Diagnosing comorbidity in substance abusers. Computer assessment and clinical validation

Area of Science:

• Psychiatry
• Clinical Psychology
• Health Informatics

Background:

• Accurate diagnosis of substance use disorders and comorbid conditions is crucial for effective treatment.
• Automated diagnostic tools are being developed to aid clinical assessment.
• The Computerized Diagnostic Interview Schedule (C-DIS) is one such tool for diagnosing mental health conditions.

Purpose of the Study:

• To compare the diagnostic accuracy of the C-DIS with clinician-based diagnoses for substance abusers.
• To evaluate the C-DIS as a potential screening instrument for Axis I disorders and comorbid conditions.

Main Methods:

• 173 substance abusers in treatment were interviewed using the C-DIS.
• Clinicians conducted Structured Clinical Interviews for DSM-III-R (SCID) and reviewed patient charts.
• Consensus diagnoses were established using all available information, including a second SCID in a subset of patients.

Main Results:

• The C-DIS demonstrated poor diagnostic agreement with SCID diagnoses, except for antisocial personality disorder and most psychoactive substance use disorders.
• C-DIS showed potential as a screening tool, identifying most subjects with Axis I (nondrug) disorders but with a high rate of false positives.
• A negative C-DIS result for comorbid disorders was highly reliable, confirmed in 90% of cases.

Conclusions:

• The C-DIS, in its current form, has limited utility for definitive diagnosis in substance abusers compared to structured clinical interviews.
• The C-DIS may serve as a screening tool for Axis I disorders, but its overdiagnosis rate requires careful clinical interpretation.
• The C-DIS shows promise for ruling out comorbid disorders when results are negative.