J Med Assoc Thai 2014; 97 (4):439

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Under-Recognized Alcohol-Related Disorders in Psychiatric Outpatient Unit
Ratta-apha W Mail, Sitdhiraksa N , Pariwatcharakul P , Saisavoey N , Limsricharoen K , Thongchot L , Kumkan P , Sanguanpanich N , Ketumarn P

Objective: Problematic alcohol consumption is associated with multiple medical conditions and psychiatric comorbidities. Previous publications reported the under-recognition of alcohol-related problems in the clinical setting. The present study comprises of two objectives, 1) to examine the process use by physicians to recognize alcohol-related problems in psychiatric outpatient units, and 2) to compare the results of a CAGE interview and a written version of the CAGE questionnaire.

Material and Method: The participants were recruited via interview using the alcohol section of the Thai version of Diagnostic Interview for Genetic Studies (Th-DIGS), which included 165 psychiatric outpatients with alcohol dependence and 165 psychiatric outpatients without alcohol-related disorders. The validity of diagnoses provided by psychiatrists and physicians (in the records) compared with the Th-DIGS diagnoses were analyzed. Kappa statistics were applied to compare the agreement of the responses for the written version and the oral CAGE interviews.

Results: Compared with the diagnoses using Th-DIGS, the physician specificity and positive predictive value were 100% (95% CI: 97.8-100% and 94.9-100%, respectively). However, the sensitivity and negative predictive value were 43% (95% CI: 35.4-51%) and 63.5% (95% CI: 57.5-69.6%), respectively. The Kappa value for the written version of the CAGE questionnaire and the CAGE oral interview was 0.723.

Conclusion: The results of the present study suggest the need to increase physician awareness regarding alcohol-related problems. A brief and high-sensitivity screening questionnaire, such as the CAGE questionnaire, written versions and oral interview, can be implemented for screening alcohol-related disorders in a clinical setting.

Keywords: Alcohol-related disorder, Alcohol dependence, Outpatient unit, CAGE questionnaire

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