Benchmark Co Occurring Disorders Worksheet

PCN-153: Topic 1 Benchmark - Co-Occurring Disorders Worksheet Prior to beginning this assignment make sure you have read "Introduction to the DSM" located in the Class Resources. As a practitioner, using the DSM allows you to assess the symptoms and diagnose co-existing disorders. This assignment will help you start to become familiar with the DSM. In this assignment you will:     Become familiar with criterion for specific diagnoses Compare and contrast the similarities and distinctions between co-occurring disorders (mental health disorder and substance use disorder) Understand the importance of severity levels and how to use them effectively Recognize the purpose and use of specifiers in providing a clear more specific diagnosis for an individual client. Directions: Complete the chart below by using the DSM to compare the diagnostic criteria for two disorders, one substance use, and one mental health disorder. Include at least two scholarly sources to support your responses. (Example) Criteria Substance Use Disorder Mental Health Disorder Stimulant Use Disorder A pattern of use of an amphetamine like substance, characterized by at least two of the following within a 12-month period. 1. The stimulant is often taken in larger amounts or over a longer period than was intended. 2. There is a persistent desire or unsuccessful efforts to cut down or control stimulant use. 3. A great deal of time is spent in activities Generalized Anxiety Disorder A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance). B. The individual finds it difficult to control the worry. C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months); Note: Only one item is required in Substance Use Disorder Stimulant Use Disorder necessary to obtain the stimulant, use the stimulant, or recover from its effects. 4. Craving, or a strong desire or urge to use the stimulant. 5. Recurrent stimulant use resulting in a failure to fulfill major role obligations at work, school, or home. 6. Continued stimulant use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of the stimulant. 7. Important social, occupational, or recreational activities are given up or reduced because of stimulant use. 8. Recurrent stimulant use in situations in which it is physically hazardous. 9. Stimulant use is continued despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the stimulant. 10. Tolerance, as defined by either of the following:  A need for markedly increased amounts of the Mental Health Disorder Generalized Anxiety Disorder children. 1. Restlessness or feeling keyed up or on edge. 2. Being easily fatigued. 3. Difficulty concentrating or mind going blank. 4. Irritability. 5. Muscle tension. 6. Sleep disturbance (difficulty falling or staying asleep, or restless, unsatisfying sleep). D. The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. E. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, a medication) or another medical condition (e.g., hyperthyroidism). F. The disturbance is not better explained by another mental disorder (e.g., anxiety or worry about having panic attacks in panic disorder, negative evaluation in social anxiety disorder [social phobia], contamination or other obsessions in obsessivecompulsive disorder, separation from attachment figures in separation anxiety disorder, reminders of traumatic events in posttraumatic stress disorder, gaining weight in anorexia nervosa, physical complaints in somatic symptom disorder, perceived appearance flaws in body dysmorphic disorder, having a serious illness in illness anxiety Explanation of Severity Levels Examples of Specifiers Substance Use Disorder Mental Health Disorder Stimulant Use Disorder stimulant to achieve intoxication or desired effect  A markedly diminished effect with continued use if the same amount of the stimulant. 11. Withdrawal, as manifested by either of the following: a. The characteristic withdrawal syndrome for the stimulant (refer to Criteria A and B of the criteria set for stimulant withdrawal, p. 569). b. The stimulant (or a closely related substance) is taken to relieve or avoid withdrawal symptoms  Mild = Presence of two to three symptoms  Moderate = Presences of four to five symptoms  Severe = Presences of six or more symptoms. In early remission: After full criteria for stimulant use disorder were previously met, none of the criteria for stimulant use disorder have been met for at least 3 months but for less than 12 months (with the exception that Criterion A4, “Craving, or a strong desire or urge to use the stimulant,” may be met).  In sustained remission: After full criteria for Generalized Anxiety Disorder disorder, or the content of delusional beliefs in schizophrenia or delusional disorder) Different rating scales can show the severity level of patients.  Mild  Moderate  Severe Recurrent unexpected panic attacks. An abrupt surge of intense fear or intense discomfort that reaches a peak within minutes, and during which time at least four of the following symptoms occur (Note: The abrupt surge can occur from a calm state or an anxious state): 1. Sweating Substance Use Disorder Stimulant Use Disorder stimulant use disorder were previously met, none of the criteria for stimulant use disorder have been met at any time during a period of 12 months or longer (with the exception that Criterion A4, “Craving, or a strong desire or urge to use the stimulant,” may be met). Mental Health Disorder Generalized Anxiety Disorder 2. Trembling or shaking 3. Unsteady, dizziness, light-headed, or faint 4. Derealization (feelings of unreality) or depersonalization (being detached from oneself) 5. Excessive/accelerated heart rate, palpitations, or pounding heart 6. Nausea or abdominal distress 7. Tingling, numbness, parathesesias 8. Shortness of breath 9. Fear of losing control or “going crazy” 10. Fear of dying 11. Choking feelings 12. Chest pain or discomfort 13. Chills or heat sensations Criteria (250-350 words) Substance Use Disorder: Alcohol Use Disorder Alcohol use disorder is “a problematic pattern of alcohol use leading to clinically significant impairment or distress, as manifested by at least two of the following [criteria], occurring within a 12month period” according to the DSM-5 (ARK, 2022). If the patient experiences any two of the symptoms from the following criteria in the past year, they can be diagnosed with AUD (ARK, 2022). 1. Alcohol is taken often in large amounts or during a longer period than intended. 2. There is a persistent desire or unsuccessful efforts to cut back or control the use.’ 3. A lot of time is spent in activities to obtain alcohol, use it, or recover from using it. 4. Craving, or a strong desire or urge to use alcohol. 5. Recurrent alcohol use resulting in a failure to fulfill major role obligations at work, school, or home. 6. Continued alcohol use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by Mental Health Disorder: Bipolar Disorder For someone to be diagnosed with bipolar disorder a patient must have experienced an episode of mania or hypomania. To be established as mania, the mood of elevation, expansive, or irritation must last for at least a week and be present most of the day almost every day. To be established as hypomania, moods must last for at least four days and be present most of those day almost everyday (Truschel, 2020). During the period, three or more of the symptoms must be present and replicate a significant change from normal behavior. 1. Inflated self-esteem or grandiosity 2. A decrease in need of sleep 3. More talkative 4. Racing thoughts 5. Easily distracted 6. Increase in goal-directed activity or psychomotor agitation 7. Doing activities that can be painful in consequences: buying sprees Bipolar disorder on the depressive side is established by an episode of major depression and can result in depressed mood or loss of interest or pleasure in doing things. A patient must experience five or more of the following symptoms in 2 weeks to be considered someone with major depressive episode: 1. Mood of depression almost Explanation of Severity Levels (75-150 words) Substance Use Disorder: Alcohol Use Disorder the effects of alcohol. 7. Important social, occupational, or recreational activities are given up or reduced because of alcohol use. 8. Recurrent alcohol use in situations in which it is physically hazardous. 9. Alcohol use is continued despite knowledge of having a persistent or recurrent psychical or psychological problem that is likely to have been caused or exacerbated by alcohol. 10. Tolerance, as defined by either of the following: a need for markedly increased amounts of alcohol to achieve intoxication or desired effect, or a markedly diminished effect with continued use of the same amount of alcohol. 11. Withdrawal, as manifested by wither of the follow: the characteristic withdrawal syndrome for alcohol, or alcohol (or closely related substance, such as a benzodiazepine) is taken to relieve or avoid alcohol withdrawal symptoms. Classification by the DSM-5 for alcohol use disorder by the severity is determined by how many of the 11 diagnostic criteria are met. Mental Health Disorder: Bipolar Disorder everyday for most of the day 2. No interest in things or pleasure for most things 3. Weight loss/increase in appetite or decrease 4. Doing purposeless movements like pacing 5. Loss of energy 6. Feelings of guilt/worthlessness 7. Can’t think or concentrate, undecided 8. Thinking about death, or suicidal Most severe: Bipolar 1 disorder which defined my manic episodes must last at least 7 days. Mild: Bipolar 2 disorder which is defined by depressive episodes but Examples of Specifiers (200-300 words) Substance Use Disorder: Alcohol Use Disorder  Mild: A presence of 2-3 of the criteria.  Moderate: A presence of 4-5 of the criteria  Severe: Presence of 6 or more of the criteria The severity levels are used by clinicians often to determine the risk, the eligibility for different treatment programs, or recommendations for options of treatment including the cost (ARK, 2022). The DSM-5 criteria can include if someone is in “early remission”, which is when it’s been 3-12 months since the patient has met AUD criteria. During that time, they have not had any symptom with the exception for cravings (#4). “Partial remission” being that it has been over 12 months since patient has met AUD criteria. During that time the patient has not had symptoms with exception of cravings (#4). Lastly, “In a controlled environment” is when the patient does not have access to alcohol which can include treatment facility or incarceration (Murray, 2021). Mental Health Disorder: Bipolar Disorder less severe than manic episodes (NIH, 2022). There are specified 6 different types of bipolar 1 disorder.  Disorder with a single manic episode (Specify if: Mixed symptoms meet criteria for a mixed episode)  Disorder with most recent hypomanic episode (Specify if: longitudinal course specifier with or without interepisode recovery)  Disorder with most recent mixed episode (Specify if: severity/psychotic/remission specifiers, with catatonic features, with postpartum onset).  Disorder with most recent depressed episode (specify if: severity/psychotic/remission specifiers, chronic, with catatonic features, with melancholic features, with atypical, postpartum onset)  Disorder with most recent episode unspecified (SAMSHA, 2016). Commentary about the importance of a counselor differentiating between the two disorders (75-150 words) Substance Use Disorder: Mental Health Disorder: Alcohol Use Disorder Bipolar Disorder If bipolar disorder 1 or 2 was a condition the patient already had, then it would be more harmful to them if they abused alcohol. If the correct assessments and criterion are not met than the treatment of the person would not be effective. The issues in both cases would also not be addressed properly which would cause the patient to inherit more issues with bipolar disorder as well as alcohol use disorder.