DÉDALE. Dual Diagnosis Special Unit

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Rosanna Goodwin
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1 DÉDALE Dual Diagnosis Special Unit

2 BACKGROUND Most of the people diagnosed with psychotic disorder use ilicit drugs or alcohol; which may increase psychiatric symptoms severity. The term Dual Diagnosis (DD) is the term used to describe patients with both psychotic disorder and problematic drug and/or alcohol use.

3 BACKGROUND Compared to people showing other psychiatric conditions, DD population has a lot of additional difficulties, which aren t solely medical, psychological or psychiatric. For instance, they are more likely to : Come into contact with mental health services, Be in crisis (psychiatric relapses) Commit suicide, Have problems relating to social and legal matters, Have problems relating to housing, welfare and lifestyle matters.

4 BACKGROUND Research shows that medically orientated services can t always help with multi-problems like these, which often reflect the social stigma that people with dual diagnosis face. It has ben suggested that special unit where drug misuse and psychosis are treated simultaneously, in an intensive and integrated manner (rather than consecutively) would be appropriate.

5 INFRASTRUCTURE Inpatient unit active since 03 with a 10 beds capacity Multidiscipliary team (17: psychiatrist, psychologists, criminologist, nurses, educators, social worker, sport monitor, ergotherapist) trained for dual diagnosis.

6 THERAPEUTIC PROJECT Intensive and integrated care for people with Dual Diagnosis (drug misuse and psychosis). Inclusion criteria: > 18 years Psychosis diagnosis Drug or alcohol misuse Exclusion criteria: Intellectual deficiency (IQ less than 65) Somatic chronic pathology

7 OBJECTIVES Psychiatric stabilisation Decrease relapse Decrease drug misuse and related difficulties Increase people health and welfare Increase cognitive ans social habilities Allow people to receive care in their living environment Decrease hospitalisation Socialisation in collaboration with the regional care network

8 4 STEPS Most of the time, people come on their own or are refered by GP or general hospitals. After a pre-admission interview (psychologist and nurse), allowing to ascertain the orientation, people may integrate the inpatient unit where they are offered a 4 steps hospitalization: Step 1 : Observation and evaluation Step 2 : Life project elaboration Step 3: Life project concretisation Step 4: Continuity of care

9 1. OBSERVATION AND EVALUATION Anamnesis: «Roman de vie» Referent interview Psychiatric assessment : Psychiatric interview Social assessment: Social interview Psychologic interview Case management: Checking and collaboration with the pre-existing network Meeting with the entourage Sociogenogram Psychologic and cognitive assessments : Cognitive assessment Testing and scales Psychologic interview Functional assessment: Profinteg (functionnal screen.) Autonomy assessment (cuisine, lessive) Everyday life observation

10 2. LIFE PROJECT ELABORATION Pharmacologic treatment Psychologic / cognitive treatment Social help and CM Drug misuse Replacement therapy, Degressive therapy, Anti-craving treatment,... Psychosis Typical antipsychotics Atypical antipsychotics Injection Integrated pharmacological treatment Drug misuse MI CBT Psychoeducation Support group Psychosis MI Psychoéducation Social practice CBT Cogn. Rem. Support group Integrated psychologic / cognitive treatment Drug misuse Psychosis Integrated social help

11 3. LIFE PROJECT CONCRETISATION According to the person needs and ressources and according to his project (step 2), the CM helps and supports to find : A place to live (appartment, hosting service, psychiatric long-term care facility, residential facility! DD, ) Medical, psychologic and social care (GP, psychiatrist, pharmacy, mental health service, ) Meaningfull occupation (cultural activity, sport, vocational training, job, self-help, support group, )

12 4. CONTINUITY OF CARE Each person can benefit from the intervention of the mobile team (LILAS) during three months before or 6 months after hospitalization. This trained team coordinated by the CM offers home visit and orientation, communication and collaboration with the care network ( PSI ).

13 Thank you for your attention

Early Intervention Teams services for early psychosis

Early Intervention Teams services for early psychosis Early intervention services work with people who are usually between 14 and 35, and are either at risk of or are currently experiencing a first episode