Magazine article Clinical Psychiatry News

Lack of Response Psychopharmacology in Dual-Diagnosis Patients? Try Higher Doses. (Mental Illness, Substance Abuse)

Magazine article Clinical Psychiatry News

Lack of Response Psychopharmacology in Dual-Diagnosis Patients? Try Higher Doses. (Mental Illness, Substance Abuse)

Article excerpt

COLORADO SPRINGS -- A major reason for lack of response to psychiatric medications in patients with comorbid mental illness and substance abuse is that dual-diagnosis patients often require higher dosing than those with psychiatric disorders only, Dr. Elizabeth B. Stuyt said at a symposium on addictive disorders sponsored by Psychotherapy Associates.

"This population has really induced their hepatic enzyme system through their drug and alcohol use. These people have cytochrome p450 systems that work phenomenally so they can tolerate a lot of medication. And sometimes this is the reason why their medication isn't working," said Dr. Sruyt, medical director of the Circle Program at the Colorado Mental Health Institute at Pueblo.

The Circle Program is an innovative 90day intensive inpatient cognitive-behavioral--based treatment program for dualdiagnosis patients who've failed other treatment programs.

Dr. Stuyt recently admitted a patient who spectacularly illustrated this phenomenon of increased dosing requirements because of heightened liver enzyme activity.

"This young man came in on 1,700 mg/day of Seroquel. But that wasn't all. He was also on 300 mg/day of Effexor, 400 mg of Wellbutrin, 60 mg of buspirone, and on and on. He came in on this huge amount of medication, walking and talking, and totally alert and awake. This man had a major p450 induction. And yet he complained of anxiety. That was his diagnosis--and he was still anxious," the psychiatrist recalled.

Another common explanation for the ineffectiveness of psychiatric medication in a dual-diagnosis patient is continued use of alcohol and/or drugs.

"When you're working with this population, you have to be monitoring them. You have to do random urine drug screening. I recommend having a breathalyzer in your office. This is something that you just do," Dr. Stuyt continued.

Noncompliance is another possibility, but in Dr. Stuyt's experience with dual-diagnosis patients it isn't all that common. Most drug-addicted patients really like taking drugs, including those of the medically indicated prescription variety. …

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