17
Co-Occurring Psychiatric Disorders
Î A comprehensive assessment including determination of mental
health status should evaluate whether the patient is stable.
• Patients with suicidal or homicidal ideation should be referred immediately for
treatment and possibly hospitalization.
Î Management of patients at risk for suicide should include:
a. reducing immediate risk
b. managing underlying factors associated with suicidal intent and
c. monitoring and follow-up.
Î All patients with psychiatric disorders should be asked about suicidal
ideation and behavior.
• Patients with a history of suicidal ideation or attempts should have OUD, and
psychiatric medication use, monitored.
Î Assessment for psychiatric disorder should occur at the onset of
agonist or antagonist treatment.
• Reassessment using a detailed mental status examination should occur after
stabilization with methadone, buprenorphine or naltrexone.
Î Pharmacotherapy in conjunction with psychosocial treatment should
be considered for patients with OUD and a co-occurring psychiatric
disorder.
Î Clinicians should be aware of potential interactions between
medications used to treat co-occurring psychiatric conditions and OUD.
Î Assertive community treatment should be considered for patients with
co-occurring schizophrenia and OUD who have a recent history of, or
are at risk of, repeated hospitalization or homelessness.
Individuals in the Criminal Justice System
Î Pharmacotherapy for the continued treatment of OUDs, or the
initiation of pharmacotherapy, has been shown to be effective and is
recommended for prisoners and parolees regardless of the length of
their sentenced term.
Î Individuals with OUD who are within the criminal justice system
should be treated with some type of pharmacotherapy in addition to
psychosocial treatment.
Î Opioid agonists (methadone and buprenorphine) and antagonists
(naltrexone) may be considered for treatment.
• There is insufficient evidence to recommend any one treatment as superior to
another for prisoners or parolees.
Î Pharmacotherapy should be initiated a minimum of 30 days prior to
release from prison.
