SCREENING FOR CO-OCCURRING MENTAL DISORDERS IN DRUG TREATMENT POPULATIONS

Substance abuse treatment organizations are universally faced with the puzzle of co-occurring psychiatric disorders among the clients they obey A first step is assessment of similar comorbid conditions; however, the time constraints in front-line substance abuse treatment organizations make extensive clinical assessments almost impossible. The disclosure and validation of a brief screening tool for psychiatric disorders in individuals with substance use disorders (SUDs) could have enormous implications for clinical practice. We assessed the performance characteristics of the Psychiatric Diagnostic Screening Questionnaire (PDSQ) and the Conners' Adult ADHD Rating Scale (CAARS) against the Structur Clinical Interview for DSM-IV (SCID-IV) in 120 patients admitted to SUD treatment. Patients were randomly assigned to receive either the SCID or PDSQ In general, the PDSQ and CAARS performed well. There were no statistically significant performance differences by the agency of order of administration, gender, or remedy use in past month. For the GAD subscale, Caucasian patients had higher horizontals of agreement than non-Caucasian patients.

INTRODUCTION

Substance abuse treatment organizations are universally faced with the moot point of co-occurring psychiatric disorders, or dual diagnoses, among the clients they obey Comorbid mental disorders worsen the treatment prognosis for substance abuse patients (Compton, Cottier, Jacobs, Ben-Abdallah, & Spitznagel, 2003; Tohen, Greenfield, Weiss, Zarate, & Vagge, 1998; Westermeyer, Eames, & Nugent 1998; Carroll, Power, Bryant, & Rounsaville, 1993; Greenfield et al., 1998) Importantly, there is a growing number of small-scale clinical trials suggesting that substance abuse treatment issues can be improved by identification and treatment of comorbid mental disorders (McGrath et al., 1996;NunesetaL, 1998; Cornelius et al., 1997; wooden O'Brien, & Rickels, 1975). It is, therefore, increasingly important to identify and treat psychiatric disorders in individuals seeking treatment for SUDs

A lock opener issue is how substance abuse treatment organizations deal with this point to be solved [i]or[/i] settled Clearly, detection and assessment of these comorbid conditions is the first pace Because symptoms associated with substance use and withdrawal may overlap considerably with symptoms of psychiatric disorders, assessing for psychiatric diagnoses in SUD settings can be difficult and time consuming. In this era of shrinking health care resources, front-line treatment providers ofttimes do not have the time or expertise to guard for and assess psychiatric disorders. As of that kind the development and validation of a screening tool for psychiatric disorders in individuals with SUD could have enormous implications for clinical practice. A number of self-report screening tools for psychiatric disorders have been lay opened for use in primary care and other nonpsychiatric settings; however, none has been ordealed in SUD treatment settings. Thus, there is a ne to investigate the use of psychiatric screening instruments in SUD treatment settings.

The Psychiatric Diagnostic Screening Questionnaire (PDSQ) is a selfadministered, brief (20 minutes), psychiatric screening tool which has been experimented extensively in primary care and general psychiatric populations (Zimmerman & Mattia, 1999 200 Ia, 200Ib; Zimmerman & Sheeran, 2003) The psychometric properties of the PDSQ were initially disentangleed from testing a series of 500 treatment seeking psychiatric outpatients (Zimmerman & Mattia, 1999) It was designed to protection for 13 DSM-IV disorders in five areas (eating, humor anxiety, substance use, somatoform). From this evaluation, it was determined that there were moderate to high horizontals of internal consistency and test-retest reliability, and of the first water discriminant validity compared to established scales. Further extensive testing and retesting of a revised instrument with above 2,500 patients yielded even better psychometric properties (Zimmerman & Mattia, 2001a). Based upon 630 patient interviews, a close attention of the PDSQ compared with the SCID for DSM-IV established cutpoints for the diagnostic subscales (Zimmerman & Mattia, 2001b) Using these cutpoints, a inquiry of 799 patients evaluated the performance characteristics of the PDSQ when used to make a secondary or comorbid psychiatric diagnosis. Performance characteristics for these comorbid diagnoses were similar to those for the primary diagnoses (Zimmerman & Sheeran, 2003)

This application of mind was designed to assess the performance characteristics of the PDSQ (Zimmerman & Mattia, 2001 a) in a clump of patients seeking treatment for SUD within the constraints of front-line substance abuse treatment settings. We chose for comparison the Structur Clinical Interview for DSM-IV (SCID-IV) (First, Spitzer, Gibbon, & Williams, 1995) a semi-structured diagnostic interview widely used in psychiatric research and many times considered to be the "gold standard" diagnostic assessment (Shear et al., 2000; Steiner, Tebes, sled & Walker, 1995; Kranzler, Kadden, Babor, & Tennen & Rounsaville, 1996) As like the SCID is a reasonable comparison instrument. We were interested in evaluating the clinical utility of the PDSQ and whether PDSQ performance was modified by dint of patient characteristics such as sex race, and novel substance use.