From Clinicaltools.com

Medical, Psychiatric, and Polysubstance Comorbidities

Description

(Steve draft) Here the physician needs to realize that a patient doesn't misuse alcohol in a vacuum and that it is important for them to be aware of other circumstances which can influence them achieving the project goal.

It is essential that the role of addiction and psychiatric medications are fully understood so that proper treatment can be utilized with them. Recognizing co-morbid problems and how treatment regimes will interact with each other will more properly ready a physician.

URL

Need

There are a number of comorbidities that must be understood when treating alcohol use problems. Negative treatment outcomes are possible if other disorders are not considered when coming up with a treatment plan for the alcohol use issues.

Needs Analysis

In the spring of 2008, we conducted a focus group with 13 medical school faculty and addiction consultants. The results

Brief Summary: The focus group shaped our module outline and content. With a rating scale of 1-5, the importance of Psychiatric and Other Co-Morbidities was rated 4.55 and a rating of 4.54 was given for the belief that the average medical student would benefit from additional instruction in this topic. Faculty determined that the module would easily fit into their institution's current curriculum, with a rating of 3.83, and that they would include the module into their current teachings, giving this a rating of 4.23. The respondents felt they would encourage their students to learn more about the topic, with a rating of 4.63, as that the topic aligned with recommended physician competencies in the area of substance abuse, with a rating of 4.31. The most respondents (6) thought that 1 hour of lecture time should be devoted to this topic. Respondents also identified certain areas within the topic which they felt should be concentrated on, which we took under consideration when writing the module.

Vision

Physicians in training can effectively treat patients who abuse alcohol who also may have a medical, psychiatric, or polysubstance comorbidity.

Mission

The CTI Solution.

Solution is to inform the physician of the medical, psychiatric and other comorbidities which can be commonly involved in the intervention of a patient's negative alcohol use.

It is the mission of this course to make medical students aware of and train for the impact co-morbidities might have on treatment.

Goal

After taking this course, medical students will have a better understanding of how co-morbidities might impact treatment, and how to be aware of such co-morbidities.

Learning Objectives

Diagnose (identify) alcohol related medical complications
Diagnose (identify) comorbid mental health complications
Diagnose (identify) polysubstance treatment needs

Case Study 1: Derek

Case Focus: Derek is presented in 5 different, consecutive pages in his own section, following "Medical Complications". We present Derek to show how a medical complication, in this case fatty liver (Steatosis), and how alcohol consumption can affect this medical comorbidity.

Case Goal: Physicians-in-training should be able to diagnose medical complications that arise from increased alcohol use and counsel patients about ways to decrease alcohol use.

Course Objectives Met: 1

Patient: Derek - 29YOWM

Chief Complaint: Slight, ongoing pain in abdomen. Pain has continued for a month and OTC pain meds don't relieve pain. Skin appears yellow and abdomen near liver is tender to touch.
Narrative: Derek is 29 years old and works in the factory outside town with his father. He is not married, but has a couple of friends from work who he hangs out with socially. Derek comes to the office with abdomen pain. A CT scan reveals an enlarged liver. Diagnosis: fatty liver (Steatosis). Through conversation, it is revealed that Derek started drinking at age 16
Alcohol Use: Known alcohol use, coupled with pain medication
AUD Diagnosis:At risk for alcohol use disorder. Patient diagnosed with fatty liver, presumably caused by years of drinking.
Treatment Decision: In this case, counsel Derek to abstain from alcohol use and develop a treatment plan.
Relevant Past Medical, Psychosocial, Family History: Works with father
Take Home Message: It is important to probe for alcohol use for all patients. In this case, Derek's long term use of alcohol may have contributed to his developing fatty liver.
Practice Tip: It is important that you be forthright about the potential long-term health effects that alcohol can have on patient condition. By outlining what will happen if they continue their bad health habits, it will show the damage that can be done and how to prevent it.
URL's: Derek Case Study

Case Study 2: Camilla

Case Focus: Camilla is presented in 5 different, consecutive pages in her own section, following a discussion of psychiatric comorbidities.

Case Goal: Physicians-in-training should be able to incorporate polysubstance abuse treatment needs in patients who have a co-occurring disorder along with their alcohol abuse, as well as identify the mental complications that arise from increased alcohol use, such as bipolar disorder, antisocial personality disorder, suicidality.

Course Objectives Met: 2

Patient: Camilla - 44YOWF

Chief Complaint: Coworkers concerned about drinking, comes in because she needs a referral for specialist treatment
Narrative: Camilla is 44 years old and moved to the local area in 2002 after her divorce. She has no local family, but has built relationships with her coworkers. Camilla has been previously diagnosed with depression and received medication for that. She's also tried AA, but that hasn't worked for her.
Alcohol Use: Long term alcohol misuse.
AUD Diagnosis: Alcohol dependence
Treatment Decision: At this point in her treatment history, Camilla needs a combination therapy to treat her depression and alcohol together and she needs to go to a detox facility. Detox facilities allow concentration on the reasons behind drinking without outside distractions.
Relevant Past Medical, Psychosocial, Family History: Divorced, in a community with few friends. Previously diagnosed as depressive.
Take Home Message: Detox facilities allow concentration on the reasons behind drinking without outside distractions. Combination therapy allows treatment of co-occurring disorders.
Practice Tip: Camilla has been a long term alcohol abuser and has comorbid psychiatric conditions. It is important to treat both alcohol use and psychiatric conditions simultaneously.
URL's: Camilla Case Study