2014 4 th ANNUAL DC SUMMIT Child/Youth & Co-Occurring Disorders
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- Slide 1
- 2014 4 th ANNUAL DC SUMMIT Child/Youth & Co-Occurring
Disorders
- Slide 2
- Objectives Review the prevalence of co-occurring substance use
and psychiatric disorders in youth. Review the relationship between
substance use and specific co-occurring mental health disorders.
Understand effective treatment approaches and challenges for youth
with co-occurring disorders.
- Slide 3
- Introduction Psychiatric disorders 3/4 by age 24 Most adults
with SUD started using as adolescents 60-85% adolescents with SUD
have co-occurring psychiatric disorder(s).
- Slide 4
- Co-Occurrence of MH & SUD Substance abuse treatment helps
to reduce the frequency of use and the number of abuse/dependence
symptoms but has only indirect impact on emotional and behavioral
problems (M. Dennis, 2004) Psychiatric treatment alone for youth
with mood disorders and co-occurring SUD does not significantly
reduce substance use (Geller et al., 1998)
- Slide 5
- Risk Factors: Familial Influence on Substance Use Familial
influencebiological and behavioral A common genetic influence
accounts for comorbid substance use during adolescence,
specifically problem use of tobacco, alcohol, and cannabis.
Approximately 50% of the risk of substance abuse or dependence in
adolescence is genetically influenced. Exposure to parental
substance use increases childrens risk
- Slide 6
- A Day in the Life of American Adolescents: Substance Use
Facts
- Slide 7
- Table 1. Illicit drug use in the past month among individuals
aged 12 or older: 2013 SubstanceAged 12 or olderAged 12 to 17Aged
18 or older Number (in thousands) PercentNumber (in thousands)
PercentNumber (in thousands) Percent Illicit drug
use24,5739.42,1978.82,23769.4 Marijuana and
hashish19,8107.51,7627.118,0487.6 Cocaine1,5490.6430.21,5050.6
Inhalants4960.21210.53750.2 Hallucinogens1,3330.51540.61,1790.5
Heroin2890.1130.12770.1 Nonmedical use of prescription-type drugs
6,4842.55492.25,9352.5 Pain relievers4,5211.74251.74,0961.7 SAMHSA,
Center for Behavioral Health Statistics and Quality, National
Survey on Drug Use and Health (NSDUH )
- Slide 8
- Substance use disorder (SUD) in the past year among individuals
aged 12 or older: 2013
- Slide 9
- Mental health issues in the past year among adolescents aged 12
to 17 and adults aged 18 or older: 2013
- Slide 10
- Co-occurring Substance Use Disorders and Mental Health Issues
among Adolescents and Adults
- Slide 11
- 4,333 Total Child/Youth Served (DBH) - FY13 MH SUD COD 3693 640
221 5%
- Slide 12
- Primary Substance Type Substance TypeCountPercentage
Alcohol105% Cocaine/Crack52% Heroin10% Marijuana/Hashish/THC12054%
Other84% Other Opiates and Synthetics21% Other Stimulants31% PCP94%
No Primary Listed6329% Total221100%
- Slide 13
- Diagnoses vs. Medications
- Slide 14
- CFSA Youth with Co-occurring Disorders
- Slide 15
- PIW Stats 75-85% of children/adolescents treated at PIW have
past or current substance use issues
- Slide 16
- Chicken or Egg? Substance-induced Mood Disorder There is no
Cannabis-induced Depressive D/O Not in DSM-IV TR Not in DSM-5
Self-medication
- Slide 17
- ADHD Prevalence approx. 3-5% but those receiving medications
for ADHD is 1- 20% Male:Female is 4:1 Medication treatment for ADHD
is one of the most studied areas in C&A psychiatry Over- vs.
under-medication
- Slide 18
- Course of ADHD Rule of 1/3s: 1/3 show significant improvement
over time 1/3 have a few symptoms into adulthood (inattention) 1/3
continue to have significant problems into adulthood Untreated:
Increased risk of MVAs, drop outs, family discord, and substance
use (15% comorbidity)
- Slide 19
- Stimulant Medications Absolute Contraindications:
Cardiovascular disorders, hypertension Hyperthyroidism Glaucoma
Active Psychosis Co-administration with MAO-Is Relative
contraindications: Seizures (no evidence of decreasing sz thresold)
Drug Abuse
- Slide 20
- Major Depressive Disorder At least 2 wks pervasive change in
mood manifested by either: Depressed or irritable mood and/or Loss
of interest/pleasure Other sx: Same criteria as for adult MDD but
presents differently Lack of joy Withdrawal Irritability Boredom
Failing grades Act out Aggression
- Slide 21
- Treatment Options Mild-moderate depression: psychotherapy
Cognitive Behavior Therapy (CBT) Moderate-severe: pharmacotherapy +
psychotherapy Pharmacotherapy may not be sufficient alone due to
strong psychosocial influences
- Slide 22
- Pharmacotherapy SSRIs are the predominant medications used for
both depressive disorders and anxiety disorders Older
antidepressants (TCAs) have not shown much benefit and have more
side effects
- Slide 23
- FDA Black Box Warning 24 placebo-controlled trials, >4400
patients: Placebo 2%; on antidepressants 4% Double risk of suicidal
thinking/behavior No completed suicides Could be linked to
behavioral activation or akathisia Impulsive Agitated UK banned use
of all SSRIs except fluoxetine for C/A
- Slide 24
- Anxiety Disorders Probably the 2 nd most common group of
disorders; however, do not get recognized so people often do not
present for tx Prevalence rates from 6-20% for one disorder
Children/youth may not recognize fear as unreasonable Very common
to have somatic c/o, crying, irritability, outbursts
- Slide 25
- Anxiety Disorders Obsessive Compulsive Disorder* DSM-5:
Obsessive-Compulsive and Related Disorders Post Traumatic Stress
Disorder* DSM-5: Trauma and Stress-Related Disorders Separation
Anxiety Disorder School refusal Generalized Anxiety Disorder Panic
Disorder Social Phobia Selective mutism Specific Phobia
- Slide 26
- Anxiety Disorders Treatment Guidelines Begin with psychotherapy
for mild cases: CBT- exposure/response prevention Family and
Parent-Child Consider psychotherapy + medication for: Acute symptom
reduction for moderately-severely anxious child BZDs vs. buspirone
Co-morbid disorder that requires treatment Partial response to
psychotherapy Potential for improved outcome with combination
- Slide 27
- Bipolar Disorder Commonly has onset in adolescence Gen
population lifetime prevalence for Bipolar I is 0.4%- 1.6% For C/A
ranges from 1%-13% Overall affects both sexes equally, early-onset
pre- dominantly male (esp. onset