Download - Co-morbidity among IDUs
What is co-morbidity?What is co-morbidity?
Presence of two or more conditions Presence of two or more conditions together in an individual (co-together in an individual (co-occurrence)occurrence)– The conditions can occur simultaneouslyThe conditions can occur simultaneously– One condition can precede another oneOne condition can precede another one
Co-occurrence of mental illness along Co-occurrence of mental illness along with drug use problem is called as with drug use problem is called as dual diagnosisdual diagnosis
Co-morbidity among drug Co-morbidity among drug usersusers
Physical illnessPhysical illness– TuberculosisTuberculosis– HIVHIV– Hepatitis B & CHepatitis B & C– AbscessesAbscesses– COPD and other COPD and other
respiratory illnessrespiratory illness– Systemic Systemic
infectionsinfections
Mental IllnessMental Illness– DepressionDepression– Anxiety Anxiety
disordersdisorders– Schizophrenia Schizophrenia
and other and other psychotic psychotic disordersdisorders
– Personality Personality disordersdisorders
Physical illnessPhysical illness
Physical illness among Physical illness among IDUs is more common as IDUs is more common as compared to the general compared to the general populationpopulation– A Study from Chennai A Study from Chennai
conducted in 2005 – 06 conducted in 2005 – 06 showed increased rates of showed increased rates of physical illnessphysical illness
(Solomon et al, (Solomon et al, 2008)2008)
– The same group also The same group also showed that mortality is showed that mortality is more in comparison with more in comparison with the following causes: the following causes: Overdose, AIDS, Overdose, AIDS, tuberculosis, accident tuberculosis, accident
(Solomon et al, (Solomon et al, 2009)2009)
IllnessIllness PrevalencPrevalence / rate e / rate
(%)(%)
TuberculosisTuberculosis 33.933.9
Lower respiratory Lower respiratory tract infectionstract infections
16.116.1
AnaemiaAnaemia 22.922.9
Hepatitis BHepatitis B 11.911.9
Hepatitis CHepatitis C 94.194.1
CellulitisCellulitis 6.86.8
Herpes simplexHerpes simplex 9.39.3
Herpes zosterHerpes zoster 9.39.3
Oral candidiasisOral candidiasis 43.243.2
Physical illness – reasons Physical illness – reasons
Three main factors for increased rates of Three main factors for increased rates of physical illnessphysical illness– Drug use itself may lead to increased ratesDrug use itself may lead to increased rates
E.g. smoking may lead to respiratory problems; E.g. smoking may lead to respiratory problems; nicotine and alcohol may lead to cancer; nicotine and alcohol may lead to cancer; injecting may lead to abscesses, HIV, hepatitisinjecting may lead to abscesses, HIV, hepatitis
– Individual may use drugs due to existing Individual may use drugs due to existing physical illnessphysical illness E.g. person with pain condition may initiate drug E.g. person with pain condition may initiate drug
use and then become ‘addicted’ to the druguse and then become ‘addicted’ to the drug Some addictive drugs banned today were used Some addictive drugs banned today were used
earlier to treat physical illnessearlier to treat physical illness
Cocaine used in coca-cola as energy drink
Cocaine used to relieve toothache
Heroin used for relief of cough
Physical illness – reasons Physical illness – reasons
Both drug use and Both drug use and physical illness may physical illness may be caused by be caused by overlapping factors overlapping factors leading to both leading to both illnessesillnesses– E.g. genetic factors, E.g. genetic factors,
stress related factorsstress related factors– Drug use and TB may Drug use and TB may
be caused by the be caused by the individual living in poor individual living in poor socio-economic socio-economic conditionsconditions
Common vulnerability factors
Drug usePhysical illness
Physical illness – Hepatitis CPhysical illness – Hepatitis C
Hepatitis C infection is a Hepatitis C infection is a major concern among major concern among IDUsIDUs– 80 – 90% IDUs infected 80 – 90% IDUs infected
with Hepatitis C in some with Hepatitis C in some parts of Indiaparts of India
Hepatitis is inflammation Hepatitis is inflammation of liverof liver– Liver can be inflamed by Liver can be inflamed by
toxins, infection, alcohol, toxins, infection, alcohol, etc. etc.
Physical illness – Hepatitis Physical illness – Hepatitis Liver is a vital organ of Liver is a vital organ of
the body. Functions the body. Functions include: include: – Processing food for energy Processing food for energy
conversionconversion– Neutralise toxins and other Neutralise toxins and other
drugsdrugs– Store iron and important Store iron and important
vitaminsvitamins– Process hormonesProcess hormones– Fight infectionsFight infections– Produce important proteins Produce important proteins
in the bodyin the body Liver can re-grow, if Liver can re-grow, if
injuredinjured
Physical illness – Hepatitis Physical illness – Hepatitis When liver is inflamed When liver is inflamed
chronically, it causes chronically, it causes scarring, called as fibrosisscarring, called as fibrosis– Extensive scarring and re-Extensive scarring and re-
growth of liver leads to growth of liver leads to cirrhosiscirrhosis
– The end-stage of cirrhosis The end-stage of cirrhosis is liver failure, which leads is liver failure, which leads to symptoms such as to symptoms such as jaundice, collection of fluid jaundice, collection of fluid in abdomen, easy bleeding, in abdomen, easy bleeding, toxins entering into blood toxins entering into blood stream and also brain stream and also brain (encephalopathy) which (encephalopathy) which can make the individual can make the individual comatosecomatose
Fluid collection in abdomen
Physical illness – Hepatitis Physical illness – Hepatitis
Viral hepatitisViral hepatitis– 5 types of viral 5 types of viral
hepatitis: A, B, C, hepatitis: A, B, C, D, ED, E
– Reaction in liver is Reaction in liver is samesame
– Degree of Degree of damage and damage and persistence of persistence of infection depends infection depends on the type on the type (summarised in (summarised in table)table)
Type Type of of virusvirus
Route of Route of transmissiontransmission
prognosisprognosis
AA Eating Eating unhygienic unhygienic foodfood
Transient; very Transient; very good prognosisgood prognosis
BB Injection, Injection, sexualsexual
Chronic infectionChronic infection
CC Injection, Injection, sexualsexual
Chronic infectionChronic infection
DD Occurs along Occurs along with hepatitis with hepatitis BB
Worsens prognosis Worsens prognosis of hepatitis Bof hepatitis B
EE Unhygienic Unhygienic foodfood
Poorer than Poorer than Hepatitis AHepatitis A
Transmission of Hepatitis CTransmission of Hepatitis C– Sharing of contaminated injecting equipments Sharing of contaminated injecting equipments
in majority of casesin majority of cases Other injecting equipments such as spoons, Other injecting equipments such as spoons,
tourniquet, swabs, water in addition to N/Stourniquet, swabs, water in addition to N/S Contamination of hands during mixing of drugContamination of hands during mixing of drug
– Transfusion of infected blood and blood Transfusion of infected blood and blood productsproducts
– Mother to baby (5% chances)Mother to baby (5% chances)– Very low risk through sexual route, (but still Very low risk through sexual route, (but still
chances exist)chances exist)
Physical illness – Hepatitis C Physical illness – Hepatitis C
Stages of infectionStages of infection– Acute: some infected individuals have Acute: some infected individuals have
symptoms during this stage: symptoms during this stage: Nausea, vomiting, jaundice – ‘Acute Nausea, vomiting, jaundice – ‘Acute
hepatitis’hepatitis’
– 25% of individuals clear the virus from 25% of individuals clear the virus from their body by 2 years of infectiontheir body by 2 years of infection
Physical illness – Hepatitis C Physical illness – Hepatitis C
Physical illness – Hepatitis CPhysical illness – Hepatitis C
– Chronic: 75% of infected individuals will have Chronic: 75% of infected individuals will have chronic hepatitis with presence of virus in body chronic hepatitis with presence of virus in body and ability to transmit it to othersand ability to transmit it to others About 45% do not develop liver damageAbout 45% do not develop liver damage About 30 – 40% develop mild liver damageAbout 30 – 40% develop mild liver damage About 10 – 20% develop liver cirrhosisAbout 10 – 20% develop liver cirrhosis About 1 – 5% develop liver failure or liver cancerAbout 1 – 5% develop liver failure or liver cancer
Treatment of Hepatitis CTreatment of Hepatitis C– Not everybody requires treatmentNot everybody requires treatment– Success rate is only 30 – 40%Success rate is only 30 – 40%– Treatment is currently very costly in IndiaTreatment is currently very costly in India
Hepatitis C – counselling issuesHepatitis C – counselling issues
For every IDU, the TI counsellor should: For every IDU, the TI counsellor should: – Educate about the transmission dynamics of Hepatitis CEducate about the transmission dynamics of Hepatitis C– Stress on using safe injecting equipment (not only N/S, Stress on using safe injecting equipment (not only N/S,
but also others)but also others)– Teach the clients on how to inject safelyTeach the clients on how to inject safely
For Hepatitis C infected IDU clientsFor Hepatitis C infected IDU clients– Instil hope in the client that not every case is fatalInstil hope in the client that not every case is fatal– No special diet is required, but if the client is obese, fat No special diet is required, but if the client is obese, fat
foods should be avoidedfoods should be avoided– Alcohol IS STRICTLY prohibited: this message should be Alcohol IS STRICTLY prohibited: this message should be
strongly delivered to the clientstrongly delivered to the client If the client has problem alcohol use, he should be If the client has problem alcohol use, he should be
counselled accordingly, and if required, should be sent counselled accordingly, and if required, should be sent to a de-addiction centreto a de-addiction centre
Physical illness – Physical illness – Tuberculosis Tuberculosis
Tuberculosis (TB) is Tuberculosis (TB) is caused by a microscopic caused by a microscopic organism – bacteria – organism – bacteria – mycobacterium mycobacterium tuberculosistuberculosis
Can affect any body part Can affect any body part – Usually affect lungsUsually affect lungs– Other sites: lymph nodes, Other sites: lymph nodes,
bone, brain, spinal cord, bone, brain, spinal cord, genital-urinary system, genital-urinary system, etc. etc.
TB causing bacteria
Physical illness – Physical illness – TuberculosisTuberculosis
TB is contagious and spreads through airTB is contagious and spreads through air– Transmitted from one person to another Transmitted from one person to another
through droplets through droplets – When an infected person sneezes, coughs When an infected person sneezes, coughs
or talks, tiny droplets of saliva/mucus or talks, tiny droplets of saliva/mucus spread to another person, who can get spread to another person, who can get infectedinfected
If not treated, each infected person with If not treated, each infected person with active TB will infect 10 – 15 person every active TB will infect 10 – 15 person every year year
TB is not transmitted by touching clothes TB is not transmitted by touching clothes or shaking hands of an infected personor shaking hands of an infected person
Physical illness – TuberculosisPhysical illness – Tuberculosis
Inhaled by another Person
Entry into his lungs
Strong immune system
Low immune system
Tuberculosis disease
Fibre wall around the bacteria
If low immunity
Bacteria breaks the wall
Droplet
spread
Risk factors for tuberculosisRisk factors for tuberculosis
Physical illness – Physical illness – TuberculosisTuberculosis
Injecting Drug UsersInjecting Drug Users DiabetesDiabetes Certain cancersCertain cancers HIV infectionHIV infection Health care Health care
workers, including workers, including doctors and nursesdoctors and nurses
Living with a person Living with a person who has an active who has an active TBTB
PovertyPoverty HomelessnessHomelessness Nursing home Nursing home
residentsresidents Prison inmatesPrison inmates AlcoholicsAlcoholics
Symptoms of active tuberculosisSymptoms of active tuberculosis
Physical illness – Physical illness – TuberculosisTuberculosis
Coughing up of Coughing up of sputumsputum
Coughing bloodCoughing blood Shortness of breathShortness of breath If other systems If other systems
involved, symptoms involved, symptoms according to the according to the function of the function of the organorgan– E.g. Brain: fits, E.g. Brain: fits,
unconsciousnessunconsciousness
Generalised Generalised tiredness/weaknesstiredness/weakness
Weight lossWeight loss FeverFever Night sweatsNight sweats CoughCough Chest painChest pain
Diagnosis based onDiagnosis based on– Symptom profileSymptom profile– Chest X rayChest X ray– Sputum examinationSputum examination– Skin test (Monteux test)Skin test (Monteux test)
TreatmentTreatment– Nearest TB centre under RNTCP Nearest TB centre under RNTCP – Directly Observed treatment (DOT)Directly Observed treatment (DOT)– Duration 9 – 12 months for complete cureDuration 9 – 12 months for complete cure– Person becomes non-infectious within 3 weeks Person becomes non-infectious within 3 weeks
of initiating treatmentof initiating treatment
Physical illness – Physical illness – TuberculosisTuberculosis
Other important considerationsOther important considerations– TB is the leading killer of people with HIVTB is the leading killer of people with HIV
HIV infected people are 20 – 40 times more likely to HIV infected people are 20 – 40 times more likely to develop active TBdevelop active TB
TB has resurfaced in the global epidemic because of TB has resurfaced in the global epidemic because of the onset of HIV infectionthe onset of HIV infection
– Multi drug resistant TB (MDR-TB): form of TB Multi drug resistant TB (MDR-TB): form of TB that is difficult and expensive to treat which that is difficult and expensive to treat which fails to respond to standard treatmentfails to respond to standard treatment
– Extensively drug resistant TB (XDR-TB): form of Extensively drug resistant TB (XDR-TB): form of TB which is resistant to drugs used in MDR-TBTB which is resistant to drugs used in MDR-TB
Physical illness – Physical illness – TuberculosisTuberculosis
IDU related issues for TBIDU related issues for TB– IDUs have a very high rate of TB IDUs have a very high rate of TB
Reasons are many – poverty, homelessness, poor living Reasons are many – poverty, homelessness, poor living conditions, low immunity, poor nutrition, high HIV ratesconditions, low immunity, poor nutrition, high HIV rates
Early symptoms of TB may be mistaken for Early symptoms of TB may be mistaken for other conditions. For e.g. other conditions. For e.g. – Weight loss, weakness or tiredness Weight loss, weakness or tiredness general general
debilitydebility– Cough, chest pain Cough, chest pain chronic bronchitis associated chronic bronchitis associated
with co-morbid smokingwith co-morbid smoking
Physical illness – Physical illness – TuberculosisTuberculosis
During every follow up, symptoms of TB During every follow up, symptoms of TB must be positively ruled outmust be positively ruled out
Baseline screening must be ensured by Baseline screening must be ensured by the counsellor by referral to the physicianthe counsellor by referral to the physician
Clients should be educated on Clients should be educated on signs/symptoms of TBsigns/symptoms of TB
Clients with symptoms resembling TB Clients with symptoms resembling TB must be referred to nearby DOTS centremust be referred to nearby DOTS centre
For those on treatment for TB: counselling For those on treatment for TB: counselling for adherence, physically verify whether for adherence, physically verify whether the client is taking TB medicines or notthe client is taking TB medicines or not
Physical illness – Physical illness – TuberculosisTuberculosis
Mental illnessMental illness
Mental illness rates more common in Mental illness rates more common in Drug using population – dual diagnosisDrug using population – dual diagnosis
Mental IllnessMental Illness Rates (%)Rates (%)
Anti-social personality Anti-social personality disorderdisorder
15.515.5
ManiaMania 14.514.5
SchizophreniaSchizophrenia 10.110.1
DepressionDepression 4.14.1
Obsessive compulsive Obsessive compulsive disorderdisorder
3.43.4
PhobiaPhobia 2.12.1National Co-morbidity Study, USA
Mental illnessMental illness
Reasons for increased rates of mental Reasons for increased rates of mental illness: illness: – Drug use itself may cause mental illnessDrug use itself may cause mental illness
E.g. cannabis use for a long time seen to cause E.g. cannabis use for a long time seen to cause psychosis in somepsychosis in some
– Individuals suffering from mental illness may Individuals suffering from mental illness may initiate drug use – self medication hypothesisinitiate drug use – self medication hypothesis E.g. individuals suffering from schizophrenia increase E.g. individuals suffering from schizophrenia increase
tobacco/cigarette consumption to reverse the tobacco/cigarette consumption to reverse the slowness in thinking due to their illness or due to the slowness in thinking due to their illness or due to the medicines used to treat schizophreniamedicines used to treat schizophrenia
– Both drug use and mental illness may be Both drug use and mental illness may be caused by the same underlying factorscaused by the same underlying factors E.g. genetic vulnerability, stress related factors, etc. E.g. genetic vulnerability, stress related factors, etc.
Mental illness – Depression Mental illness – Depression
Depression is a very Depression is a very commonly occurring mental commonly occurring mental illness, with great morbidityillness, with great morbidity
Everyone feels sad at some Everyone feels sad at some point of timepoint of time
Depression is morbid state Depression is morbid state of sadnessof sadness– Affects the productivity and Affects the productivity and
normal functioning of an normal functioning of an individualindividual
Depression – symptoms Depression – symptoms Symptoms in an individual for at least two weeks period Symptoms in an individual for at least two weeks period
leading to difficulty in work OR personal sufferingleading to difficulty in work OR personal suffering
Low mood /sadness Low mood /sadness – Varies little from day to Varies little from day to
dayday– Unresponsive to Unresponsive to
external situationsexternal situations Reduced energy Reduced energy
– Marked tiredness even Marked tiredness even after minimal effortafter minimal effort
Decreased activityDecreased activity– Psychic (thought level)Psychic (thought level)– Motor (physical level)Motor (physical level)
Reduced capacity to Reduced capacity to enjoyenjoy
Reduced interest in work Reduced interest in work and pleasureand pleasure
Reduced concentrationReduced concentration Thinking becomes Thinking becomes
muddled and hazymuddled and hazy Sleep disturbedSleep disturbed
– Early morning Early morning awakeningawakening
– Frequent awakening Frequent awakening from sleepfrom sleep
– Does not feel refreshedDoes not feel refreshed
Depression – symptoms Depression – symptoms
Loss of appetiteLoss of appetite Reduced self esteem Reduced self esteem
and confidenceand confidence Ideas of guiltIdeas of guilt
– feeling that he has feeling that he has committed wrongcommitted wrong
Ideas of worthlessnessIdeas of worthlessness– Feeling that he does not Feeling that he does not
have any worth, which have any worth, which he deserves he deserves
Ideas of hopelessnessIdeas of hopelessness– Feeling that there is no Feeling that there is no
hope for him in this hope for him in this worldworld
Ideas of helplessnessIdeas of helplessness– Feeling that no body can Feeling that no body can
help him from his help him from his present conditionpresent condition
Wishes to dieWishes to die Suicidal acts/attemptsSuicidal acts/attempts
– Feeling that life is not Feeling that life is not worth living and attempt worth living and attempt to end lifeto end life
Mental illness – anxiety Mental illness – anxiety disorders disorders
Anxiety as a symptomAnxiety as a symptom– Anxiety is irrational fear, or fear out of Anxiety is irrational fear, or fear out of
proportion to what is expected in the proportion to what is expected in the given situationgiven situation
– Almost everyone experiences fear or Almost everyone experiences fear or nervousness one time or the othernervousness one time or the other
– The fear is usually in anticipation or The fear is usually in anticipation or presence of a stimulus (e.g. darkness, presence of a stimulus (e.g. darkness, animals, exams, etc.)animals, exams, etc.) Fear helps the person in responding to the Fear helps the person in responding to the
situation: either fight the situation or situation: either fight the situation or prepare to run away (flight)prepare to run away (flight)
Anxiety disordersAnxiety disorders
– The fear is labeled as disorder if it: The fear is labeled as disorder if it: occurs without any stimulus occurs without any stimulus
is out of proportionis out of proportion to what is expected in the to what is expected in the given situation by majority of individualsgiven situation by majority of individuals
Hampers or hinders the individual’s Hampers or hinders the individual’s performanceperformance
Anxiety disorder: group of disorders in Anxiety disorder: group of disorders in which the predominant symptom is which the predominant symptom is anxietyanxiety
Anxiety disorders – type Anxiety disorders – type
Common types:Common types:1.1. Specific phobia Specific phobia
Irrational fear of a specific object, animal or situationIrrational fear of a specific object, animal or situation E.g. phobia for heights, spiders, water, exams, E.g. phobia for heights, spiders, water, exams,
2.2. Social phobiaSocial phobia Irrational fear of being judged negatively or publically Irrational fear of being judged negatively or publically
embarrassed in societyembarrassed in society
3.3. Panic disorderPanic disorder Characterised by repeated panic attacksCharacterised by repeated panic attacks Panic attack: state of extreme anxiety and fear with Panic attack: state of extreme anxiety and fear with
sense of dying without any external stimulus sense of dying without any external stimulus (spontaneous attack)(spontaneous attack)
Anxiety disorders – type Anxiety disorders – type Common types:Common types:
4.4. Obsessive compulsive disorderObsessive compulsive disorder Characterised by obsessions and compulsionsCharacterised by obsessions and compulsions Obsessions: anxiety provoking thoughts which Obsessions: anxiety provoking thoughts which
intrude into the mind repeatedly, and are intrude into the mind repeatedly, and are irrationalirrational
Compulsions: irrational actions which the patient Compulsions: irrational actions which the patient is compelled to perform repeatedlyis compelled to perform repeatedly
E.g. repeated thoughts of being dirty/unclean: though the E.g. repeated thoughts of being dirty/unclean: though the patient knows that he is not unclean, he is not able to resist patient knows that he is not unclean, he is not able to resist these thoughts and resisting them provokes anxiety these thoughts and resisting them provokes anxiety obsessions; as a result of these obsessions, the person obsessions; as a result of these obsessions, the person repeatedly washes his hands repeatedly washes his hands compulsions compulsions
Anxiety disorders – Anxiety disorders – symptoms symptoms
Excessive unrealistic Excessive unrealistic worryingworrying
Trembling/shakinessTrembling/shakiness Churning stomachChurning stomach NauseaNausea DiarrheaDiarrhea HeadacheHeadache BackacheBackache Heart palpitationsHeart palpitations Sweating/flushingSweating/flushing
Numbness/pins and Numbness/pins and needle sensation in needle sensation in arms, hands or legsarms, hands or legs
RestlessnessRestlessness Easily tiredEasily tired Poor concentrationPoor concentration Easy irritabilityEasy irritability Muscle tensionMuscle tension Frequent urinationFrequent urination Sleep difficultiesSleep difficulties Easy startleEasy startle
Apart from Anxiety as the main symptom, one or more of the following:
Mental illness – PsychosisMental illness – Psychosis
Group of mental illness characterised Group of mental illness characterised by a loss of realityby a loss of reality
Disorganisation in thoughts, perception Disorganisation in thoughts, perception and behaviourand behaviour
Psychotic Disorders : Psychotic Disorders : – SchizophreniaSchizophrenia– Delusional disorderDelusional disorder– Bipolar disorderBipolar disorder– Acute PsychosisAcute Psychosis
Psychosis – symptomsPsychosis – symptoms
DelusionsDelusions– False beliefs which are not part of the person’s False beliefs which are not part of the person’s
culture; these beliefs are not amenable to culture; these beliefs are not amenable to reasoning, and are held tightly by the person reasoning, and are held tightly by the person despite evidence to contrarydespite evidence to contrary
– Examples: Examples: Belief of being persecuted Belief of being persecuted persecutory delusions persecutory delusions Belief of being talked about Belief of being talked about referential delusions referential delusions Belief of having powers Belief of having powers grandiose delusions grandiose delusions
– Bizzare Delusions seen in schizophrenia Bizzare Delusions seen in schizophrenia E.g. patient may feel that neighbours are controlling E.g. patient may feel that neighbours are controlling
his mind and compelling him to perform actions by his mind and compelling him to perform actions by magnetic wavesmagnetic waves
Psychosis – symptomsPsychosis – symptoms
HallucinationHallucination– Sensory perception without any stimulusSensory perception without any stimulus– Any sense organ can be involvedAny sense organ can be involved
Most common is hearing – auditory Most common is hearing – auditory hallucinationshallucinations
– E.g. a person may hear voices talking bad E.g. a person may hear voices talking bad about him/ swearing at him when in reality about him/ swearing at him when in reality nobody is talking, and others around the nobody is talking, and others around the patient are not able to hear itpatient are not able to hear it
Psychosis – symptomsPsychosis – symptoms Thought disordersThought disorders
– Break in logical connection between one thought Break in logical connection between one thought chain to anotherchain to another
– Results in not understanding what the patient is Results in not understanding what the patient is sayingsaying
Negative symptomsNegative symptoms– Found in chronic psychotic disorders, e.g. Found in chronic psychotic disorders, e.g.
schizophreniaschizophrenia– Disruption of normal emotions and behaviour, Disruption of normal emotions and behaviour,
what is expected in a normal personwhat is expected in a normal person E.g. loss of emotions when a person speaks (loss of E.g. loss of emotions when a person speaks (loss of
affect), not speaking when required, loss of will power affect), not speaking when required, loss of will power to initiate, loss of goals in life, etc. to initiate, loss of goals in life, etc.
Mental illness – Mental illness – counselling issuescounselling issues
If the IDU presents with one of the symptoms If the IDU presents with one of the symptoms of mental illness, explore other symptoms of of mental illness, explore other symptoms of mental illnessmental illness– If suspicion of mental illness, refer to a psychiatristIf suspicion of mental illness, refer to a psychiatrist
Educate the client that Educate the client that – Mental illness are treatableMental illness are treatable– Having a mental illness does not mean that the Having a mental illness does not mean that the
person has some defect of will powerperson has some defect of will power– Instill hope that outcome of mental illness such as Instill hope that outcome of mental illness such as
depression and anxiety is good, if treated for depression and anxiety is good, if treated for adequate durationadequate duration
Mental illness – Mental illness – counselling issuescounselling issues
Reinforce risk reduction message, as the Reinforce risk reduction message, as the chances of sharing are increased due to chances of sharing are increased due to despairdespair
Emphasize on chances of overdoseEmphasize on chances of overdose– Due to suicidal ideationDue to suicidal ideation– To relieve symptoms of mental illnessTo relieve symptoms of mental illness
Seek support of family during this crisis of Seek support of family during this crisis of the IDUthe IDU
Regularly follow up with IDU and counsel Regularly follow up with IDU and counsel him during the follow up phasehim during the follow up phase