Screening and diagnosis of anxiety and mood disorders in substance abuse patients.
The aims of this study are (1) to study the prevalence of anxiety and mood disorders in a clinical substance abuse population, (2) to asses the pre- and post-detoxification change in SCL-90 score in this population for subjects with psychopathology compared to subjects without psychopathology, and (3) to asses the value of the SCL-90 and the Addiction Severity Index-psychiatric problems scale as clinical diagnostic screening instrument for psychopathology. The design was a longitudinal prospective cohort study with pre-detoxification ASI and SCL-90 data and post-detoxification CIDI and SCL-90 data on a clinical sample of 116 substance abuse patients. The present results indicate that the ASI-Psychiatric problems score is a limited indicator of psychiatric comorbidity. When a pre-detoxification screening for psychopathology is warranted, the present results show that the use of the SCL-90 is preferable above the ASI-PSY scale. Of the screening scores under study, the post-detoxification SCL-90 score is found to be the most valid screening instrument for diagnosis of anxiety and mood disorders in a clinical substance abuse population. Although the post-detoxification SCL-90 score holds moderate specificity combined with high sensitivity, applying this instrument in clinical substance abuse practice will result in a substantial reduction of patients unnecessarily referred for further psychiatric diagnostic evaluation. Further studies aimed at improvement of screening instruments in this population are needed.
Franken
I H
IH
Parnassia Psychiatric Centre, Parnassia Addiction Research Centre (PARC), P.O. Box 53002, 2505 AA The Hague, The Netherlands. i.franken@parnassia.nl
Hendriks
V M
VM
D000293:Adolescent; D000328:Adult; D001008:Anxiety Disorders / Q000175:diagnosis / Q000453:epidemiology*; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D019964:Mood Disorders / Q000175:diagnosis / Q000453:epidemiology*; D015995:Prevalence; D011569:Psychiatric Status Rating Scales; D012680:Sensitivity and Specificity; D019966:Substance-Related Disorders / Q000150:complications* / Q000523:psychology*