Psychiatric disease and drug abuse.
OBJECTIVE
The term 'dual diagnosis' most commonly refers to the combination of severe mental illness and substance-use disorder (SUD). It is estimated that 7-10 million people in the USA alone have at a minimum one psychiatric disorder in addition to a SUD. As many of the psychiatric illnesses implicated have their origins in childhood, the pediatric population is not immune to this 'dual diagnosis', particularly with the increasing availability of street drugs and increasing accessibility to prescription drugs. The purpose of this review is to identify the magnitude of the problem and strengthen awareness among pediatric healthcare professionals who may provide prevention and/or early intervention.


RESULTS
Causes for the dual diagnosis are unknown, but there are four hypotheses: common factors (risk factors common to both disorders), secondary mental disorder (substance use precipitates mental disorder), secondary substance use ('self-medication hypothesis') and bidirectional (presence of either mental illness or SUD can contribute to the development of the other).


CONCLUSIONS
Those with the presence of this dual diagnosis are more likely to be nonadherent to treatment and may well have poorer outcomes. Integrated care for the maladies rather than split or isolated care is recommended. Psychosocial therapy holds promise for treating patients with dual diagnosis.
Yale University School of Medicine, New Haven, Connecticut, USA. karen.santucci@yale.edu
Karen
K
Santucci
D000293:Adolescent; D002648:Child; D017831:Diagnosis, Dual (Psychiatry); D006801:Humans; D001523:Mental Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D019966:Substance-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy