Psychiatric Disorders And Co-Occurring Illnesses (Dual Diagnosis/Dual Disorders)
A third of my private practice involves working with addictive processes and the quest for a qualitative recovery. The other realm of my practice includes working with people who suffer from psychiatric illnesses, human struggles and co0occurring disorders (dual diagnosis). This is my field of interest and passion, based on my varied 30 years of experience in the field of psychiatry.
I will first elaborate on the psychiatric disorders and then move on to the co-occurring disorders.
The various psychiatric disorders that my work includes in my private practice are:
Mood Disorders:
- Major depressive disorders
- Dysthymic and Cyclthymic disorders
- Mood disorders due to a medical condition
- Bipolar affective disorder
Anxiety Disorders:
- Generalised anxiety disorders
- Social anxiety disorder
- Obsessive compulsive disorder
Co-Occurring Illnesses
I provide psychotherapy,(highlight) which is an interactive process, in the context of a safe and peaceful setting utilizing the therapeutic relationship and various therapeutic techniques to facilitate change. This includes the exploration and resolution of troublesome thoughts (obsessions), distorted beliefs, feelings and behaviours for the purpose of problem-solving, gaining insight and therefore, opportunities to change, or achieving higher levels of functioning or more functional ways of interacting.
The goal of psychotherapy is to diminish, eliminate or control disabling or troublesome symptoms so as to improve the quality of the person’s existence, create a sense of empowerment over their lives, an installation of hope and a belief in their abilities to make the necessary changes.
In working with psychiatric disorders I work collaboratively with psychiatrists and general practitioners (highlight) for medical and psychological evaluations and managing psycho-pharmacological interventions and longer term management. I am reticent to work with individuals who have been prescribed medication for a particular disorder, without the involvement of their/a psychiatrist or general practitioner.
There are many forms of psychotherapy and it can be used with individuals, families and in groups. I use an eclectic and (not or) integrative approach tailored to a particular disorder and individual.
The various techniques that I utilize include:
- Cognitive Behavioural Therapy (CBT)
- Dialectical Behavioural Therapy (DBT)
- Systemic Therapy
- Rational-Emotive-Behavioural Therapy
- Mindfulness, Meditation and Relaxation Techniques
- Sleep Hygiene Practices
- Promotion of Health – Exercise and Eating Patterns
- Promotion of Self-Help Groups
Cognitive Behavioural Therapy (CBT) – Modifying patterns of thoughts and behaviours….changing how we think about things; highly effective in the treatment of depression and OCD;
Dialectical behavioural Therapy (DBT) – It is an offshoot of CBT and is focused on enhancing client motivation, developing and applying new skills to specific challenges, for example, mindfulness, distress tolerance, interpersonal effectiveness and emotional regulation. It is effective in treating depression, substance abuse, eating disorders, PTSD and borderline personality disorders.
Systemic Therapy – Addresses a network of relationships as well as the individuals themselves;
Behavioural therapy – what we do;
Rational Emotive-Behavioural Therapy – This is an active directive, solution-based therapy which focuses on resolving emotional, cognitive and behavioural problems in clients;
Mindfulness, meditation and relaxation techniques;
Sleep hygiene practices;
Exercise;
Self-help groups.
Co – Occurring Disorders: (Dual Disorder/Dual Diagnosis)
Co-occurring disorders (COD) refers to clients who are suffering from a mental illness or illnesses and a co-morbid substance abuse disorder. A diagnosis of co-occurring disorders occurs when at least one disorder of each type can be established independent of the other and is not simply a cluster of symptoms resulting from the one disorder.
The term co-occurring disorders replaces the terms dual disorder or dual diagnosis. The latter terms, refers to the combination of two disorders occurring at the same time, for example, addiction and a mental disorder, which can be confusing if there are more than 2 disorders that the individual suffers from. The combinations of co-occurring disorders vary along important dimensions, such as severity, chronicity, disability and degree of impairment in functioning.
Common examples of COD can include the combination of:
- Major depression with cocaine abuse;
- Alcohol substance abuse with panic disorder;
- Alcohol and poly substance abuse with schizophrenia;
- Borderline personality disorder with episodic poly substance abuse;
- Attention deficit disorder with substance use disorder.
Treatment of co-occurring disorders can be complicated and therefore, it requires an integrated treatment approach (remove s) which is the blending of interventions, with a consistent philosophy, into a uniquely devised treatment program for the client. The treatment needs to be collaborative in order to treat the addiction as well as the co-morbid psychiatric illness(s).
Effective treatment for helping a client face the challenge of a co-occurring illness should include:
- A stable, supportive psychotherapeutic relationship;
- Use of techniques specific to the prominent personality traits, psychotherapy and other psychosocial interventions;
- Individual psychotherapy centres on tasks like building motivation, identifying self-defeating thoughts, learning positive new behaviour and relapse prevention;
- Group therapy offers a strong support network for individuals who are struggling with mental health disorders as well as addiction;
- Psychopharmacology (medications) can be utilised selectively to address distressing, overwhelming and problematic thoughts, moods and behaviours that impair the individual’s functioning;
- Treatment also includes managing acute/emergent situations such as self-harm and/or suicidality.
- Encouraged to attend 12 Step support groups.
Clients suffering from a co-occurring illness (including their families) face complex challenges such as developmental disabilities, domestic violence, trauma, legal, educational and other social issues and have an increased rate of relapse and hospitalizations. In my work with these clients I am supportive, consistent and respectful in their quest for dignity and pursuit of their own meaningful goals in life. I encourage the client to take responsibility for their illnesses and in so doing they can reach a point of acceptance.