Co-Occurring Disorders Flashcards

A patient with co-occurring major depression and opioid use disorder is started on buprenorphine/naloxone. Which additional benefit of this medication is particularly relevant to this patient's psychiatric comorbidity?

Answer: Buprenorphine has demonstrated antidepressant properties through kappa-opioid receptor antagonism

Buprenorphine's antagonism at kappa-opioid receptors, which are implicated in depressive states, may contribute to antidepressant effects in patients with co-occurring depression and opioid use disorder.

A nurse in an integrated treatment program notices a patient with co-occurring disorders is rotating between individual therapy, group therapy, and case management in the same week. This model is BEST described as:

Answer: Integrated treatment

Integrated treatment involves a unified team addressing both substance use and mental health within the same program simultaneously, which is distinct from sequential or parallel models.

Which of the following is a key principle of Assertive Community Treatment (ACT) that makes it particularly effective for individuals with co-occurring serious mental illness and substance use disorders?

Answer: High staff-to-patient ratios with outreach in the community

ACT uses high staff-to-patient ratios and meets patients in their natural environment, making it highly effective for engaging individuals with serious mental illness and co-occurring substance use disorders who struggle with traditional clinic-based care.

A patient with co-occurring alcohol use disorder and liver cirrhosis needs pharmacotherapy for depression. Which antidepressant should be used with GREATEST caution?

Answer: Nefazodone

Nefazodone carries a black box warning for potentially fatal hepatic failure and is contraindicated in patients with liver disease, making it particularly dangerous in patients with alcohol-related cirrhosis.

When using the SAMHSA No Wrong Door approach for individuals with co-occurring disorders, the primary goal is to:

Answer: Allow any system entry point to connect individuals to comprehensive services

The No Wrong Door approach ensures that regardless of which system a person enters — mental health, substance use, or primary care — they are connected to comprehensive, coordinated services for all their needs.

A patient with co-occurring cocaine use disorder and depression has been abstinent for 3 weeks but reports persistent anhedonia and low mood. The nurse should FIRST:

Answer: Reassess after 4-6 weeks of abstinence before diagnosing independent depression

Cocaine-induced depression can persist beyond 2 weeks; reassessing after 4-6 weeks of abstinence allows clinicians to distinguish substance-induced from independent depressive disorders before initiating antidepressant pharmacotherapy.

Which approach to trauma-informed care is MOST important when working with patients with co-occurring PTSD and substance use disorders?

Answer: Creating a safe environment that emphasizes trust, choice, and collaboration

Trauma-informed care emphasizes creating physical and emotional safety, building trust, offering choice and collaboration, and empowering patients — foundational elements especially critical for patients with co-occurring PTSD and substance use disorders.