many cases; symptoms recur when the drugs are no longer taken. ...
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...the condition such as NMDA & Serotonin. N-methyl D-asparate (NMDA) modulation has been used with success for a number of other conditions such as pain control and Alzheimer’s disease. Due to the high incidence of relapse and treatment failure of current therapies, it is vitally important that medical science looks further into the modulation of the other neurotransmitters involved. Aim: To report one case that illustrates a novel presentation of treatment resistant schizophrenia, that through extensive investigation produced a diagnosis of anti-NMDA antibody encephalitis. Clinical details and outcome: The patient had experienced extensive treatment for schizophrenia over at least 5 documented years at a number of institutions & hospitals with varying degrees of success. The patient’s presentation to TPCH resulted in the detection of Anti-NMDA antibodies leading to the diagnosis. Treatments used included immunomodulators and antipsychotics. Conclusions: After a prolonged admission, the patient was discharged back to her family substantially improved and is receiving maintenance immunoglobulin doses every 3 months. The antipsychotic medications have been weaned over a prolonged period to ensure no relapse of symptoms. Abstract Word count: 206 Case report word count: 1601 INTRODUCTION Schizophrenia is a chronic neuropsychiatric disorder that has a worldwide prevalence of 1% and doesn’t vary significantly between geographical regions1. The disorder is characterised...
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...Running Head: DRUGS AND ALCOHOL ABUSE Drugs and Alcohol Substance Abuse What is substance abuse and addiction? Substance abuse is a pattern of use of drugs and/or alcohol for non-medical purposes for altering the mood, mind, and behavior. This is a serious problem and people that abuse drugs and/or alcohol can get sick, destroy their lives and the lives of family and friends. Death has resulted from substance abuse. Commonly abused is alcohol, prescription or over the counter drugs such as amphetamines, cocaine, depressants, inhalants, marijuana, narcotics, and even tobacco. Substance abuse can occur in all ages, social statuses and races. Addiction is dependence and a compulsive need to use the substance no matter what the outcome may be. Addiction is the compulsion to use the substance to feel satisfied and a person that is addicted to drugs or alcohol will have withdrawal symptoms if they stop using the substance. With addiction there is a psychological and physical aspect in that the person is unable to control the addiction without help. Addiction is not a habit. A habit can be controlled and a person can choose to stop a habit without issues. Addiction puts a person out of control of choices and not in control of their life. The drugs or alcohol are controlling the person. The cause of addiction can be a combination of physical, emotional, mental and a change of circumstances in a person’s life. According to Hammer (2012), addiction has been understood...
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...intoxication and withdrawal symptoms. The real issues arise from the length of methadone treatment. Even though researches show that, no ill effects arise from continual use. However, the Center for Disease Control (2002) shows that most patients under methadone abandon the treatment before a year is complete; the clinic sometimes encourages the patients to leave or the patients fail to comply with the program. Amore obvious reason is that taking methadone becomes difficult and unpleasant for most patients. In effect, most methadone patients relapse and start using cocaine again. In this light, the question of which treatment approach is best for treating cocaine addicts still remain. Considerably, other drug addiction treatments, such as CBT- cognitive-behavioral therapy and CM –contingency management show promise in helping patient dissuade from taking drug, even after the initial drug treatment is stopped. In this light, hypothesis for creating an effective cocaine treatment is draw from the use of CBT and CM after the initial treatment of methadone. Research Question What is the best approach to treating cocaine addiction? Hypothesis People taken off methadone treatment who continue their other treatments (CBT- cognitive-behavioral therapy and CM –contingency management) will have greater success at beating their addiction than people who continue with methadone alone. . Sampling Method...
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...Substance Use Among Inpatient Substance-Dependent Clients (Lin 2004) the researchers wanted to test Forgiveness Therapy (FT) as a tool for treating clients dealing with substance abuse related to negative emotional overload. They focused on anxiety, depression and anger which, according to Lin, are triggers for substance abuse (2004, pg. 1114). They set out to talk and interview forty three potential participants who were recommended by their counselors from a residential drug rehabilitation center. This population was chosen due to the rigid course of treatment they were already receiving from the treatment facility in response to the personal calamity being experiences by the client. These were the most severe cases since they usually experienced repeated relapses, petty crimes and a lower motivation for change. While conducting the research what they found was not really surprising but rather normal for this group of clients. The participation started to fall off and by the end of the research they had fallen to less than half of the original commitment. Seven men and seven women finished the project with seven random clients receiving FT and the other seven the standard Alcohol and Drug Counseling (ADC). Although the researchers said the final fourteen participants was a rather small number it was, in fact, not unusual. Lin says, “Given the high levels of mobility and chaos that characterize the lives of this client...
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...Substance Use Among Inpatient Substance-Dependent Clients (Lin 2004) the researchers wanted to test Forgiveness Therapy (FT) as a tool for treating clients dealing with substance abuse related to negative emotional overload. They focused on anxiety, depression and anger which, according to Lin, are triggers for substance abuse (2004, pg. 1114). They set out to talk and interview forty three potential participants who were recommended by their counselors from a residential drug rehabilitation center. This population was chosen due to the rigid course of treatment they were already receiving from the treatment facility in response to the personal calamity being experiences by the client. These were the most severe cases since they usually experienced repeated relapses, petty crimes and a lower motivation for change. While conducting the research what they found was not really surprising but rather normal for this group of clients. The participation started to fall off and by the end of the research they had fallen to less than half of the original commitment. Seven men and seven women finished the project with seven random clients receiving FT and the other seven the standard Alcohol and Drug Counseling (ADC). Although the researchers said the final fourteen participants was a rather small number it was, in fact, not unusual. Lin says, “Given the high levels of mobility and chaos that characterize the lives of this client population, this...
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...Comprehensive Health History and Holistic Plan of Care Schizophrenia is a mental illness that is difficult to diagnose. In the prodromal period people exhibit suspicion and withdrawal along with an increase of unusual thoughts. The exact causes of the disease are unknown, but genetics, brain chemistry, and a variety of environmental factors are thought to be contributing factors. Stress, malnutrition, and viruses are environmental factors that may play a part in the development of disease (National Institute of Mental Health, n.d.). The patient is a 40 year old female who has experienced a schizophrenic episode including psychotic symptoms, (see psycho-social history) and was recently released from the psychiatric ward of a hospital in Detroit, Michigan. She is temporarily living with her mother. The patient has no history of mental health illness, and it is unclear how long she has been having psychotic symptoms. The patient’s mother reports that she was informed by the patient’s husband that the delusions have been going on for about six months. She is no longer delusional, and is refusing medication. She currently presents with a slight vitamin B12 deficiency and exhibits negative characteristics of schizophrenia, as well as exhibiting lethargy and anhedonia, which are symptoms of mental illness, and vitamin deficiency. I have used the data assessment tools of a comprehensive health history, a psychiatric nursing interview, and the brief...
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...someone that is huge when in actuality they may be average size and weight. Once a person is diagnosed with anorexia it is hard for them to recover. Not only is it hard for a person with AN to recover, it is also extremely easy to relapse. It takes intense therapy and treatment to cure someone with anorexia. AN exists in every culture and race; it varies amongst African Americans differently as opposed to other cultures. Symptoms of anorexia include an intense fear of gaining weight, refusal to keep body weight up, and amenorrhea for 3 consecutive months (Kumar, Tung, & Iqbai, 2010). Amenorrhea is the abnormal absence of menstruation. Some other symptoms of AN are lanugo, joint swelling, dental cavities, tooth loss, and abdominal distension (Kumar, Tung, & Iqbai, 2010). Lanugo is the growth of fine white hair that grows when anorexics have no body fat left to keep themselves warm (Morrisey, 2010). There also tends to be changes in the endocrine and metabolic systems that encourage AN patients to further constrain their diet. People with anorexia have major impairments in psychological functioning, severe medical complications, and is associated with psychiatric morbidity (Carter et al., 2009). Anorexia can even cause bone loss in individuals of severe cases. It is obvious why people with anorexia...
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