As a nurse, if
you have not worked with a patient afflicted with mental illness, and that has
a dual diagnosis, at some point you will.
Mental illness is more easily diagnosed today than it was even 10 years
ago. Many patients have more than one
diagnosis, which can make it difficult to treat until there is a full work-up
and diagnosis. When a patient comes
under your care, there will come a time that you note two diagnoses of mental
illness. It's important to consider both
conditions in providing treatment for the patient.
Dual Conditions
If your
patient suffers from acute obsessive compulsive disorder, there may be
ritualistic behaviors displayed from them, however, if you add bi-polar to this
condition, it could mean that on one visit they will openly discuss their OCD,
yet on the next, they may refuse to discuss it at all. Both conditions must be considered in order
to provide the proper treatment of the patient.
Common Dual Diagnosis’
- Obsessive Compulsive Disorder & Autism- two conditions that are often seen together in patients. Asperger's syndrome is a form of autism, and it is estimated that 8 out of 10 individuals with Asperger's, also suffers from OCD.
- Bipolar & Depression- this may indicate mood swing with your patient, and there may be times that they are to the point of being despondent. If the patient is not eating or is refusing medications, consult with the attending physician.
- Schizophrenia and Paranoia- this particular dual diagnosed patient may be more difficult to treat. If their conditions are not properly managed, they may see visions, which they conceive as people, giving them ideas, thoughts, or instructions. The paranoia may cause them to feel the medication or treatment plan is going to hurt, rather than help them. Consider how you might feel if you were accepting pills from a person, and assuming they are poison that is part of living in the world of a paranoid patient.
Commonality of Dual Diagnosis
Approximately
1/3 of people with mental illness, and ½ with severe mental illness are also
dealing with substance abuse. In
substance abuse programs, about half of the patients report having some form of
mental illness.
Symptoms
Displayed with Dual Diagnosis Patients (alcohol & substance abuse)
•
Withdrawn
from Family and Friends
•
Abrupt
changes in behavior
•
Using
substances, even when overdosing is possible
•
Engaging
in risky behaviors
•
Unable
to control the use of substances
•
Acting
out of character in order to obtain substance of choice
•
Encountering
withdrawal when not using the substance
Treatment of Dual Diagnosis Patients
Most forms of
mental illness are treated with at least one, and often more types of
medication. This is usually accompanied
with some form of therapy. In a
situation where there is a dual diagnosis, the patient may be prescribed multiple
medications to control their conditions.
Common complications with mental health drugs are that patients may
plateau on them, and require a different form of medication. Patients are occasionally admitted to the
hospital in order to regulate their medications. Once an appropriate response from the patient
is reached, the combination of drugs is then used to improve the patient's
quality of life and well being. In many
cases, some type of therapy is generally recommended to assist the patient in
coping with their condition. In some
cases it may be necessary to work to treat the most severe of the conditions,
and get that under control before adding medication or therapy to treat the
second.
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In most cases,
once a condition or conditions have been diagnosed, the process to achieve the
right balance of medication and therapy begins.
When treatment appears to be successful, the patient is usually
monitored on a regular basis to ensure success continues. The majority of patients improve, once
medications are regulated, they go on to be successful and live their normal
life.
Mental
illness is a disease, and regardless of diagnosis, it does not define the
person, it simply indicates they need treatment for the condition, just as
hypertensive patients need proper medicines to regulate their condition. The patient may face some challenging times
while optimum medication levels, however if the end result is success, it's
worth it.
No longer is a
hidden topic, or one to be ashamed of, mental illness simply a condition that
must be addressed and treated. Attending
a seminar on mental illness, or taking additional training may provide a better
insight from the patient's perspective.
You may also visit unlimited resources on the web to learn more.
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