Alcohol Research & Health. Ramesh Shivani, M.D., R. Jeffrey Goldsmith, M.D., and Robert M. Anthenelli, M.D. Ramesh Shivani, M.D., is an addiction psychiatry fellow; R. Jeffrey Goldsmith, M.D., is a clinical professor of psychiatry at and director of the Addiction Fellowships Program; and Robert M. Anthenelli, M.D., is an associate professor Amazon Beauty of psychiatry and director of the Addiction Psychiatry Division and of the Substance Dependence Program; all three at the University of Cincinnati College of Medicine, Cincinnati Veterans' Affairs Medical Center, Cincinnati, Ohio. Clinicians working with alcoholabusing or alcoholdependent patients sometimes face a difficult task assessing their patient's psychiatric complaints because heavy drinking associated with alcoholism can coexist with, contribute to, or result from several different psychiatric syndromes. In order to improve diagnostic accuracy, clinicians can follow an algorithm that distinguishes among alcoholrelated psychiatric symptoms and signs, alcoholinduced 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. This da ta has be en done wi th the help of GSA Content Generator DEMO.
Moreover, clinicians need to remain flexible with their working diagnoses and revise them as needed while monitoring abstinence from alcohol. 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 cooccur, patients are more likely to have difficulty maintaining abstinence, to attempt or commit suicide, and to utilize mental health services (Helzer 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 cooccur 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. A 50yearold man presents to the emergency room complaining: "I'm going to end it all . . . life's just not worth living." The clinician elicits an approximate 1week 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. 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. Is the patient clinically depressed in the sense that he has a major depressive episode requiring aggressive pharmacological and psychosocial treatment? What role, if any, is alcohol playing in the patient's complaints? How does one tease out whether drinking is the cause of the man's mood problems or snackdeals.shop the result of them? If the man's condition is not a major depression, what is it, what is its likely course, food and how can it be treated? As is usually the case (Anthenelli 1997; Helzer and Przybeck 1988), the patient in this example does not volunteer his alcohol abuse history but comes to the hospital for help with his psychological distress.