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Comorbidity General Lecture

Marc A. Schuckit, M.D.

Department of Psychiatry

University of California, San Diego

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Some Explanations for Comorbidity

1. Substance induced temporary disorders

2. Substances intensify prior psychiatric conditions

3. A few psychiatric disorders increase the risk for substance use disorders

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Rationale

• Drugs can cause psychiatric symptoms

• These last days to weeks

• They clear spontaneously

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Source: Brown S, Schuckit M. (1988) J Stud Alcohol;49:412-417.

Hamilton Depression Score > 20*

Weeks Abstinent

40%

16

20%

30%

10%

0%1 2 43

* Mood swings last longer

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Source: Brown S, Schuckit M. J Stud Alcohol. 1990;51:34-41.

Anxiety In 171 Primary Alcoholics

Symptom

• Withdrawal palpitations and/or shortness of breath 80%

• Panic while drinking 4%

• Panic while sober 2%

• Generalized anxiety while sober 4%

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When 2+ Disorders Are Observed:

• Which one(s) should be treated?

• What is best therapy?

• Will disorders and/or treatments interact?

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Comorbidity is Common in SUD

• 2 / 3 have 2nd diagnosis

BUT

• Most are ASPD and other SUD

• Many others are organic

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Studies of Children Of Alcoholics

Don't reveal increased psychiatric disorders

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Diagnosis Can Indicate:

• When to intervene

• Treatment with best asset to risk ratio

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DSM IV Major Depressive Episode

• A. 5/9 symptoms for two weeks with either (1) depressed mood or (2) loss of interest or pleasure

• B-E. Exclusion criteria

• MDD is diagnosed by symptoms and history

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Alcoholism Course

• Fluctuating:

– controlled use

– problems

– abstinence

• 20% spontaneous remission

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Anxiety Disorders

• Panic Disorder with or without Agoraphobia

• Agoraphobia

• Social Phobia

• Specific Phobia

• Obsessive-Compulsive Disorder

• Posttraumatic Stress Disorder

• Generalized Anxiety Disorder

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Depressive Symptoms in Alcoholics

• 80% Sadness

• 30% - 40% Depressive Episodes

• Question: What is the best treatment?