Manejo clínico de pacientes con diagnóstico dual. Evaluación diagnóstica de los pacientes farmacodependientes que sufren de comorbilidad psiquiátrica

introduction: dually diagnosed patients with major psychiatric disorders are considered an important public health issue worldwide. objective: our main goal was to establish practical guidelines for psychiatrists in charge of the treatment of dually diagnosed patients. method: we searched the biomedical literature in medline, ovid, proquest, scielo, and embase for articles matching the medical subjects headings (mesh) "dual diagnosis" with "substance related disorders", "tobacco", and "epidemiology", limiting the results only to clinical trials, systematic reviews and meta-analysis published in the last 25 years in the adult addicted population. results: we found 209 articles that met the initial inclusion criteria for the development of our clinical guidelines for dually diagnosed patients. all abstracts were carefully revised, and only 100 of the 209 articles were selected to be included in the main framework, based on their methodology and clinical significance of their results. conclusions: making a precise and accurate diagnosis of dual pathology in psychiatry should be the main goal of everyone involved in the care of patients with tobacco, substance and alcohol-related disorders. due to the complexity of dual diagnosis, every patient with substance abuse and alcohol-related problems should received an adequate and structured screening during his initial clinical evaluation.