Abstract
Many clinical and epidemiologic studies have shown a high frequency of co-occurrence of substance abuse and psychiatric disorders, with important consequences from health and social perspective. However, the identification of reliable and valid diagnosis of psychiatric comorbidity in substance abusers is problematic, mainly because the acute or chronic effects of substance abuse can mimic symptoms of many other mental disorders, making difficult to differentiate psychiatric symptoms that represent effects of acute or chronic substance use or withdrawal, of those that represent an independent disorder. While DSM-IIII-R and earlier nomenclatures were unclear in differentiating independent from other psychiatric disorders, DSM-IV and DSM-IV-TR provided clearer guidelines in diagnosing psychiatric disorders in heavy users of alcohol and drugs, providing three categories: “primary” psychiatric disorders, “substanceinduced” disorders, and “expected effects” of the substances, meaning expected intoxication and/or withdrawal symptoms that should not be diagnosed as symptoms of a psychiatric disorder. The use of the “Psychiatric Research Interview for Substance and Mental Disorders (PRISM)”, a structured interview developed to improve the diagnosis of co morbidity in drug abusers according DSM-IV, supplies new opportunities in the clinical research in this field.
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References
Abram KM and LA Teplin (1991) Co-occurring disorders among mentally ill jail detainees: implications for public policy.Am. Psyhologist 4, 1036–1045.
Aharonovich E, X Liu, E Nunes and DS Hasin (2002) Suicide attempts in substance abusers: effects of major depression in relation to substance use disorders.Am. J. Psychiatry 159, 1600–1602.
American Psychiatric Association (1980)Diagnostic and Statistical Manual of Mental Disorders, 3rd Ed. (American Psychiatric Press:Washington DC).
American Psychiatric Association (1987)Diagnostic and Statistical Manual of Mental Disorders, 3rd Ed, rev. (American Psychiatric Press:Washington DC).
American Psychiatric Association (1994a)Diagnostic and Statistical Manual of Mental Disorders, 4th Ed. (American Psychiatric Press: Washington DC).
American Psychiatric Association (1994b)Diagnostic and Statistical Manual of Mental Disorders.4th Ed-TR. (American Psychiatric Press: Washington DC).
Appleby L (2000) Drug misuse and suicide: a tale of two services.Addiction 95, 175–177.
Astals M, A Domingo-Salvany, M Almendros, C Fos, A Orteils, L Torralba and M Torrens (2001) Validaciön de un instrumenta de screening para la detectión de patología psiquiátrica en toxicomanías.Trastornos Adictivos 3, 293–294.
Brady KT and R Sinha (2005) Co-occurring mental and substance use disorders: the neurobiological effects of chronic stress.Am. J. Psychiatry 162, 1483–1493.
Bryant KJ, BJ Rounsaville, RL Spitzer and JBW Williams (1992) Reliability of dual diagnosis: substance dependence and psychiatric disorders.J. Nerv. Ment. Dis. 180, 251–257.
Carey MP, KB Carey, SA Maisto, CM Gordon and PA Vanable (2001) Prevalence and correlates of sexual activity and HIV-related risk bahavior among psychiatric outpatients.J. Consult. Clin. Psychol. 69, 846–850.
Caton CL, PE Shrout, PF Eagle, LA Opler, A Felix and B Dominguez (1994) Risk factors for homelessness among schizophrenic men: a case-control study.Am. J. Public Health 84, 265–270.
Cuffel B, M Shumway and T Chouljian (1994) A longitudinal study of substance use and community violence in schizophrenia.J. Nerv. Mental Dis. 182, 704–708.
Curran GM, G Sullivan, K Williams, X Han, K Collins, J Keys and KJ Kotrla (2003) Emergency department use of persons with comorbid psychiatric and substance abuse disorders.Ann. Emerg. Med. 41, 659–667.
Endicott J and RL Spitzer (1978) A diagnostic interview: the schedule for affective disorders and schizophrenia.Arch. Gen. Psychiatry 35, 837–844.
Feighner JP, E Robins, SB Guze, RA Woodruff Jr, G Winokur and R Munoz (1972) Diagnostic criteria for use in psychiatric research.Arch. Gen. Psychiatry 26, 57–63.
First MB, RL Spitzer, M Gibbon and JBW Williams (1997)Structured Clinical Interview for DSM-IV Axis I Disorders (SCID). (American Psychiatric Press:Washington DC).
Grant BF, DA Dawson and DS Hasin (2001)The Alcohol Use Disorder and Associated Disabilities Interview Schedule-DSM-IV Version (National Institute on Alcohol Abuse and Alcoholism: Bethesda, MD).
Hasin DS, KD Trautman, GM Miele, S Samet, M Smith and J Endicott (1996) Psychiatric research interview for substance and mental disorders (PRISM): reliability for substance abusers.Am. J. Psychiatry 153, 1195–1201.
Hasin D, K Trautman and J Endicott (1998) Psychiatric research interview for substance and mental disorders: phenomenologically based diagnosis in patients who abuse alcohol or drugs.Psychopharmacol. Bull. 34, 3–8.
Hasin D, S Samet, J Meydan, G Miele and J Endicott (2001)Psychiatric Research Interview for Substance and Mental-Disorders (PRISM-IV). Version 6.0.
Hasin DS, S Samet, E Nunes, J Meydan, K Matseoane and R Waxman (2006) Diagnosis of comorbid psychiatric disorders in substance users assessed with the Psychiatric Research Interview for Substance and Mental Disorders for DSM-IV.Am. 1 Psychiatry 163, 689–696.
Janca A, TB Ustun and N Sartorius (1994). New versions of World Health Organization instruments for the assessment of mental disorders.Acta Psychiatr. Scand. 90, 73–83.
Kadden R, H Kranzler and B Rounsaville (1995) Validity of the distinction between “substance-induced” and “independent” depression and anxiety disorders.Am. J. Addict. 4, 107–117.
King VL, MS Kidorf, KB Stoller and RK Brooner (2000) Influence of psychiatric comorbidity on HIV risk behaviors: changes during drug abuse treatment.J. Addict. Disord. 19, 65–83.
Kranzler HR, RM Kadden, TF Babor and BJ Rounsaville (1994) Longitudinal, expert, all data procedure for psychiatric diagnosis in patients with psychoactive substance use disorders.J. Nerv. Ment. Disord. 182, 277–283.
Kranzler HR, RM Kadden, TF Babor, H Tenne and BJ Rounsaville (1996) Validity of the SCID in substance abuse patients.Addiction 91, 859–868.
Kranzler HR, H Tennen, TF Babor, RM Kadden and BJ Rounsaville (1997) Validity of the longitudinal, expert, all data procedure for psychiatric diagnosis in patients with psychoactive substance use disorders.Drug Alcohol Depend. 45, 93–104.
Lambert MT, JM LePage and AL Schmitt (2003) Five-year outcomes following psychiatric consultation to a tertiary care emergency room..Am. J. Psychiatry 160, 1350–1353.
Martin-Santos R, F Fonseca, A Domingo-Salvany, JM Ginés, ML Imaz, R Navinés, JC Pascual and M Torrens (2006) Dual diagnosis in the psychiatric emergency room in Spain.Eur. J. Psychiatry. In press
Nunes EV and FR Levin (2004) Treatment of depression in patients with alcohol or other drug dependence: a metaanalysis.JAMA 291, 1887–1896.
O’Brien CP, DS Charney, L Lewis, JW Cornish, RM Post, GE Woodyet al. (2004) Priority actions to improve the care of persons with co-occurring substance abuse and other mental disorders: a call to action.Biol. Psychiatry 56, 703–713.
Oyefeso A, H Ghodse, C Clancy and J Corkery (1999) Suicide among drag addicts in the United Kingdom.Br. J. Psychiatry 175, 277–282.
Robins LN, J Wing, HU Wittchen, JE Heizer, TF Babor, J Burke, A Farmer, A Jablenski, R Pickens, DA Regieret al. (1988) The Composite International Diagnostic Interview. An epidemiologic instrument suitable for use in conjunction with different diagnostic systems and in different cultures.Arch. Gen. Psychiatry 45, 1069–1077.
Rosenberg SD, LA Goodman, FC Osher, MS Swartz, SM Essock, MI Butterfield, NT Constantine, GL Wolford and MP Salyers (2001) Prevalence of HIV, hepatitis B, and hepatitis C in people with severe mental illness.Am. J. Public Health 91, 31–37.
Ross H, R Swinson, S Doumani and E Larkin (1995) Diagnosing comorbidity in substance abusers.Am. J. Drug Alcohol Abuse 21, 176–185.
Rounsaville BJ, SF Anton, K Carroll, D Budde, B Prusoff and F Gawin (1991) Psychiatric diagnoses of treatment-seeking cocaine abusers.Arch. Gen. Psychiatry 48, 43–51.
Spitzer RL, J Endicott and E Robins (1978) Research Diagnostic Criteria: rationale and reliability.Arch. Gen. Psychiatry 35, 773–782.
Spitzer RL (1983) Psychiatric diagnosis: are clinicians still necessary?Compr. Psychiatry 24, 399–411.
Spitzer RL, JBW Williams, M Gibbon and MB First (1992) The Structured Clinical Interview for DSM-III-R (SCID), I: history, rationale, and description.Arch. Gen. Psychiatry 49, 624–629.
Torrens M, D Serrano, M Astals, G Pérez-Domínguez and R Martin-Santos (2004) Diagnosing psychiatric comorbidity in substance abusers. Validity of the Spanish versions of psychiatric research interview for substance and mental disorders (PRISM-IV) and the structured clinical interview for DSM-IV (SCID-IV).Am. J. Psychiatry 161, 1231–1237.
Torrens M, F Fonseca, G Mateu and M Farre (2005) Efficacy of antidepressants in substance use disorders with and without comorbid depression. A systematic review and meta-analysis.Drug Alcohol Depend. 78, 1–22.
Vazquez C, M Munoz and J Sanz (1997) Lifetime and 12- month prevalence of DSM-III-R mental disorders among the homeless in Madrid: a European study using the CIDI.Acta Psychiatr. Scand. 95, 523–530.
Weiss RD, SM Mirin and ML Griffin (1992) Methodological considerations in the diagnosis of coexisting psychiatric disorders in substance abusers.Br. J. Addict. 87, 179–187.
Williams JBW, M Gibbon, MB First, RL Spitzer, J Boms, MJ Howes, J Kane, HG Pope, B Rounsaville and H-U Wittchen (1992) The structured clinical interview for DSM-III-R (SCID), II: multisite test-retest reliability.Arch. Gen. Psychiatry 49, 630–636.
World Health Organization (1992)Classification of Mental and Behavioral Disorders-Clinical Descriptions and Diagnostic Guidelines (WHO, Geneva).
World Health Organization (1998)Composite International Diagnostic Interview (CIDI): Core, Version 2.1 (WHO, Geneva).
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Torrens, M., Martin-Santos, R. & Samet, S. Importance of clinical diagnoses for comorbidity studies in substance use disorders. neurotox res 10, 253–261 (2006). https://doi.org/10.1007/BF03033361
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DOI: https://doi.org/10.1007/BF03033361