Integrating mental health and substance abuse into HIV services

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Integrating mental health and substance abuse
into HIV services

• Carol Cano

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Assessment and Appropriate Placement

• Drug Use
• Medical Diagnosis
• Psychiatric Diagnosis
• Psychosocial Issues

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Multiple Diagnosis Patients

• Chemical Dependency
• Psychiatric Disorder
• Medical Diagnosis

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Medical disorder mimic Psychiatric disorders

• Diabetes mellitus-Mood swings with fluctuating
  blood glucose levels
• Cirrhosis(alcoholHCVHBV)- Fatigue/depression
• Thyroid Disease- Hyperactive-confusion,
  anxiety,agitated depression,mania,delusions,halluc
  inations

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HIV/AIDSNeuropsychiatric

• Generalized Anxiety Disorder
• Post Traumatic Stress Disorder
• Obsessive Compulsive Disorder
• Adjustment Disorder(5-20)
• Depressive Disorder(4-40)
• Dementia

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Substance Abuse mimics Psychiatric Disorder

• Stimulants Bipolar Affective DisorderMajor
  Depressive disorderAnxiety
• AlcoholAnxietyDepressionPsychosis
• Heroin/opiates DepressionMasks psychosis
• Marijuana ParanoiaAnxiety

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Treatment

• Need for An Integral Approach
• Health Education
• Realistic Goal Setting

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Ascertain Proper Placement

• Drug Use
• Medical Diagnoses
• Psychiatric Diagnoses
• Psychosocial Issues

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Drug Use

• Type
• Frequency
• Duration
• Withdrawal Symptoms
• Rule of Thumb

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Type

• Alcohol
• Benzodiazedines
• Other Sedative-Hypnotics
• Opiates
• Stimulants

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Frequency

• Several Times A Day
• Daily
• 3 Times A Week
• Weekly

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Program OptionsOutpatient

• Social Model
• Medically neutral
• Medical Model
• Methadone or non-methadone

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Program OptionsInpatient

• Social Model
• Medical Model
• Social Model with medical supervision
• Therapeutic Community

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Psychiatric DisorderIn general

• Antisocial Personality Disorder
• 30-60 with Substance Abuse
• Depression
• 30-50 opioid abuse or dependence
• 40 alcohol abuse or dependence

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Alcohol-related disorders

• Other substance-related disorders
• Antisocial Personality Disorder
• Mood Disorders
• Anxiety Disorder

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Opioid-dependence

• Major Depressive Disorder
• Alcohol Use Disorders
• Antisocial Personality Disorders
• Anxiety Disorder

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Chemical Dependency

• Methamphetamine
• Alcohol
• Herion
• Other Crack cocaine

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TreatmentNeed For An Integral Approach

• Chemical Dependency
• Mental Health
• Medical/physical
• Legal
• Housing Employment

• Relationship
• Education
• Relationships
• Family/social
• Economic/Financial
• Spiritual
• Personal/other

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Multidisciplinary Team

• Internist/Family Practitioner
• Psychiatrist-Addictionist
• Licensed Clinical Supervisor
• Case Manager
• Substance Abuse Counselor
• Spiritual Issues
• Cultural Sensitivity

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Develop Virtual Team

• Where Resources Are Limited

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Health Education for Patients

• Fitness
• Nutrition
• Chemical dependency and physical illness
• Chemical dependency and mental illness
• Medication Adherence/compliance issues
• Complementary therapies
• Nature and Healing

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Realistic Goal Setting

• Different Outcome Expectations
• Need for Greater Tolerance working with Multiple
  Dual Diagnosis Patients
• Capacity for Honoring Diversity Essential

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