Dual diagnosis Symposium

The symposium will focus on an overview of dual diagnosis, management strategies and discuss gambling in relation to psychiatric illness.Dual Diagnosis is the co-occurrence of mental illness and substance misuse. People with Dual Diagnoses are more likely to have longer admissions to hospital, have poor quality of life and place enormous burden upon carers. Increased violence and suicide have been reported in this population. Poor compliance with treatment recommendations is a feature that causes considerable frustration to clinicians, families,service administrators and police alike.Ethical and legal aspects of current treatments will be examined. A discussion of the historical background and legacies of different treatment philosophies in the Mental Health and Drug Treatment systems will precede a description of the various means of attempting to ensure that treatment is undertaken. The impact of various legislative arrangements will be reviewed, using state legislation from Victoria as examples. This will be followed by a study that investigated the views of health workers in South Australia about how to respond to patients who have substance use disorders and other mental illnesses.A working group (comprising workers and consumers) developed an array of typical case scenarios based on actual patients with co-morbidity problems. The scenarios included how patients were managed, that were then re-worked into what was thought would be“best practice” management. The scenarios were then examined together to identify the main themes, which indicated problems and solutions in helping this group of patients. The themes settled into areas of; assessment of patients,training of staff, co-operation and collaboration between institutions,knowledge of what are best practices, and facilities and resources. Not only the ensuing policies but also the processes by which they were derived were found to be helpful.We would next review management guidelines for those admitted to an acute in patient facility.Relatively large numbers of in-patients have comorbid substance use problems. Unless specifically questioned they may not divulge their drug habit, hence relevant inquiry is a sine qua non. Making diagnoses pose challenges to the psychiatrist not only among those patients ‘new’to the service but even among those who are longer term service recipients.A diagnostic formulation at the time of admission will dictate the management plan. Along with the treatment of the psychiatric disorder any withdrawal symptoms need to be dealt with. Educating the patient and carers, acknowledging our limitations are an important facet.Referral to appropriate services for management of the drug habit is necessary. A zero tolerance approach is recommended for the ward.Finally the issue of Problem Gambling and the relationship of this problem to other habitual behaviours, especially alcohol and illicit drugs will be examined. The overlap with other psychiatric conditions will be explored with the view that depression is natural to the consequences of gambling rather than the cause in most situations, and that an overlap with other conditions occurs but is rare.