Under-Recognized Alcohol-Related Disorders in Psychiatric Outpatient Unit
Woraphat Ratta-apha MD, PhD*, Nantawat Sitdhiraksa MD, PhD*, Pornjira Pariwatcharakul MD, MSc*, Nattha Saisavoey MD*, Kanokwan Limsricharoen MD*, Lakkhana Thongchot BS*, Phedcharut Kumkan BS*, Naratip Sanguanpanich BSc*, Panom Ketumarn MD*
Affiliation : * Department of Psychiatry, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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
