Recognising drug and alcohol problems in patients referred to consultation-liaison psychiatry
Smith, G.C.; Clarke, D.M.; Handrinos, D.
Medical Journal of Australia 163(6): 307 310-2
1995
ISSN/ISBN: 0025-729X PMID: 7565237 Document Number: 441217
Objective: To study the extent of recognition by referring doctors of drug and alcohol problems in patients referred to consultation-liaison psychiatry for any reason, and the factors associated with non-recognition. Design: comparison of referring doctors' reasons for referral and psychiatrists' DSM-III-R diagnoses in 2347 in-patients referred consecutively over three years, by means of the prospective MICRO-CARES clinical database used by the consultation-liaison psychiatry service of each hospital involved. Setting: Four general teaching hospitals of Monash University. Results: Psychiatrists considered a psychoactive substance use disorder diagnosis likely in 336 (14%) of the referred patient; referring doctors missed 188 (56%) of these, referring instead for "depression", "anxiety" and "suicide attempt evaluation". The factors correlating with this discordance included younger age, male sex, having a personality disorder diagnosed, and having attempted self-harm. Conclusions: The extent of the failure to identify drug and alcohol problems in patients in whom some psychological problem worthy of referral to psychiatry had been detected is symptomatic of the extent of this failure in medicine generally. Education and the use of screening procedures may lead to development of coherent drug and alcohol protocols in individual institutions.