Substance-Related and Addictive Disorders: Alcohol Use Disorder – DSM-5

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Alcohol use has never been a topic that lends itself naturally to sober, intellectual discourse. This is hardly surprising, really, given that what’s at stake is nothing less than our lives. Below I am going to mention co-morbidities associated with alcohol use disorder and the criteria of the DSM-5 for the diagnosis of Alcohol Use Disorder (AUD).

AUD is associated with psychotic disorders, bipolar disorders, depressive disorders, anxiety disorders, obsessive-compulsive disorders, sleep disorders, sexual dysfunctions, delirium, and neurocognitive disorders. The onset of these co-morbidities can be during intoxication and/or withdrawal.

It is worth noting that the word “addiction” is not mentioned in the DSM-5, however, it is in common usage in many countries and disciplines to describe severe problems related to compulsive and habitual use of substances.

The following are the diagnostic criteria for AUD:

A problematic patter of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following, occurring within a 12-month period:

1. Alcohol is often taken in large amounts or over a longer period than was intended.
2. There is a persistent desire or unsuccessful efforts to cut down or control alcohol use.
3. A great deal of time is spent in activities necessary to obtain alcohol, use alcohol, or recover from its effects.
4. Craving, or a strong desire or urge to use alcohol.
5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home.
6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of alcohol.
7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use.
8. Recurrent alcohol use in situations in which it is physically hazardous.
9. Alcohol use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by alcohol.
10. Tolerance, as defined by either of the following:
a. A need for markedly increased amounts of alcohol to achieve desired effect.
b. A markedly diminished effect with continued use of the same amount of alcohol.
11. Withdrawal, as manifested by either of the following:
a. The characteristic withdrawal syndrome for alcohol.
b. Alcohol is taken to relieve or avoid withdrawal symptoms.

Stay sober and watch out for the people you love for any signs of alcohol addiction, and most importantly Never Ever Drink and Drive.

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The Patient-Therapist Relationship: Secret of the Care

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“…Time, sympathy, and understanding must be lavishly dispensed, but the reward is to be found in that personal bond which forms the greatest satisfaction of the practice of medicine. One of the essential qualities of the clinician is interest in humanity, for the secret of the care of the patient is in caring for the patient.”  

 – Francis Peabody, MD

 Therapists (e.g. advanced practice psychiatric nurse, psychiatrist, and psychologist) should initially make sure that they know a patient’s name and that the patient knows the therapist’s name.  They should introduce themselves to other people who have come with the patient and should find out whether the patient wants another person present during the initial interview.

 Qualities of the caregiver:

  • Imperturbability: the ability to maintain extreme calm and steadiness
  • Presence of mind: self-control in emergency
  • Clear judgment: the ability to make an informed opinion that is free of ambiguity
  • Ability to endure frustration: the capacity to remain firm and deal with insecurity
  • Infinite patience: unlimited ability to hear pain
  • Charity towards others: to be generous especially to the needy and suffering
  • The search for absolute truth: investigate facts and pursue reality
  • Composure: calmness of mind and bearing
  • Bravery: the capacity to face or endure events with courage
  • Charity towards others: to be generous especially to the needy and suffering
  • The search for absolute truth: investigate facts and pursue reality
  • Composure: calmness of mind and bearing
  • Bravery: the capacity to face or endure events with courage

Confidentiality:

As much as physicians must legally and ethically respect patients’ confidentiality, it may be wholly or partially broken in patients’ situations. If a patient makes clear that he or she intends to harm someone, the therapist has a responsibility to notify the victim.

Countertransference:

Emotions breed countermotions. For example, if the care giver is hostile, the patient becomes hostile; the care giver then becomes even angrier than before and the relationship deteriorates rapidly. Rising above such emotions involves being able to step back from the intense countertransferential reactions and explore why the patient is reacting in a self-defeating way. If the therapist can understand that the patient’s antagonism is in some ways defensive or self-protective and most likely reflects transferential fears of disrespect, abuse, and disappointment, the doctor may be less angry and more empathetic.

Empathy:

Empathy is a way of increasing rapport. An empathetic therapist may anticipate what is felt before it is spoken and can often help patients articulate what they are feeling. Patients sometimes say “How can you understand me if you haven’t gone through what I’m going through?” Clinical psychiatry, however, is predicated on the belief that it is not necessary to have other people’s literal experiences to understand them. The shared experience of being human is often sufficient.

While much early work on this subject was generated from a psychodynamic perspective, researchers from other orientations have since investigated this area. It has been found to predict treatment adherence (compliance) and concordance and outcome across a range of client/patient diagnoses and treatment settings. Research on the statistical power of the therapeutic relationship now reflects more than 1,000 findings.

Most New Teachers Feel Unprepared to Help Students Deal With Mental Health Problems

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  • Toronto district school board found stress and anxiety to be the most prevalent emotional issues among students
  • More than 100,000 students and 75 secondary school teachers
  • 92% of teachers reported that they had students struggling with mental issues
  • 97.4% of them agreed or strongly agreed that it was part of their job
  • 93.3% felt that their education training did not qualify them for dealing with mental health issues

 

Prevalence of Emotional Issues Among Students of Toronto 

                                                        Grade 7-8                                      Grade  9-12
Positive feelings
Feel good about yourself 80% 70%
Feel reasonably happy 78% 67%
Able to enjoy daily activities 76% 64%
Hopeful about the future 72% 62%
Like the way you look 67% 58%
Physical symptoms
Tired for no reason 58% 76%
Difficulty concentrating 56% 76%
Difficulty making decisions 56% 72%
Losing sleep bcz of worry 38% 57%
Doesnt overcomedifficulties 31% 47%
Feel like crying 21% 29%
Emotional challenges
Feel lonely 29% 43%
Feel down 32% 48%
Losing confidence 32% 48%
Under a lot of stress 40% 66%
Feel nervous/anxious 63% 72%

 

Action Plan:

1- Raising awareness about mental health issues (e. g., teen suicide, and bullying)

2- Providing resources to help students with mental health problems

3- Addressing the need of bachelor programs of student teachers to have a more thorough understanding of mental illness and its consequences

 

References

Sarah, B. (2013). Most new teachers feel unprepared to help students deal with mental health   problems: study. National Post. Retrieved from   http://news.nationalpost.com/2013/06/02/teachers-feel-
unprepared-to-help-students-
  deal-with-mental-health-issues/

Schizophrenia Spectrum and Other Psychotic Disorders, DSM-5

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To make it easy on psych students.

A diagnosis of Schizophrenia is quite debilitating on the patient and his/her family, that’s why it is crucial to distinguish between Schizophrenic patient and other disorders on its spectrum.

Schizophrenia diagnosis is made when you have at least one of the following: delusions, hallucinations, or disorganised speech in addition to catatonic behavior or negative symptoms (e.g., diminished emotions expression). the latter symptoms must persist for at least 1 month, and continuous signs of the disturbance must persist for at least 6 months.
Brief Psychotic disorder is relatively easy to distinguish from Schizophrenia since the symptoms must be present for less than 1 month.
Delusional disorder on the other hand, can be diagnosed when the criteria mentioned above in schizophrenia are never met, and the functioning of the patient is not as impaired as in schizophrenia.
Schizoaffective disorder can be considered as schizophrenia coupled with severe mood disturbances, and the clinician can specify whether its bipolar type or depressive type.
Last but not least, the schizophreniform disorder is similar to schizophrenia but with lesser impairment in functioning. Research shows that patients with schizophreniform disorder are more receptive to treatment and report less remission rates compared to those with schizophrenia.

Always make sure that the psychotic disorder is not substance induced and is not due to another medical condition (e.g. brain tumor, multiple sclerosis)

Nurses’ Day Eve

A big thank you to all nurses of the world! You are the heart of the healthcare system.

NurseManifest

It is the eve of our special day

Can we honor nurses’ caring in a new found way?

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Can we as a profession unite?

Centering and shining our healing light.

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It’s our own day emerging from here, nurses’ day eve

Supporting one another, let’s believe:

 

That all nurses can earn a superior pay

That love and caring will rule the day

That hope and healing reign supreme

That we soon shall realize Nightingale’s dream

That we shine the light in any places remaining dark

That each nurse may leave her or his healing mark

That nursing education moves fully toward caring science

That we remain cohesive and united, growing our reliance

Yes, the field of nursing is moving out of oppression

Journeying forward to our own art, science, and caring expression.

~

 

With great thanks to the many nurses actively striving to create transformative change, innovations…

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