CARN Co-Occurring Disorders 2 — Questions and Answers
Question 1: A nurse is caring for a patient with schizophrenia and alcohol use disorder. Which treatment approach is most evidence-based for this population?
- Treat the psychiatric disorder first, then the addiction
- Treat the addiction first, then the psychiatric disorder
- Integrated dual diagnosis treatment addressing both simultaneously (Correct answer)
- Refer to separate specialized programs for each disorder
Correct answer: Integrated dual diagnosis treatment addressing both simultaneously
Integrated dual diagnosis treatment that addresses both co-occurring disorders simultaneously is the most evidence-based approach for individuals with serious mental illness and substance use disorders.
Question 2: Which medication is FDA-approved for alcohol use disorder and has also shown benefit in reducing cravings in patients with bipolar disorder?
- Disulfiram
- Naltrexone (Correct answer)
- Acamprosate
- Topiramate
Correct answer: Naltrexone
Naltrexone, an opioid antagonist, is FDA-approved for alcohol use disorder and has demonstrated efficacy in reducing alcohol cravings in patients with co-occurring bipolar disorder.
Question 3: A patient presents with severe anxiety and benzodiazepine dependence. After stabilization, which non-addictive anxiolytic medication would be most appropriate for long-term anxiety management?
- Clonazepam
- Alprazolam
- Buspirone (Correct answer)
- Lorazepam
Correct answer: Buspirone
Buspirone is a non-addictive anxiolytic that does not carry abuse potential, making it appropriate for long-term anxiety management in patients with benzodiazepine use disorder.
Question 4: The term 'self-medication hypothesis' in the context of co-occurring disorders refers to:
- Patients prescribing their own psychiatric medications
- Individuals using substances to manage untreated psychiatric symptoms (Correct answer)
- Healthcare providers allowing patients to manage their own detox
- The use of over-the-counter drugs for mental health conditions
Correct answer: Individuals using substances to manage untreated psychiatric symptoms
The self-medication hypothesis proposes that individuals with psychiatric disorders use substances to alleviate distressing symptoms such as anxiety, depression, or psychosis.
Question 5: Which psychiatric disorder has the HIGHEST comorbidity rate with substance use disorders?
- Major depressive disorder
- Generalized anxiety disorder
- Antisocial personality disorder (Correct answer)
- Obsessive-compulsive disorder
Correct answer: Antisocial personality disorder
Antisocial personality disorder has the highest comorbidity rate with substance use disorders, with studies showing up to 84% of individuals with ASPD meeting criteria for a substance use disorder.
Question 6: A nurse assesses a patient in early opioid withdrawal who also has a history of PTSD. Which symptom would be MOST concerning and warrant immediate intervention?
- Mild nausea and diaphoresis
- Suicidal ideation with a plan (Correct answer)
- Mild anxiety and irritability
- Yawning and lacrimation
Correct answer: Suicidal ideation with a plan
Suicidal ideation with a plan is an immediate safety concern requiring urgent psychiatric intervention, as individuals with co-occurring PTSD and opioid withdrawal are at elevated suicide risk.
Question 7: Which of the following best describes 'diagnostic overshadowing' in the context of co-occurring disorders?
- A patient hiding their substance use from providers
- Attributing psychiatric symptoms solely to substance use, missing underlying mental illness (Correct answer)
- A comorbid condition that worsens substance use outcomes
- The use of multiple diagnoses to explain one set of symptoms
Correct answer: Attributing psychiatric symptoms solely to substance use, missing underlying mental illness
Diagnostic overshadowing occurs when clinicians attribute all symptoms to one condition (substance use) and fail to recognize or diagnose a co-occurring psychiatric disorder.
CARN Co-Occurring Disorders 2
A nurse is caring for a patient with schizophrenia and alcohol use disorder.
Which treatment approach is most evidence-based for this population?