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Diagnosing comorbidity: concepts, criteria, and methods

Published online by Cambridge University Press:  24 June 2014

S. Samet ,
E. V. Nunes  and
D. Hasin
S. Samet*
Affiliation:
New York State Psychiatric Institute
E. V. Nunes
Affiliation:
New York State Psychiatric Institute College of Physicians and Surgeons, Department of Psychiatry, Columbia University
D. Hasin
Affiliation:
New York State Psychiatric Institute Mailman School of Public Health, Division of Epidemiology, Columbia University, New York, NY
*
Sharon Samet, MSW, Columbia University/New York State Psychiatric Institute, 1051 Riverside Drive, Box 123, New York, NY 10032. E-mail: [email protected]
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Abstract

Background:

The clinical and etiologic implications of comorbid psychiatric and substance-use disorders are relevant across countries and cultures. The DSM-IV now places greater emphasis on the clinical and research utility of the substance-induced disorders classification, and clarifies several important diagnostic issues specific to primary and substance-induced disorders. However, no research consensus exists over the core problem of identifying and differentiating the drug and alcohol intoxication and withdrawal symptoms that can mimic psychiatric symptoms in heavy drinkers and drug users.

Objective:

To investigate how various diagnostic instruments have measured comorbid psychiatric and substance-use disorders and how each instrument operationalizes the DSM-IV classification.

Method:

We review the evolution of the concept of comorbidity beginning with its formalization as the ‘primary–secondary’ distinction in the Feighner Criteria. We address the ‘organic–non-organic’ distinction found in the RDC, DSM-III, and DSM-III-R; and finally, review the ‘primary’ and ‘substance-induced’ categories of DSM-IV, DSM-IV-TR and ICD-10. We describe how these distinctions have been operationalized in widely used diagnostic instruments.

Conclusion:

Further understanding of these classifications and the relationship of co-occurring psychiatric and substance disorders can be accomplished with the range of available measures, particularly the Psychiatric Research Interview for Substance and Mental Disorders (PRISM), which reliably utilizes and refines DSM-IV classification distinctions.

Keywords

substance-induced disordersdiagnostic interviewspsychiatric comorbiditydual diagnosisdiagnostic criteria
Type
Research Article
Information
Acta Neuropsychiatrica , Volume 16 , Issue 1 , February 2004 , pp. 9 - 18
Copyright
Copyright © 2004 Blackwell Munksgaard

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