From Clinicaltools.com

Course Details

MedStudentLearning.com URL

Physiological, Psychiatric, and Other Comorbidities

Description

Patients who misuse alcohol often have other comorbid diagnoses. This course will present some of the more common comorbidities associated with alcohol misuse so that you may be aware of other circumstances which can influence patient treatment.

Need

When treating patients who misuse alcohol, physicians-in-training need to be aware of comorbid mental and physical problems that may exist which might influence patient treatment.

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 other comorbidity.

Mission

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

Goal

You will be able to recognize that patients who misuse alcohol often have comorbid conditions that affect alcohol treatment.

Learning Objectives

Discover and interpret medical complications that arise from increased alcohol use, such as fatty liver, heart damage, and alcoholic hepatitis
Discuss with patients how comorbid mental health complications may affect treatment outcomes
Evaluate how treatment needs might be modified when more than one substance is abused.

Case Studies

Case Study 1: Derek

Educational Objectives

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)

Expected Diagnosis: At risk for alcohol use disorder. Patient diagnosed with fatty liver, presumably caused by years of drinking.

Take Home Message/Practice Tip: In this case, counsel Derek to abstain from alcohol use and develop a treatment plan. 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. 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.

Case Specifics

Patient: Derek - 29YOWM

Case Information: 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

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.

Relevant Past Medical, Psychosocial, Family History: Works with father. Known alcohol use, coupled with pain medication

Case Study 2: Camilla

Educational Objectives

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)

Expected Diagnosis: Alcohol dependence

Take Home Message/Practice Tip: 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. Detox facilities allow concentration on the reasons behind drinking without outside distractions. Combination therapy allows treatment of co-occurring disorders. 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.

Case Specifics

Patient: Camilla - 44YOWF

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

Chief Complaint: Coworkers concerned about drinking, comes in because she needs a referral for specialist treatment

Relevant Past Medical, Psychosocial, Family History: Divorced, in a community with few friends. Previously diagnosed as depressive. Long term alcohol misuse.

Case Study 3: Thomas

Educational Objectives

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.

Course Objectives Met: (3)

Expected Diagnosis: Alcohol dependence

Take Home Message/Practice Tip: Simultaneous treatment for co-dependence and depression is the best course of action.

Case Specifics

Patient: Thomas - 48 YOWM

Narrative: Thomas has applied for a new job and one of the requirements is that he get a physical. He has noted that he drinks as well as smokes, but says that since he is young he's not worried about the long-term effects. However, upon questioning, he says that he gets anxious and feels down when he decreases his use.

Chief Complaint: Physical

Relevant Past Medical, Psychosocial, Family History: Alcohol and tobacco use