CARN Managing Co-Occurring Disorders 4 — Questions and Answers
Question 1: A patient with generalized anxiety disorder (GAD) and benzodiazepine use disorder requires anxiolytic treatment. The safest pharmacological option is:
- Lorazepam at a reduced dose
- Buspirone, a non-benzodiazepine anxiolytic (Correct answer)
- Diazepam with weekly prescription refills
- Alprazolam due to its rapid onset of action
Correct answer: Buspirone, a non-benzodiazepine anxiolytic
Buspirone is a non-addictive anxiolytic without abuse potential, making it the safest option for patients with co-occurring benzodiazepine use disorder.
Question 2: When conducting a suicide risk assessment in a patient with co-occurring depression and alcohol use disorder, which factor increases suicide risk most significantly?
- Participation in group therapy
- Active alcohol intoxication combined with depressive symptoms (Correct answer)
- Prescribed antidepressant therapy
- Engagement with a sponsor in a 12-step program
Correct answer: Active alcohol intoxication combined with depressive symptoms
Active alcohol intoxication dramatically increases impulsivity and lowers inhibitions, significantly elevating suicide risk in patients with co-occurring depression.
Question 3: A patient with schizophrenia in recovery from methamphetamine use disorder begins experiencing worsening psychosis. The CARN should first:
- Assume relapse to methamphetamine and obtain a urine drug screen (Correct answer)
- Increase antipsychotic medication immediately without assessment
- Discharge the patient to an emergency psychiatric facility
- Reduce the antipsychotic dose to minimize side effects
Correct answer: Assume relapse to methamphetamine and obtain a urine drug screen
Methamphetamine use can worsen psychotic symptoms, and confirming or ruling out relapse through drug screening is the essential first step.
Question 4: Which stage of the Prochaska transtheoretical model describes a patient who acknowledges their substance use is problematic but is not yet planning to change?
- Precontemplation
- Contemplation (Correct answer)
- Preparation
- Action
Correct answer: Contemplation
In the contemplation stage, individuals are aware of the problem and considering change but have not yet committed to taking action.
Question 5: Naltrexone is contraindicated in a patient with co-occurring opioid use disorder and:
- Major depressive disorder
- Acute hepatitis with elevated liver enzymes (more than 3-5x normal) (Correct answer)
- Generalized anxiety disorder
- Post-traumatic stress disorder
Correct answer: Acute hepatitis with elevated liver enzymes (more than 3-5x normal)
Naltrexone is hepatotoxic at high doses and is contraindicated in patients with significant hepatic impairment, including acute hepatitis with elevated transaminases.
Question 6: A patient with co-occurring major depressive disorder and opioid use disorder on buprenorphine/naloxone reports that their antidepressant is 'not working.' The most important consideration is:
- Buprenorphine has antidepressant properties that may mask the need for additional medication
- Immediately switch to a different antidepressant class
- Confirm the patient is taking the antidepressant as prescribed and assess for ongoing substance use (Correct answer)
- Discontinue buprenorphine therapy to enhance antidepressant effectiveness
Correct answer: Confirm the patient is taking the antidepressant as prescribed and assess for ongoing substance use
Non-adherence and ongoing substance use are the most common reasons for apparent antidepressant treatment failure in patients with co-occurring disorders.
Question 7: Family involvement in the treatment of co-occurring disorders is important primarily because:
- Families can control patient behavior more effectively than clinicians
- Family systems often enable both the substance use and mental illness (Correct answer)
- Families should be held legally responsible for patient relapses
- Family therapy replaces the need for individual treatment
Correct answer: Family systems often enable both the substance use and mental illness
Family dynamics can inadvertently reinforce both substance use and mental health symptoms through enabling behaviors, making family involvement critical to recovery.
CARN Managing Co-Occurring Disorders 4
A patient with generalized anxiety disorder (GAD) and benzodiazepine use disorder requires anxiolytic treatment.
The safest pharmacological option is: