Diagnosis after an acute psychiatric inpatient stay: how do psychotic and non-psychotic diagnoses relate to the results of psychometric tests of substance abuse?

Abstract

Substance abuse is a frequent comorbidity in patients referred for severe acute psychiatric disorders, but is not always documented in medical record diagnoses. We estimated the presence of substance abuse problems in 74 acute patients in a psychiatric intensive care unit. Instruments used were the AUDIT (Alcohol Use Disorders Identification Test), and DUDIT (Drug Use Disorders Identification Test). Medical record diagnoses were divided into four groups: psychotic disorders (N=18), affective disorders (N=34), substance abuse disorders (N=9) and other diagnosis (N=13).The AUDIT questionnaire indicated scores above cut-off for seven (38.9%) patients with a psychotic disorder, 18 (52.9%) with an affective disorder, six (66.7%) with a substance abuse diagnosis and three (23.1%) with other diagnoses. The DUDIT questionnaire indicated scores above cut-off for six (33.3%) patients with a psychotic disorder, four (11.8%) with an affective disorder, seven (77.8%) with a substance abuse diagnosis and none of the patients with other diagnoses. The sensitivity and specificity of the AUDIT test in this sample were calculated as 0.67 and 0.57 respectively and of the DUDIT test as 0.78 and 0.13 respectively.Substance abuse in patients in an acute ward is under-communicated in medical record file diagnoses. Using tests could enhance diagnostic accuracy and help clinicians in choosing correct treatment.