Co-morbidity in Substance Abuse Schizophrenia

PSYC 8012 - Psychopathology

University of Cincinnati

Introduction

"The characteristic symptoms of schizophrenia involve a range of

cognitive, behavioral, and emotional dysfunctions, but no single

symptom is pathognomonic of the disorder" (American Psychiatric

Association, 2013, p. 100).

"Bipolar disorders, schizophrenia, and anti-social personality disorder

are associated with a markedly increased rate of alcohol use

disorder…" (American Psychiatric Association, 2013, p.496)

Discuss the clinical picture of substance abuse. Focus on co-

morbidity in substance abuse disorders

Patients with Schizophrenia have higher rates of alcohol, tobacco, and

drug use disorders than the general population. This can lead to opioid

addiction for many individuals (Hartz, 2014). Substance abuse and

mental illness are considered overlapping factors, such as genetic

factors. The mor Co-morbidity also implies that the illnesses interact,

affecting the course and prognosis known as anxiety disorders. These

are considered a generalized anxiety disorder, panic disorder, and

post-traumatic stress disorder (Hartz, 2014). Substance abuse occurs

in mental disorders and bipolar depression, ADHD, borderline

personality disorder, anti-social personality disorder, and even

Schizophrenia. Co-morbid disorders can also be seen among youth

and transitions to adulthood. A proper mental illness diagnosis while

youth can help reduce later drug use. Many of the brain areas are

affected by substance abuse disorders and even mental illnesses. The

circuits in the brain can become disrupted by substance abuse with

multiple neurotransmitter systems and can be implicated with both

substance use disorders and other mental disorders including, but not

limited to, dopamine, serotonin, glutamate, GABA, and

norepinephrine (Hartz,2014). The environmental factors can be

increased for the risk of substance abuse due to stress and trauma.

Schizophrenia, anxiety, mood, or impulse-control disorders can lead

to changes in the brain, and drug use can precede the first symptoms

of the mental illness. The abnormalities in particular circuits of the

brain may lead individuals to Schizophrenia and increase the effects of

drugs like nicotine, and bupropion which can help for treatment with

patients that have schizophrenia disorder. Co-morbidity involving

substance abuse in schizophrenic patients is associated with poorer

clinical outcomes and contributes to significant morbidity and even

mortality (Volkow N. D., 2009). The treatments with patients for

substance abuse can include interventions for both co-morbid

Schizophrenia and SUD would consist of seeing a psychiatrist with

proper screening and medical treatments (Volkow N. D., 2009).

Explain the unique way the two symptom sets interact using the

chosen co-morbid pair

Co-morbidity is when one person suffers from two or more mental

illnesses at the same time and implies how the action or reaction of

one of those illnesses can increase the negative symptoms of both

illnesses. Dual diagnosis is when one has a mental illness and an

addiction illness, making treatment even more difficult. Addiction

changes the brain's design and changes their normal needs and desires,

replacing them with new priorities connected with seeking and using

the drug despite any possible negative consequences (NIDA, 2021).

Alcohol use disorder (AUD) is the most frequent co-occurring

disorder in those with Schizophrenia. Those with Schizophrenia and

AUD are more likely to have social, legal, and medical problems in

comparison to people with Schizophrenia alone (Drake, R.E., Mueser,

K., 2002). One biological factor that has been researched, but not fully

supported, is that those with Schizophrenia use alcohol and other

drugs to self-medicate in an attempt to alleviate the symptoms of

Schizophrenia or the side effects of the antipsychotic medications

currently prescribed to them.

Another that is more supported is how the neuropathological

abnormalities in the brain are thought to facilitate the positive

reinforcing effects of substance use (Chambers, et al., 2001).

Describe how researchers demonstrate co-morbidity among

disorders

An important factor in determining whether two or more

psychological disorders occur together is whether or not research can

reasonably show either a correlation or a direct causeand-effect

relationship. According to Marusin, Kornetove, Swarovskaya,

Vagaitseva, Pavlenyuk, and Stepanov (2017) found that 12 genetic

markers predict a predisposition to Schizophrenia and alcoholism.

This indicates that individuals with these polymorphic genetic markers

are more likely to have co-morbid diagnoses. Another way that

researchers have shown the interaction and co-morbidity of these two

diagnoses is through brain scans and interviews as conducted by

Deshmukh, Rosenbloom, De Rosa, Sullivan, and Pfefferbaum (2005).

The scans and interviews showed the variation of the compounded

deficits and the differences in those with singular diagnoses. It is

essential that researchers use not only interviews and surveys but also

scientifically recognized means to show that both disorders are, in

fact, present. Co-morbidity of these two disorders can affect how the

treatment is administered and the effective results of treatments.

Discuss the ramifications of co-morbid disorders compared to a

single diagnosis

A single diagnosis of a disorder is often found as a single disorder that

can be treated by itself. These disorders are often more

straightforward and to the point, as they do not require monitoring of

another disorder that helps induce the other or keeps the other going.

Co-morbid disorders, however, are harder to treat as they require the

treatment of two disorders at once.

Ramifications of co-morbid disorders are common among many

disorders out there. One of the most common co-morbid disorders that

are heard of is substance abuse and mental health disorders. These two

are often in conjunction with one another. Many who are diagnosed

with a mental health illness are also diagnosed with substance abuse

as well. Many mental health disorders that come with substance abuse

are depression, anxiety, ADHD, psychotic illness, antisocial

personality disorder, and bipolar disorder. Since drug addiction and

mental health go hand-in-hand, you must treat both conditions in the

succession of another. It is usually easier to start with substance abuse

to clear your mind of all of the mind altering substances before

working on the mental health issues. Doing this gives you a better

chance at diagnosing and treating mental health issues because there

will be no inhibition of drugs affecting the treatment outcome

(National Institute on Drug Abuse, 2021).

In a study of alcoholic disorder and health care services conducted by

the Australian National Survey of Mental Health and Well Being, it

was shown that those with an alcoholic disorder accompanied by a co-

morbid illness often were frequent consumers of health-care services.

This study was in comparison to those who had alcoholic disorders

with no accompanying disorders. These findings highlight the need for

continuing education for both mental health and drug and alcohol

practitioners to help them in the proper diagnosis, treatment, and

referral of clients who come with a wide variety of difficult-to-

diagnose illnesses (Burns & Teesson, 2002).