CARN Co-Occurring Disorders 4 — Questions and Answers
Question 1: A patient with schizophrenia and cannabis use disorder reports that marijuana helps reduce their auditory hallucinations. The nurse's BEST response is:
- Validate their experience and allow continued use since it is helping
- Explain that cannabis may temporarily relieve symptoms but worsens psychosis long-term (Correct answer)
- Immediately discharge the patient from treatment for noncompliance
- Increase antipsychotic medication to compete with cannabis effects
Correct answer: Explain that cannabis may temporarily relieve symptoms but worsens psychosis long-term
The nurse should use psychoeducation to explain that while cannabis may provide short-term relief, it is associated with worsened psychosis, earlier onset, and poorer long-term outcomes in schizophrenia.
Question 2: Which of the following co-occurring disorders requires the nurse to be MOST vigilant about serotonin syndrome when prescribing pharmacotherapy?
- OCD treated with SSRIs and concurrent MDMA use (Correct answer)
- ADHD treated with stimulants and alcohol use
- Bipolar disorder treated with lithium and cannabis use
- PTSD treated with prazosin and heroin use
Correct answer: OCD treated with SSRIs and concurrent MDMA use
MDMA causes massive serotonin release, and when combined with SSRIs used for OCD, creates a high risk for potentially life-threatening serotonin syndrome.
Question 3: In the ASAM multidimensional assessment for a patient with co-occurring disorders, which dimension specifically addresses emotional and behavioral conditions?
- Dimension 1: Acute Intoxication and Withdrawal Potential
- Dimension 3: Emotional, Behavioral, or Cognitive Conditions and Complications (Correct answer)
- Dimension 4: Readiness to Change
- Dimension 6: Recovery Environment
Correct answer: Dimension 3: Emotional, Behavioral, or Cognitive Conditions and Complications
ASAM Dimension 3 specifically addresses emotional, behavioral, or cognitive conditions and complications, including co-occurring psychiatric disorders.
Question 4: A nurse working with a patient with co-occurring borderline personality disorder and alcohol use disorder should prioritize which treatment approach?
- Dialectical behavior therapy combined with motivational enhancement (Correct answer)
- Strict 12-step program attendance without individual therapy
- Inpatient psychiatric hospitalization until remission
- Pharmacotherapy alone without psychotherapy
Correct answer: Dialectical behavior therapy combined with motivational enhancement
Dialectical behavior therapy combined with motivational enhancement therapy is well-supported for co-occurring BPD and alcohol use disorder, addressing both emotion dysregulation and substance use.
Question 5: When evaluating a patient for co-occurring ADHD and stimulant use disorder, which consideration is MOST important before prescribing stimulant medication?
- The patient must complete 6 months of sobriety before any ADHD treatment
- Assessment of ADHD symptom onset prior to stimulant use to confirm independent diagnosis (Correct answer)
- ADHD medications are absolutely contraindicated in all substance use disorder patients
- Stimulant medications should be the last resort after all other options fail
Correct answer: Assessment of ADHD symptom onset prior to stimulant use to confirm independent diagnosis
Confirming that ADHD symptoms predated stimulant use is essential to establish an independent diagnosis, as stimulant intoxication and withdrawal can mimic ADHD symptoms.
Question 6: A patient with generalized anxiety disorder and benzodiazepine use disorder is being treated with a taper protocol. Which adjunct medication would MOST appropriately address anxiety during and after the taper?
- Another benzodiazepine at lower dose
- Propranolol for cardiac symptoms only
- Selective serotonin reuptake inhibitor (SSRI) (Correct answer)
- Hydroxyzine only at bedtime
Correct answer: Selective serotonin reuptake inhibitor (SSRI)
SSRIs are first-line pharmacotherapy for generalized anxiety disorder and are non-addictive, making them appropriate adjuncts during benzodiazepine tapering in patients with co-occurring benzodiazepine use disorder.
Question 7: Which statement about the prevalence of co-occurring disorders in the United States is most accurate?
- Less than 10% of people with substance use disorders have a co-occurring mental health condition
- Approximately half of people with substance use disorders also have a co-occurring mental health disorder (Correct answer)
- Co-occurring disorders are equally distributed across all socioeconomic groups
- Co-occurring disorders are more common in women than men by a 3:1 ratio
Correct answer: Approximately half of people with substance use disorders also have a co-occurring mental health disorder
Epidemiological studies, including SAMHSA's National Survey on Drug Use and Health, consistently show that approximately half of people with substance use disorders also meet criteria for a co-occurring mental health disorder.
CARN Co-Occurring Disorders 4
A patient with schizophrenia and cannabis use disorder reports that marijuana helps reduce their auditory hallucinations.
The nurse's BEST response is: