Subodh B N, Sharma Nidhi, Shah Raghav
Department of Psychiatry, Post-Graduate Institute of Medical Education and Research (PGIMER), Chandigarh, India.
Indian J Psychiatry. 2018 Feb;60(Suppl 4):S494-S500. doi: 10.4103/psychiatry.IndianJPsychiatry_18_18.
Management of patients with dual diagnosis (Mental illness and substance use disorders) is a challenge. A lack of improvement in either disorder can lead to a relapse in both. The current consensus opinion favours an integrated approach to management of both the disorders wherein the same team of professionals manages both the disorders in the same setting. The role of pharmacotherapy for such dual diagnosis patients is well established but the non-pharmacological approaches for their management are still evolving. After stabilization of the acute phase of illnesses, non-pharmacological management takes centre stage. Evidence points to the beneficial effect of psychosocial approaches in maintaining abstinence, adherence to medication, maintenance of a healthy life style, better integration in to community, occupational rehabilitation and an overall improvement in functioning. Psychosocial approaches although beneficial, are difficult to implement. They require teamwork, involving professionals other than psychiatrists and psychologists alone. These approaches need to be comprehensive, individualized and require training to various levels that is difficult to achieve in most Indian settings. In this article we provide a brief review of these approaches.
双重诊断（精神疾病和物质使用障碍）患者的管理是一项挑战。任何一种疾病若未得到改善，都可能导致两种疾病复发。目前的共识意见倾向于采用综合方法来管理这两种疾病，即由同一专业团队在同一环境中管理这两种疾病。药物治疗在此类双重诊断患者中的作用已得到充分确立，但针对其管理的非药物方法仍在不断发展。在疾病急性期稳定后，非药物管理成为核心。有证据表明，社会心理方法在保持戒断、坚持服药、维持健康生活方式、更好地融入社区、职业康复以及整体功能改善方面具有有益效果。社会心理方法虽然有益，但实施起来困难重重。它们需要团队合作，不仅涉及精神科医生和心理学家，还包括其他专业人员。这些方法需要全面、个性化，并且需要针对不同层面进行培训，而这在大多数印度环境中很难实现。在本文中，我们对这些方法进行简要综述。
