CLINICAL HANDBOOK OF SCHIZOPHRENIA

CHAPTER 13ASSESSMENT OFCO-OCCURRING DISORDERSKAREN WOHLHEITERLISA DIXONThis chapter covers the assessment of a range of disorders that commonly co-occur withschizophrenia. These include use and abuse of different substances, such as alcohol, otherdrugs, and nicotine. The increased recognition of the important role that mental healthprofessionals assume in the diagnosis and management of co-occurring somatic disordershas required that mental health practitioners perform routine monitoring and assessmentof such disorders. Assessment of co-occurring addiction and somatic disorders often requirestwo types of approaches. The first approach involves asking the patient a series ofquestions. The second approach includes a variety of biophysical tests. Both are coveredin this chapter.SUBSTANCE ABUSE DISORDERSApproximately 50% of persons with schizophrenia have a lifetime rates of co-occurringsubstance abuse, with rates approaching 70–80% in more acutely ill samples. Substanceabuse is associated with a number of adverse clinical, social, and behavioral outcomes.Thus, assessment is critical, so that appropriate treatment can be initiated. Integrated,stage-specific treatments have been found to be effective for patients with co-occurringsubstance use disorders. Once patients are diagnosed with a substance abuse disorder, itis important to assess regularly for drug and alcohol abuse, using a multifaceted approachthroughout treatment.Studies report a number of methods for assessing substance use. Self-report is often acommon technique; however, due to frequent underreporting by patients, this techniquemay best be utilized as a collateral data point with biochemical tests, such as urine toxicologyor breath analysis and clinician ratings. Typically data are collected from multiplesources, and patients are assessed for substance use over a period of time.125