IMPACTO FAMILIAR DEL JUEGO PATOLÓGICO

Abstract

1. OBJECTIVES 1) To explore the diagnostic challenges associated with dual-diagnosis.2) To enhance clinicians' understanding of the clinical features related to dual-diagnosis.3) Discussing effective treatments and interventions to help better understand dual-diagnosis for improving patient outcomes. MATERIALS AND METHODSThe presented case involves a 28-year-old male with a complex history of substance use disorders, psychiatric comorbidities, and recent onset psychotic symptoms.The patient reported a history of depression and anxiety, with exacerbation of symptoms coinciding with increased use of cannabis, methamphetamine, and opioids.Notably, the patient experienced auditory hallucinations described as "chatters" both during and between substance use sobriety episodes, with concerns around psychosis.Physical Examination-Benign except general appearance + anxious appearing, limited hygiene and grooming, poor dentition.Mildly dilated pupils.Mental Status Examination-Benign except + fidgety, anxious appearing,+ somewhat paranoid appearing, organized & linear thought process, + racing thoughts, + auditory hallucinations, mood + anxious and congruent w/ affect, fair insight, with limited judgement.Labs: Negative except UDS + opioids, cannabis; Lipids -LDL 160 mg/dL 3. RESULTS & CONCLUSION Psychopharmacological Interventions: * Olanzapine (15 mg at bedtime): Targeting psychotic symptoms.* Fluoxetine (40 mg daily): Addressing depression and anxiety.Substance Use Disorder Treatment: * The patient was referred to an opioid treatment program for initiation on Suboxone, addressing opioid use disorder and chronic pain.* The patient is currently on Suboxone 6 mg sublingual (BID) and has achieved sobriety from opioids; he has most recently been sober from cannabis.Significant reduction in methamphetamine use has also been reported.Outpatient Follow-Up: * Given the absence of immediate safety concerns, the decision was made to continue treatment on an outpatient basis with close follow-up.Regular monitoring is crucial for assessing the effectiveness of interventions and addressing emerging symptoms.Prognosis and Challenges: * The patient's guarded prognosis is influenced by the complexity of co-occurring substance use disorders, psychiatric symptoms, and social factors.* Ongoing challenges include the risk of return to use, managing chronic pain, and addressing potential psychosocial stressors such as unemployment, social support.In conclusion, this case underscores the intricate interplay between substance use and mental health.A comprehensive and integrated treatment approach, encompassing psychopharmacological interventions, substance use disorder treatment, and close outpatient follow-up, had been initiated to address the patient's unique needs and challenges.Continued monitoring and adjustment of the treatment plan be essential for optimizing outcomes and supporting the patient on their path to recovery.