Alcoholism and Psychiatric Disorders: Diagnostic Challenges.

Clinicians working with alcohol-abusing or alcohol-dependent patients sometimes face a difficult task assessing their patient's psychiatric complaints because heavy drinking associated with alcoholism can co-exist with, contribute to, or result from several different psychiatric syndromes. In order to improve diagnostic accuracy, clinicians can follow an algorithm that distinguishes among alcohol-related psychiatric symptoms and signs, alcohol-induced psychiatric syndromes, and independent psychiatric disorders that are commonly associated with alcoholism. The patient's gender, family history, and course of illness over time also should be considered to attain an accurate diagnosis. Moreover, clinicians need to remain flexible with their working diagnoses and revise them as needed while monitoring abstinence from alcohol KEY WORDS: AODD (alcohol and other drug dependence); diagnostic algorithm; diagnostic criteria; screening and diagnostic method for potential AODD; patient assessment; AODR (AOD related) mental disorder; behavioral and mental disorder; symptom; comorbidity; major depression; manicdepressive psychosis; personality disorder; anxiety; patient family history; medical history The evaluation of psychiatric complaints in patients with alcohol use disorders (i.e., alcohol abuse or dependence, which hereafter are collectively called alcoholism) can sometimes be challenging. Heavy drinking associated with alcoholism can coexist with, contribute to, or result from several different psychiatric syndromes. As a result, alcoholism can complicate or mimic practically any psychiatric syndrome seen in the mental health setting, at times making it difficult to accurately diagnose the nature of the psychiatric complaints (Anthenelli 1997; ModestoLowe and Kranzler 1999). When alcoholism and psychiatric disorders co-occur, patients are more likely to have difficulty maintaining abstinence, to attempt or commit suicide, and to utilize mental health services (Hetzer and Przybeck 1988; Kessler et al. 1997). Thus, a thorough evaluation of psychiatric complaints in alcoholic patients is important to reduce illness severity in these individuals. This article presents an overview of the common diagnostic difficulties associated with the comorbidity of alcoholism and other psychiatric disorders. It then briefly reviews the relationship between alcoholism and several psychiatric disorders that commonly co-occur with alcoholism and which clinicians should consider in their differential diagnosis. The article also provides some general guidelines to help clinicians meet the challenges encountered in the psychiatric assessment of alcoholic clients. DIAGNOSTIC DIFFICULTIES IN ASSESSING PSYCHIATRIC COMPLAINTS IN ALCOHOLIC PATIENTS A Case Example A 50-year-old man presents to the emergency room complaining. `Ifn going to end it all... life just not worth living. " The clinician elicits an approximate 1-week history of depressed mood, feelings of guilt, and occasional suicidal ideas that have grown in intensity since the man's wife left him the previous day The client denies difficulty sleeping, poor concentration, or any changes in his appetite or weight prior to his wife's departure. He appears unshaven and slightly unkempt, but states that he was able to go to work and function on the job until his wife left, The scent of alcohol is present on the man's breath. When queried about this, he admits to having 'a few drinks to ease the pain" earlier that morning, but does not expand on this theme. He seeks help for his low mood and demoralization, acknowledging later in the interview that "I really don't want to kill myself, I just want my life back to the way it used to be. " The above case is a composite of many clinical examples observed across mental health settings each day, illustrating the challenges clinicians face when evaluating psychiatric complaints in alcoholic patients. The questions facing the clinician in this example include: * Is the patient clinically depressed in the sense that he has a major depressive episode requiring aggressive pharmacological and psychosocial treatment? …