ORIGIN OF THE DISORDER AND
CLINICAL PREDOMINANCE

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In order to better understand dual diagnosis, some authors suggest determining the aetiological relationship between both symptoms, taking into account the following diagnostic typologies, where we can find three possible types of relations:


Primary psychiatric disorder


In this case we can find the following possibilities:


1) The substance’s consumption behaviour can be considered a way of selfmedicating the psychiatric disorder. As a consequence, those with specific psychiatric disorders tend to chose, and prefer, certain types of substances which eliminate or soothe specific symptoms.


2) The use of substances can be seen as a confrontation mechanism, even if it could be maladaptive.


3) The symptoms of a psychiatric disorder could become risk factors for the development of a substance dependency.

 


Disorder due to a primary substance use


The psychiatric after-effects could be present in three different contexts:


1) Linked to severe intoxication manifestations.
2) Linked to acute abstinence manifestations.
3) Linked to a substance’s lengthy consumption.


In the first two cases, momentary psychiatric symptoms occur during the substance’s consumption or withdrawal. These are groups of psychiatric symptoms that result in a mental syndrome diagnosis induced by substances. It is our opinion that this element should not be seen as a constituent of a clinical picture.

The third case signals psychiatric syndromes produced by the toxic and permanent effects of the substance in the CNS. This prolonged consumption can cause a permanent disturbance in the CNS, which, as a result, leads to a psychiatric syndrome which persists long after the severe manifestations of the substance’s use disappear (for instance, alcohol dementia).



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