Schizophrenia Case Series, Part 2: Management Strategies for Dual Diagnosis in Patients with Schizophrenia
neuroscienceCME Medical Simulation
 | Patient Info: John is a 23-year-old male who recently completed 2 weeks of inpatient treatment for an acute psychotic episode. He has a personal and family history of alcohol dependence. He is consulting with his psychiatrist about possible treatment options upon discharge. |
This activity offers CE credit for:
- Physicians (ACCME/AMA PRA Category 1)
- Pharmacists (ACPE)
Credit Expiration Date:
Saturday, April 3, 2010
 | Rakesh Jain, MD, MPH Director, Adult and Child Psychopharmacology Research R/D Clinical Research, Inc. Lake Jackson, TX |
Substance dependence is a common comorbidity in patients with psychiatric illness, and is
associated with poorer long-term outcomes related to lower treatment adherence, increased
number of relapses, higher symptom severity, and sociological factors such as poor housing,
employment status, and economic situations.(1) Differential diagnosis of schizophrenia in patients
with possible drug-induced symptoms is challenging but vital to appropriate management;
conversely, appropriate assessment and diagnosis of substance use disorder also is required to
develop a treatment plan that takes into account both psychotic symptoms and alcohol and/or drug
abuse. Long-term management of dually diagnosed patients requires a multifactorial approach
including pharmacologic, nonpharmacologic, and psychosocial strategies designed to manage both
psychotic symptoms and substance abuse. There are a number of choices for the pharmacologic
management of psychotic symptoms, and selection of an appropriate agent must take into account
comorbid substance use, issues with non-adherence, side effects, and concomitant medications.
There are a number of FDA-approved agents available to help treat alcohol dependence but
each of these medications has benefits and limitations that must be considered with respect to
the particular clinical picture of the individual patient. For patients who abuse other substances,
behavioral strategies have been shown to be effective, and the need for intensive behavioral
intervention is a key consideration in selecting a long-term treatment plan.
- Green AI, Noordsy DL, Brunette MF, O'Keefe C. Substance abuse and schizophrenia: Pharmacotherapeutic intervention. J Subst Abuse Treat 2008;34:61-71.
To provide mental healthcare practitioners with clinically focused strategies drawn from the evidence base for assessing, diagnosing, and treating patients with schizophrenia and comorbid substance use disorder(s).
At the end of this CE activity, participants should be able to:
- Differentiate schizophrenia from other potential bases for psychosis in patients with substance use disorder.
- Identify the impact of dual diagnosis on the outcomes of patients.
- Develop an evidence-based, individualized long-term treatment plan for patients with dually diagnosed schizophrenia and substance abuse.
Physicians, physician assistants, and other healthcare professionals with an interest in mental health.
CME Outfitters, LLC, gratefully acknowledges an educational grant from No Commercial Supporter in support of this CE activity.
CME Credit (Physicians):
CME Outfitters, LLC, is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. CME Outfitters, LLC, designates this educational activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Note to Physician Assistants: AAPA accepts Category I credit from AOACCME, Prescribed credit from AAFP, and AMA Category I CME credit for the PRA from organizations accredited by ACCME.
CPE Credit (Pharmacists):
CME Outfitters, LLC, is accredited by the Accreditation Council for Pharmacy Education as a provider of continuing pharmacy education. 0.5 contact hours (0.05 CEUs)
Universal Program Number: 376-000-09-010-H01-P
Activity Type: knowledge-based
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Rakesh Jain, MD, MPH
Rakesh Jain, MD, MPH, is Director of Psychiatric Drug Research for the R/D Clinical
Research Center at Lake Jackson, Texas.
Dr. Jain attended medical school at the University of Calcutta in India. He then attended
graduate school at the University of Texas School of Public Health in Houston, where
he was awarded a National Institute/Center for Disease Control Competitive
Traineeship. His research thesis focused on alcohol abuse issues. He graduated from
the School of Public Health in 1987 with a Masters of Public Health (MPH) degree.
After graduate school, Dr. Jain completed a postdoctoral fellowship in Research
Psychiatry with the Gerontology Center of the University of Texas Mental Sciences
Institute in Houston. He received the National Research Service Award for the support
of the postdoctoral fellowship. After this, he served a three-year residency in Psychiatry
at the Department of Psychiatry and Behavioral Sciences at the University of Texas
Medical School at Houston as well as a two-year fellowship in Child and Adolescent
Psychiatry.
Dr. Jain is currently involved in multiple research projects studying the effects of
medications on short-term and long-term treatment of depression, anxiety, pain/mood
overlap disorders, and psychosis in adult and child/adolescent populations. He is the
author of several articles on the issue of mood and pain conditions. He serves on
several Boards focusing on drug development and disease state education. He was
recently named “Public Citizen of the Year” by the National Association of Social
Workers, Gulf Coast Chapter, in recognition of community and peer education and
championing of mental health issues. He was also recently awarded the “Extra Mile
Award” by the local school district, in recognition of the service to the children of the
school district and consultation to the teachers and counselors.
Disclosure Declaration
It is the policy of CME Outfitters, LLC, to ensure independence, balance, objectivity, and scientific rigor and integrity in all its CE activities. Faculty must disclose to the participants any significant relationships with commercial companies whose products or devices may be mentioned in faculty presentations, or with the commercial supporter of this CE activity. CME Outfitters, LLC, has evaluated, identified, and attempted to resolve any potential conflicts of interest through a rigorous content validation procedure, use of evidence-based data/research, and a multidisciplinary peer review process. The following information is for participant information only. It is not assumed that these relationships will have a negative impact on the presentations.
Dr. Jain has disclosed that he receives research support from Abbott Laboratories, Addrenex Pharmaceuticals, Inc., Aspect Medical Systems, Inc., Forest Laboratories, Inc., Eli Lilly and Company, and Pfizer Inc. He is on the speakers bureaus of Cyberonics, Inc., GlaxoSmithKline, Jazz Pharmaceuticals, Eli Lilly and Company, Pfizer Inc., Shire Pharmaceuticals, and Takeda Pharmaceuticals North America, Inc. Dr. Jain serves as a consultant to Addrenex Pharmaceuticals, Inc., IMPAX Laboratories, Inc., Eli Lilly and Company, and Shire Pharmaceuticals.
Unlabeled Use Disclosure
Faculty of this CE activity may include discussions of products or devices that are not currently labeled for use by the FDA. The faculty have been informed of their responsibility to disclose to the audience if they will be discussing off-label or investigational uses (any uses not approved by the FDA) of products or devices.
CME Outfitters, LLC, the faculty, Wyeth Pharmaceuticals, and Solvay Pharmaceuticals do not endorse the use of any product outside of the FDA labeled indications. Medical professionals should not utilize the procedures, products, or diagnosis techniques discussed during this activity without evaluation of their patient for contraindications or dangers of use.
Questions about this activity? Call us at 877.CME.PROS (877.263.7767).
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