23/06/2015 1 Concurrent Disorders: Addiction and Mental Health for Family Physicians June 18 th , 2015 Calgary Zone Mental Health Day Dr. Tim Ayas MD FRCPC CCFP MPH BSc Dr. Tim Ayas Clinical Medical Director Claresholm Centre of Mental Health and Addictions Consultant Psychiatrist Carnat Centre Consultant Psychiatrist to Okotoks, Claresholm, and Vulcan Rural Mental Health Clinics Evaluations Coordinator‐ University of Calgary Undergraduate Medical Education Unit Manager, Major Psychiatric Disorders, University of Calgary Post Graduate Medical Education Co‐Chair, Provincial Network of Concurrent Disorders, Community of Practice Clinical Lecturer University of Calgary Department of Psychiatry Faculty/Presenter Disclosure Personal disclosure: I often throw out the healthy lunches my wife makes for me to sneak in some fast food. Relationships with commercial interests: Grants/Research Support: None Speakers Bureau/Advisory Boards Honoraria: Lilly, Lundbeck, Astra Zeneca, Mylan, Otsuka, Shire, Janssen‐ Ortho, Pfizer and Purdue. Consulting Fees: None Other: None Objectives A brief overview of Concurrent Disorders‐ definition and epidemiology What should be the focus – managing substance abuse or treating the psychiatric comorbidity? Should I prescribe a psychotropic when a patient is actively abusing a non‐medicinal substance? How do you decide if a mood disorder exists when substance abuse is a predominate feature of the presentation? Tips on management based on class of addiction What does ‘Concurrent Disorders’ mean? What is the Definition? Epidemiology of Concurrent Disorders
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Faculty/Presenter Disclosure · PDF fileUnit Manager, Major Psychiatric Disorders, University of Calgary Post ... Co‐Chair, Provincial Network of Concurrent Disorders,
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23/06/2015
1
Concurrent Disorders: Addiction and Mental Health for Family
Physicians
June 18th, 2015
Calgary Zone Mental Health Day
Dr. Tim Ayas MD FRCPC CCFP MPH BSc
Dr. Tim Ayas Clinical Medical Director Claresholm Centre of Mental Health and
Addictions
Consultant Psychiatrist Carnat Centre
Consultant Psychiatrist to Okotoks, Claresholm, and Vulcan Rural Mental Health Clinics
Evaluations Coordinator‐University of Calgary Undergraduate Medical Education
Unit Manager, Major Psychiatric Disorders, University of Calgary Post Graduate Medical Education
Co‐Chair, Provincial Network of Concurrent Disorders, Community of Practice
Clinical Lecturer University of Calgary Department of Psychiatry
Faculty/Presenter Disclosure Personal disclosure: I often throw out the healthy lunches my wife makes for me to sneak in some fast food.
Objectives A brief overview of Concurrent Disorders‐definition and epidemiology
What should be the focus – managing substance abuse or treating the psychiatric comorbidity? Should I prescribe a psychotropic when a patient is actively abusing a non‐medicinal substance?
How do you decide if a mood disorder exists when substance abuse is a predominate feature of the presentation?
Tips on management based on class of addiction
What does ‘Concurrent Disorders’ mean? What is the Definition?
Epidemiology of Concurrent Disorders
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Which of the following about hallucinogens is false?
A Early records of Siberian hunters suggest they started experimenting with hallucinogenic mushrooms after watching abnormal behavior of reindeer grazing on them.
B Hallucinogen use was described in religious writings in India up to 3500 years ago.
C The use of hallucinogens has increased among high school seniors from 1.4 % in 1999 to 5% in 2005
D LSD was utilized as an effective treatment for alcohol dependence in the 1960s in Canada
Assessment Tools
Are the mood and anxiety symptoms substance‐induced? Or is the substance use depression and anxiety induced? What came first?!?!
Evolution of General Treatment Guidelines for Concurrent Disorders
Alcohol
Which one of these statements is one of the earliest recorded uses of Alcohol?
A A tribute used in Ancient Greece in ceremonies to the Greek God Dionysus
B A method for Ancient Egyptians to store grain for the winter
C A beverage consumed by Vikings to celebrate conquests
D Utilized prior to shows by court jesters in the Ming Dynasty
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Opiates
Which of the following statements is false?
A There are more than 40 chemically distinct opiod drugs in clinical use.
B Bayer patented Heroin in 1898.
C Poets Elizabeth Barrett Browning and Samuel Tayor Coleridge were well known abusers of opium
D Morphine derives it name from the Greek god of dreams Morpheus
Cannabis
All of the following are street names for Cannabis except for one
A Yellow Submarine
B Rainy‐day Woman
C Muggles
D Gruffalo sticks
Sedatives
Which of the following statements about sedatives is false?
A More than 2500 barbituates were synthesized
B The first sedative synthesized was chloral hydrate in the mid 1800s
C The first benzodiazepine synthesized was Temazepam in 1957
D Rhovane (Imovane) acts upon a benzodiazepine receptor that induces sleep
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Stimulants
Which historical figure was a well‐known advocate for the health benefits of using cocaine?
A King Louis XIV
B Thomas Edison
C Sigmund Freud
D Abraham Lincoln
What if they don’t want help? What if they don’t want help?
Where Can You Refer to? ReferencesAPA Guidelines. Practice Guidelines for the Treatment of Patients
with Substance Use Disorders. Second Edition (2006)Ciraulo DA, Piechniczek‐Buczek J, Iscan EN. (2003) Outcome
predictors in substance use disorders. Psych Clin North Am. 26. 381‐409
Diagnostic and Statistical Manual of Mental Disorders‐ IV TR. Fleury, G. E.K. Koryani Review Course in Psychiatry. Substance
Abuse and Concurrent Disorders. February 2011.Herlin DV, Rush CR, Grabowski. Agonist‐like pharmacotherapy for
stimulant dependence. J Ann. N.Y. Acad. Sci 1187 (2010) 76‐100Kaplan and Saddock. Synopsis of Psychiatry. Ninth Edition.
Lippincott, Williams, and Wilkins. 2003. Schukit, MA. Comorbidity between substance use disorders and
Questions, Comments? "Psychiatry should be outlawed. You don't know the history of psychiatry, I do." Tom Cruise to Matt Lauer, Today Show, June 25th, 2005