How Is Dual Diagnosis Assessed?


The task of assessment in the face of dual diagnosis can be especially difficult due to the co-occurring nature of the disorders involved.

It is often troublesome determining which disorder is primary to the other as most times the symptoms overlap. In order for proper assessment to be carried out, it is important for the subject at hand to be sober.

Sobriety then Assessment

 

The Diagnostic and Statistical Manual of Mental Disorders advises that diagnosis of primary psychiatric disorders should never be made in the absence of sobriety.

This is to allow time for disorders brought about by substance abuse to dissipate so that a proper primary disorder can be diagnosed.

The reason a period of detoxification is important is because most substance use disorders usually present themselves in symptoms that will disappear after substance use has stopped. Allowing a sober period of about a year gives the physician higher chances of correctly diagnosing the COD, or co-occurring disorders.

Several models have been developed to enable physicians to correctly identify the disorders present in an individual.

These include:

1. PRISM-IVPRISM (Psychiatric Research Interview for Substance and Mental Disorders)

This is one of the most widely used interview models that is applied in the clinical assessment of co-occurring disorders.

This is basically a set of structured questions which the physician uses to assess the mental illness and its relation to substance abuse.

There are over ten mental health disorders that are targeted in the PRISM model questionnaire.

These include:

  • personality disorders
  • obsessive compulsive disorders(OCD)
  • social phobias
  • panic disorders
  • major depression
  • manic depression
  • schizophrenia

The PRISM model is designed in such a way that the questions related to substance abuse come before those related to mental health illness. This way, the preceding questions can serve as a benchmark for possible mental health disorders for entrance into an alcohol treatment center.

2. Young Mania Rating Scale (YMRS)

First published in 1978, the YMRS is an eleven item diagnostic questionnaire with multiple choices.

It is used by psychiatrists to determine the severity of manic episodes in patients. It was originally designed to cater to bipolar disorder assessment but has since been modified to accommodate manic disorders.

The earliest versions of the scale were intended for adult patients but it has since been modified to include pediatric patients. In fact, a similar scale has been developed for clinicians to use in interviewing parents with the intention of diagnosing mania in children.

3. Montgomery-Asberg Depression Rating Scale(MADRS)

It is a diagnostic questionnaire of ten items.

It is used by psychiatrists to determine the severity of depressive episodes in clients suffering from mood disorders. It was designed in 1979 by researchers from Britain and Sweden.

A higher score on the MADRS indicates severe depression, with the scores ranging from 0-6 and the overall score being between 0-60.

There are more models used and they are typically diagnostic questionnaires.

Although a diagnosis that is 100% accurate might be improbable, with the right model a physician is able determine which mental health disorders are cormobid with the substance abuse problem.

Assessment of dual diagnosis is aimed at enabling the physician to determine the appropriate course of action as far as the existing COD is concerned.

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