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Psychiatry Education Forum Academy Forums General Discussions DD between dual pathology VS. Substance induced mental illness? Reply To: DD between dual pathology VS. Substance induced mental illness?

  • Ahmed

    May 17, 2021 at 12:23 pm

    Thank you Dr. Singh for your insight. In our hospital, they are strict about admitting pts to a detox unit. As this unit has collaborative meetings and activities with psychologists, social workers and ex-substance users. Any pt with active psychosis would be disruptive to the unit activities and meetings. It is like a boot camp for the half-way house and aftercare services that is attached to our facility. But many times, acute psychosis comes out, then we transfer pts to an acute psychiatric unit. Another problem comes at discharge time when medical reports are requested and long-term management plans are needed to be documented. Whether those pt would be deemed as substance induced psychosis? Or schizophrenia-spectrum ds “dual pathology”? Previous ASAM Essentials put 2-week as cutoff period. Recent ones, DSM5 and ICD11 use a vague description “for a substantial period of time after cessation of the substance use or withdrawal”! In the DSM5 text they give one month as an example. Some authors erroneously consider it as the DSM5 cutoff time between dual pathology and substance induced mental illness. I do not know a scientific answer to this question. But my observation is that the longer and heavier use behavior is, the longer a mental illness is lagging behind cessation of the substance. Sometimes it takes weeks or months, before final recovery. I do not talk about acutely destabilized pts, like in acute alcohol or stimulant intoxicated pts. My point is about how long and how much would you consider a pt as suffering from a dual pathology and two independent illness, whatever they recover from substance use or not? This problem has an administrative and legal values, even on medical reporting or documentation. I hope colleagues put their input and insight. Best regards to all